1. What subjective information should the nurse obtain?

CASE STUDY
S.R. is a 65-year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases.
The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered.

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1. What subjective information should the nurse obtain?
Answer:
Rationale:
2. The nurse is assessing the patient’s pulses. Which locations should the nurse check?
Answer:
Rationale:
3. The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas sample. How should the nurse
proceed?
Answer:
Rationale:
4. What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?
Answer:
Rationale:

SAMPLE SOLUTION

1) Subjective information that should obtained by the nurse
Answer: History of heart failure in their family, sleep experience, the urinary frequency particularly at night, and history of HTN and diabetes.
Rational: Using these subjective data, the nurse can easily determine the nature, irritability and severity of the patient’s condition.
2) Locations that the nurse | GET AN EXPERT FOR YOUR ASSIGNMENT | check when assessing the patient’s pulses
Answer: Jugular veins, Radial, peripheral and apical pulses
Rational: Jugular veins will assist the nurse in | GET AN EXPERT FOR YOUR ASSIGNMENT | hepatojugular reflux. Radial and apical checkup would help reveal pulse defect, which ought to be quite comparable if examined close to each other…