S.R. is a 45- year-old woman who presents to the emergency department complainin
ID: 138863 • Letter: S
Question
S.R. is a 45- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered.
List the primary diagnosis and at least two differential diagnoses for this patient. Explain your reasoning for each.
Discuss your management plan for this patient, including patient education, referrals, and follow-ups.
Explanation / Answer
Primary diagnosis can be congestive heart failure and pulmonary edema because it includes the primary evident symptom of shortness of breath, coughing and swelling in lower legs.
Differential diagnosis can be as follows:
Chronic obstructive pulmonary disease
Because the above diagnosis include the common symptoms of coughing, swollen legs and shortness of breath.
HEALTH education :
1. Healthy balanced diet: low in salt , fat, saturated fat, transfat and cholesterol. These are the main components of food that make the heart work harder than it needs to leading to excess fluid in the body, plaque formation in the arteries and heart disease.
2. Avoid alcohol intake: it can make the heart weaker.
3.lose weight: obese person's hear works harder. Losing weight can help ease a lot of stress placed on overworked heart.
4.Exercise: regular physical activity can help build a strong heart and healthy lungs.
5. Get enough sleep- sleep is essential for healthy heart. People who don't sleep enough are at higher risk for cardiovascular disease regardless of age weight smoking and exercise .get enough good quality sleep to lower risk of these conditions .
6. Regular follow up is a must to a cardiologist.
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