514 Pulmonary congestion and hypostasis
518.4 Acute edema of lung, unspecified
PT diagnoses/treatment diagnoses that may be associated with respiratory disorders
780.7 Malaise and fatigue
786.0 Dyspnea and respiratory abnormalities
786.05 Shortness of breath
PREFERRED PRACTICE PATTERNS1
6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders
6B Impaired Aerobic Capacity/Endurance Associated with Deconditioning
6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction
6F: Impaired Ventilation and Respiration/Gas Exchange Associated with Respiratory Failure
A 77-year-old male in a telemetry unit of an acute care facility for exacerbation of congestive heart failure (CHF) presents to the physical therapist during the second day of treatment with a sudden (new) onset of shortness of breath (respiration rate, 24; PO2 84% while on 2 L of O2 via nasal canula), crackles without wheezing heard upon auscultation, elevated blood pressure (177/109), anxiety, profuse diaphoresis, frothy pink sputum, and edema in both feet. The patient’s current relevant medications include furosemide as a diuretic, and enalapril for an angiotensin-converting enzyme (ACE) inhibitor. He is in some distress and is unable to respond to questions reliably or without further anxiety. The physical therapist notified the nurse and the physician who obtained the following STAT test results: a standard chest radiograph revealed fluid in the alveolar walls and upper lobe diversion; an echocardiogram confirmed impaired left ventricular function; a complete blood count (CBC) with differential revealed a mildly elevated white count (10,800 cells/µL/mm3); the blood urea nitrogen (BUN) was 30 mg/dL; creatinine was 1.5 mg/dL; B-type natriuretic peptide (BNP) was 600 pg/mL; and arterial blood gases revealed elevated carbon dioxide and low oxygen concentration.
Radiographs of a 67-year-old man with dyspnea. A. Standard radiography demonstrates cardiomegaly and pulmonary edema (arrow). B. Dual-energy subtraction radiograph demonstrates extensive calcification within the left anterior descending artery (LAD) (arrows). C. Three-dimensional computed tomography reconstruction of the chest confirms extensive calcifications in the LAD territory (arrow). (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart. 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
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