heart failure patient no adventitious lung sounds

[amichelleb]

i am precepting. i had a patient who had been admitted with a 10% ejection fraction. (it

was reported to me as this-i did not see the report). the patient had pitting

edema (3+) below the knee to the foot on both legs.- an improvement from the day

before. he had shortness of breath that was intermittent- again better than the

day before. he had a diagnosis of chf for about a year. the doctors attributed

some of it to drug use. pt stated his father had died at 56 from a heart attack

and did not do drugs but drank alcohol. my question is, why were there no

adventitious lung sounds when i listened? i would think there would be. i know

peripheral edema = right sided heart failure, but with an ejection fraction that

low you would think pulmonary edema- also right sided heart failure. also pt

denied a cough during assessment and at the end of the shift i heard him cough

after i left the room. i went back in and asked him about how long he had it and

if it was productive(no). pt stated he thought it was from sitting under the air

conditioner too much. it seems like pulmonary edema. is it possible to have

pulmonary edema and no adventitious breath sounds when i listen?

[Esme12, ASN, BSN, RN]

With patients anything is possible.......but probable? I would think that anyone with an EF of 10% would have some adventitious breath sounds unless he has huge pleural effusions as well. Miminal air exchange might account for what you aren't hearing by muffling the sounds.

That's all I can think of....what was his CXR?

[celtchick68]

I'm wondering how effective was the patient's breathing? If unable to take a good deep breath it's quite possible you're just not able to hear well.

Other thought process: Just because he has a dx of CHF doesn't mean he's actively in failure at this time (being treated). Think a-fib controlled with meds. Yes a hx of a-fib but not an issue at this time.

Was he there just because of a low ef and maybe slated to get an ICD?