[Answered]: John Gordon is a 65-year-old male who has a history…

John Gordon is a 65-year-old male who has a history of myocardial infarction (MI) two years ago and heart failure with a current ejection fraction (EF) of 30%. He presents to the emergency department (ED) for increasing shortness of breath (SOB) for the past three days. He is more fatigued than usual and becomes short of breath with minimal activity. The last two nights he had to sleep upright in a recliner so he could breathe easier and fall asleep. He has noted increased swelling in his lower legs and has gained six pounds the last two days. Past Medical History: Myocardial infarction 2 years ago Ischemic cardiomyopathy with ejection fraction 30% Home Medications: Aspirin 81mg PO daily Lisinopril 20mg PO daily Carvedilol 25mg PO BID You place John on a cardiac monitor, continuous pulse oximetry and quickly collect the following assessment data. Vital Signs: T: 98.6 F/37.0 C (oral) P: 92 (reg) BP: 162/84 MAP: 110 O2 Sat: 91% RA Pain: 0/10 General Appearance: Appears anxious, restless Respiratory: Breath sounds have coarse crackles on inspiration and expiration scattered throughout both lung fields anteriorly/posteriorly, effort, patient sitting upright. Cardiac: Forehead diaphoretic, cool to the touch, radial, pedal and post-tibial pulses regular 3+, has 3+ pitting edema bilateral lower extremities in feet, ankles, 2+ up to knees bilaterally, S3 gallop most prominent over apex, no jugular vein distention (JVD) noted sitting up at 45 degrees. Neuro: Alert and oriented to person, place, time, and situation (x4) GI: Voiding without difficulty, urine clear/yellow Integumentary: Pale, skin integrity intact, skin turgor elastic, no tenting present, cap refill brisk <1 second. Radiology Chest X-ray Results: Bilateral diffuse pulmonary infiltrates consistent with pulmonary edema Lab Results: Basic Metabolic Panel Na K Gluc Creatinine 133 4.9 105 1.9 Cardiac Troponin BNP Mg 0.01 985 1.8 Orders: Titrate oxygen to keep O2 sat >92% Furosemide 40mg IV push Nitroglycerin 0.4mg transdermal patch daily Strict I&O Fluid restriction of 2000ml PO daily Low sodium diet John Gordons condition improves after 5 days of treatment and is discharged home. At discharge Mr. Gordon has 1+ BLE pitting edema