Question

chapter 20- Peripheral Vascular System and Lymphatic System 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. What subjective information should the nurse obtain? The nurse is assessing the patient’s pulses. Which locations should the nurse check? The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed? What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?

Answer 1

The subjective information to be collected from the patient are

• Presence of any pain,blood while coughing out
• Does the patient have any urinary complaints to rule out whether it is related with kidney

The nurse should assess the radial pulse (in forearm at radial aretery) or apical pulse(auscultating with stethoscope directly on the heart) or carotid pulse in the neck

Collateral circulation can be checked by Allen's test ,where before going ABG the blood supply to the hand with both the hands are checked for circulation at both arteries .The nurse should proceed by asking the patient to clench his first for minute,apply pressure on both radial artery, then release it, the color has to change from pallor to red,again occlude the ulnar artery .If redness returns quickly it means it is normal ,and if slowly it indicates a problem in circulation.

The most likely cause of his symptoms are closely associated with pulmonary edema where the fluid accumulates in the lung and patient develops difficulty in breathing and may spit out mucus or phlegm in the cough and the circulation is impaired causing swelling of the lower limb.