Question

Mai Nguyen, Nam’s 76-year-old mother, has been complaining she feels tired all the time, as though she just can’t do what she normally does. She describes having a hard time catching her breath as she walks up stairs and goes about her day. Nam has noticed that his mother’s ankles are more swollen than he has ever seen them. He schedules an appointment for his mother at the family clinic where you are the nurse. Mrs. Nguyen appears pale and not her usual energetic self. Nam tells you that his mom is “not right” and seems to be confused about things at home, which is not like her. She has a history of chronic congestive heart failure.

1. A. What additional health history data would be useful to gather at this time? Suggested response:

During her visit at the clinic, you observe that Mai has a cough. She spits a small amount of pink, frothy mucus into a tissue. Mrs. Nguyen’s vital signs are as follows: BP, 142/90 mm Hg; pulse, 96 beats/min and with some irregular beats; respirations, 38 breaths/min and shallow; temperature, 97.8°F (36.5°C) oral.

1. Which of these symptoms and vital signs is/are not within normal limits?

2. For each abnormal finding, explain why you think it is occurring.

Answer 1

Answer:

1.A. Ask these questions to the patient :

* Do you have Breathing difficulty ?

*When it was started?

*Do you have Palpitation?

*Are you taking any medications regularly?

*Did you loose your weight?

*What factors aggravate your problems?

1. Pink frothy mucus , Shallow respiration with respiratory rate of 38 breaths/min

2. Pink frothy mucus is a symptom of chronic pulmonary edema in patients with congestive heart failure. Other symptoms include anxiety, paleness,sweating etc.

Tachypnea: Patient with CHF has high risk to develop pulmonary emboli which can become a burden to right ventricle and cause Tachypnea