A nurse in a provider's office is caring for a client.

For each client's finding, click to specify if the assessment finding is consistent with sickle cell disease, iron deficiency anemia, and/or pernicious anemia. Each finding may support more than 1 disease process.

• Tightness in chest that radiates to left arm: Classic symptom of acute coronary syndrome (ACS), including myocardial infarction (MI). Cardiac pain is often described as pressure, squeezing, or tightness and may radiate to the left arm, jaw, or back.
• Pain rated 7 on a scale of 0 to 10: Severe pain is a hallmark of an MI and suggests significant myocardial ischemia. Persistent or worsening chest pain should prompt urgent intervention.
• Nausea after breakfast: Nausea and gastrointestinal discomfort can be atypical signs of an MI, particularly in individuals with diabetes. The presence of nausea alongside chest pain raises suspicion for cardiac ischemia.
• Diaphoresis and shortness of breath: Sweating and dyspnea are common autonomic responses to myocardial ischemia. The body reacts to decreased cardiac output by activating the sympathetic nervous system, which results in these symptoms.
• Heart rate irregular and tachycardic: Irregular tachycardia suggests possible arrhythmias, which can be triggered by myocardial ischemia and infarction. Life-threatening dysrhythmias are a significant complication of an MI.
• Skin is cool to touch: Cool skin indicates decreased peripheral perfusion, which may result from reduced cardiac output due to myocardial dysfunction. It is a concerning sign of potential hemodynamic instability.

• Lungs clear to auscultation in all lobes: The absence of crackles or other abnormal lung sounds suggests that pulmonary congestion is not currently present.
• Bowel sounds are present in all 4 quadrants: Normal bowel sounds do not indicate any gastrointestinal pathology.
• +1 pedal pulses: Diminished pulses may suggest peripheral vascular disease but are not directly indicative of an acute cardiac event.
• Capillary refill less than 2 seconds: Normal capillary refill indicates adequate peripheral perfusion and does not suggest an immediate concern.

Indication of potential improvement:
• Shortness of breath with exertion
• Lung sounds clear

Indication of potential worsening condition:
• WBC count 11,800/mm³
• Temperature 38.5°C (101.3°F)
• Weight 113 kg (249 lb)
• Creatinine 1.8 mg/dL

Rationale:

• Shortness of breath with exertion: Previously, the client had dyspnea at rest. Improvement to exertional dyspnea suggests better fluid balance and cardiac function.

• Lung sounds clear: The initial presence of crackles indicated pulmonary congestion. Clear lung sounds suggest reduced fluid overload, reflecting improved cardiac function.

• WBC count 11,800/mm³: An increasing WBC count suggests a possible infection, which can worsen heart failure by increasing metabolic demands and fluid retention.

• Temperature 38.5°C (101.3°F): Fever indicates a possible infection, such as a UTI, which the client has a history of. Infections can exacerbate heart failure by triggering systemic inflammation and fluid shifts.

• Weight 113 kg (249 lb): Weight gain in heart failure is often due to fluid retention, indicating worsening congestion.

• Creatinine 1.8 mg/dL: A rising creatinine level suggests worsening kidney function, which may result from reduced perfusion due to heart failure or excessive diuresis from furosemide.