Question: Mr. John Is A 79 Year Old Admitted To Room 104 With CHF. BP=134/80 Temp 37.1 °C; Pulse 75 Irregular Resp 18 At Rest; 24 With Ambulation. Pain=2/10. A&Ox 4. PERRLA: Pulse Ox = 95% On 3L N/C. EKG=atrial Fibrillation Color Pink, Skin And Dry Braden Score 20. CR

Mr. John is a 79 year old admitted to room 104 with CHF. BP=134/80 Temp 37.1 °C; Pulse 75 irregular Resp 18 at rest; 24 with ambulation. Pain=2/10. A&Ox 4. PERRLA: Pulse Ox = 95% on 3L N/C. EKG=atrial fibrillation Color pink, skin and dry Braden score 20. CR<3 sec. Lung sounds=fine crackles heard bilaterally to lower lobes. Non-productive cough Pt c/o DOE Requires rest for all ADLs. MAE X 4. Hand grip = & strong. Bilateral 2+ pitting ankle edema + JVD. Pt. prefers to stay in bed. Becomes easily fatigued when walking to BR. Past Hx=CAD and Type II DM IV 1,000 ml of Normal Saline to L-antecubital @40 ml/hr s redness or swelling Lab report: Na+ 135, K+33, CL-95. Bicarb 24, BUN 12, Creatinine 0.8, Glucose 210 WBC 9,800, Hbg=13,5, Hef-42%, platelets 200,000 Dr’s orders; low Na+ 1800 cal. ADA diet. BRP OOB in chair bid as tolerated Daily weight, Monitor I & 0. Keep HOB elevated at 45° SCDs to lower legs Keep legs elevated when OOB in chair Digoxin 0.125 mg po daily furosemide 40 mg po stat then give furosemide 20 mg po daily 10 Interventions with Rationale Interventions with Ration Interventions with Rationale Evaluation Evaluation Evaluation