Mrs. C is a 75-year-old patient who underwent a left total hip replacement today. Her past medical history is positive for obesity and myocardial infarction (3 years ago). Six hours after her surgery, she begins to experience shortness of breath. Crackles are heard throughout her lung fields. Her SpO2 on 2 liters O2 per nasal cannula had been 95% but is now 88%. What additional physical assessment data would you obtain?Clinical Update: You complete your focused assessment. BP 150/80 mmHg (within the patient’s baseline); pulse 100 beats/min, slightly weak and irregular; respiratory rate 28 breaths/min. Pulse oximeter is reading 88% on 2 liters of oxygen per nasal cannula. The probe is properly placed.Patient denies having chest pain and is not coughing up sputum. She states she feels as if she can’t get in enough air. She appears to have significant increased work of breathing and is using her accessory muscles of inspiration.Auscultation of heart sounds reveals S1, S2, S3. Capillary refill is 3 seconds. JVD is elevated 4 cm above sternal angle while at 45 degrees.Assessment of extremities reveals they are cool to the touch and pink; pedal pulses +2 bilaterally; 3+ nonpitting edema is present.Intake and output (intraoperative and postoperative amounts): total 10,000 mL intake; 2000 mL urine output.What are some abnormal findings based on the patient’s history and physical? What is your interpretation of these findings?Based on your focused assessment, what health problems, if any, do you suspect? Provide data to support your decision.What additional cardiovascular diagnostic procedures might you anticipate that the provider will order?
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