AHA-Response Disc 5


Option 2 

S.P. is a 75-year-old woman who presents to the provider’s office with fatigue. 

Subjective Data 

PMH: HTN, hyperlipidemia, MI 3 years ago 

Fatigue started about a month ago, getting worse 

Relieved with rest, exacerbated with activity 

Denies chest pain 

Ankles swollen 

Objective Data 

Vital signs: T 37 P 112 R 18 BP 110/54 

Lungs: bilateral lower lobe crackles 

O2 Sat = 94% 

Skin = cool to touch 

CV = heart rate regular, positive peripheral pulses, ECG = no changes 

+2 edema bilateral ankles 

Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day 


  1. What other questions should the nurse ask about her fatigue? 
  • Is your fatigue associated with any shortness of breath (SOB)? 
  • How has it affected your activities of daily living (ADL’S)? 
  • How has your fatigue affected your appetite? 
  • How has your fatigue affected your sleep? 

 2) What other assessments are necessary for this patient? 

  • Additional questions that the nurse should ask S.P. include, 

Have you experienced any orthopnea? (SOB while lying flat and relieved when sitting up) 

Have you experienced any palpitations with or without lightheadedness? 

  • Chest x-ray- to assess for pulmonary edema/vascular congestion 
  • Labs- Troponin, CBC, CMP, BNP, Liver function test, blood urea nitrogen. 
  • Echocardiogram- to determine ventricular function and hemodynamics. 

 3) What are some causes of fatigue? 

  • Congestive Heart failure (CHF) 
  • Hypoglycemia 
  • Respiratory virus 
  • Lack of sleep 
  • Poor oral intake of required nutrients 

4) Develop a problem list from the objective and subjective data. 

S.P. is presenting with symptoms that are consistent with CHF. Symptoms of heart failure include those related to excess fluid accumulation and reduced cardiac function. 

S.P. presents with +2 edema bilateral ankles, fatigue relieved with rest and exacerbated with activity, bilateral lower lobe crackles, and increased heart rate (HR 112). 

Other symptoms of HF may include dyspnea, orthopnea, pain from hepatic congestion, abdominal distention from ascites. 

5) What should be included in the plan of care? 

  • Getting orders to diuretics if applicable 
  • Relieving signs and symptoms of fluid overload 
  • Teaching patient about dietary restrictions 
  • Relieving signs and symptoms of fatigue 
  • Promoting physical activity 
  • Teaching patient about what is HF and associated signs and symptoms 
  • Teaching patient about new medications that may be prescribed 
  • Teaching patient about daily weights 
  • Limiting sodium intake (salt)- When someone consumes too much salt, the body retains extra sodium which increases the amount of fluid in the body or outside the cells. 
  • Daily weights should be promoted for CHF patients. People are first alerted to signs of fluid retention when they notice a weight gain of 2-3 lb’s in a 24-hour period or a weight gain of 5 lb’s in a week.  

6) Based on the readings, what is this patient’s most likely cause of fatigue? 

Due to her signs and symptoms, S.P. is most likely experiencing CHF symptoms. 

Her symptoms began about one month ago and have become worse. Chronic presentation of HF differs with acute in that fatigue, anorexia, abdominal distention, and peripheral edema may be more pronounced than dyspnea. 

Malik, A. (2023, November 5). Congestive heart failure (NuRSing). StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK574497/Links to an external site. 

Treatment | NHLBI, NIH. (2022, March 24). NHLBI, NIH. https://www.nhlbi.nih.gov/health/heart-failure/treatmentLinks to an external site. 

Managing heart failure symptoms. (2023, June 13). www.heart.orgLinks to an external site.. https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure/managing-heart-failure-symptoms#:~:text=Daily%20weight.&text=This%20weight%20gain%20may%20be,if%20you%20notice%20sudden%20changesLinks to an external site.