Based on Mrs. Gilford's signs and symptoms and results of the STAT diagnostic studies, what is your primary area of concern?
Anna Gilford, a 69-year-old female, presents to the ED with pallor, dyspnea, and distended neck veins. She denies chest pain but admits to chest "pressure." Her husband states she has been short of breath for 3 days, with increasing difficulty sleeping, resulting in her spending the previous night in a recliner chair. He also notes that swelling of her feet is worse this morning and that he could not put her slippers on.
Mrs. Gilford reports her height is 5'1'' and weight 162 lb. In the ED, her current weight is 175 lb, an increase of 13 lb above her stated weight. Mr. Gilford indicates his wife has not been following any specific dietary plan and does not monitor her blood pressure at home.
She has a history of hypertension and coronary artery disease. Medications include Benicar HCT 40/35 daily, Toprol XL 100 mg/d, Lasix 40mg/d, and potassium supplement, which her husband states she needs refilled and has not taken for a week.
Vital signs are 198/102, 120, 34; pulse oximetry reading on room air: 79%. Auscultation of the lungs reveals crackles throughout both lower lobes, and a moist-sounding cough is nonproductive. Mrs. Gilford is placed on oxygen at 4 L/m by nasal canula.
Following a chest x-ray, which shows pulmonary congestion and a moderately enlarged heart.
I was really confident about Decreased Cardiac Output r/t altered afterload AEB dyspnea, pallor, SOB, edema, and elevated blood pressure, heart rate and respirations. But as I continue to research, I realized that Decreased Cardiac Output denotes low blood pressure and this patient blood pressure is 198/102. I looked at Impaired Gas Exchange and Ineffective Breathing, but it just not fit most of her symptoms... Please Help!!
