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Admission Note 

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Mr. John Jingle was admitted to the telemetry unit today for new onset congestive heart failure.   His wife is at bedside.  He is alert and oriented x 4.  He complained that he is getting shorter of breath every day and he feels like his heart is racing.  On the heart monitor his heart rate is 132 running atrial fibrillation.   Vitals signs are:  RR 31, BP 150/82, T 98.8⁰ F, O2 sat 91% on room air.  He is noted with 3+ pitting edema in bilateral lower extremities.  Radial pulses and pedal pulses noted 2+.  Capillary refill <3 seconds in all extremities.  Breathing noted labored but symmetric rise and fall of chest noted.  Lungs noted with crackles in bilateral lower lobes and scattered wheezes noted in all lobes bilaterally.  Bowel sounds active in all quadrant.  Abdomen noted distended.  Pt stated he knew he had been gaining weight over the last month or so.  He stated he normally weighs around 175 lbs.   He has a history of hypertension for 12 years, osteoarthritis for 15 years, hypercholesterolemia for 18 years, and intermittent atrial fibrillation for 2 years.  Home medications:  Lisinopril 20 mg PO daily, Metoprolol 50 mg po BID, Warfarin sodium 6 mg PO daily, Atorvastatin 40 mg PO HS, meloxicam 15 mg PO daily PRN.   -----------------------------------------------------------------------------------------------------------Dr. Smith, MD   Day 1 0730 Mr. Jingle is progressing well. Vitals stable.  EKG shows conversion to NSR but still having intermittent runs of atrial fibrillation.   Will continue diltiazem drip for now.   Weight has decreased by 3 pounds.   Will increase IV Lasix to TID.   Continue Heparin drip as well.  Continue to monitor labs.  Day 2  0800 Mr. Jingle continues to improve.  Weight is down another 5 pounds.  EKG shows NSR.  Nurse reports no run of atrial fibrillation in the last 24 hours.  Will stop diltiazem drip today and start PO diltiazem.   Plan to change Lasix to PO to see if patient can tolerate and continue to lose fluid.  Continue to monitor labs.  Nursing to call labs when complete.      Based on Mr. Jingle's admission note from Dr. Smith, what supporting cues are present to indicate Mr. Jingle is presenting with a new problem?   After reviewing Mr. Jingle's information, what are 5 nursing actions the nurse should initiate? Provide an explanation for each.          SCIENCE HEALTH SCIENCE NURSING NUR 209

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