What subjective information should the nurse obtain?
To be able to make a proper diagnosis, the nurse should seek the patient’s history, drug history, and social history (Glynn & Drake, 2017). Elaborations on presented complaints include inquiries on the onset of the symptoms, the progression, exacerbating factors as well as relieving factors. Besides these, associated factors such as paroxysmal nocturnal dyspnea, orthopnea, chest pains, syncope, and easy fatigability are further significant subjective information. Owing to the patients past medical history, it is paramount to probe about the medications she uses, her compliance to the medication,s and her social history in terms of lifestyle adjustments in light of her past medical history.
2. The nurse is assessing the patient's pulses. Which locations should the nurse check?
The nurse should assess the radial pulse in the distal radius, the brachial pulse in the antecubital fossa, the carotid pulse medial to the sternocleidomastoid muscle, popliteal pulse in the popliteal fossa, and the dorsalis pedis pulse in the dorsum of the foot. On top of the above arterial pulses, assessment of Jugular venous pressure medial to sternocleidomastoid is also useful.
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3. The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?
Use of the modified Allen test is recommended to assess collateral circulation in the hand (Dhingra, n.d.). The test procedure is such that with the patient’s fist clenched, the nurse occludes the ulnar and radial arteries while checking for pallor to confirm adequate occlusion. While timing reperfusion time the nurse should release the ulnar artery. A positive test, five to fifteen seconds, indicates adequate collateral circulation.
4. What is the most likely cause of this patient's shortness of breath, productive cough, and swelling in both legs?
Congestive heart failure is the most likely cause of this patient’s symptoms. Her shortness of breath and the productive cough could point at the pulmonary congestion while bilateral leg edema indicates systemic congestion both characteristic of CHF.
References
Dhingra, N. WHO guidelines on drawing blood . WHO.
Glynn, M., & Drake, W. (2017). Hutchinson's clinical methods (24th ed., pp. 4-40). London: Bailliere Tindall.
