What areas should the history of this patient focus on for your primary assessment?


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What areas should the history of this patient focus on for your primary assessment?


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You receive the following patient while working in the emergency department.

A 79 year old obese male arrives with the paramedics with a chief complaint of “feeling short of breath” accompanied by his daughter who is his primary care giver.  The patient’s respiratory rate is 36 per minute and oxygen saturation was 87% on room air. High flow oxygen was started by the paramedics. The patient’s blood pressure is 94/56 with a heart rate of 164 beats per minute and irregular with history of atrial fibrillation. The patient smokes every day and has history of diabetes, COPD and hypertension. The daughter tells you her father is more tired in the evenings and seems to struggle with catching his breath. Over the last couple of days, he has been sleeping an easy chair, with several pillows to support him in an upright position. On initial examination, he is sitting completely upright in bed, displaying some shortness of breath with talking, tachypnea, very pale and his ankles are edematous.

Question:
Q.1. What areas should the history of this patient focus on for your primary assessment?
Q.2. What subjective focused questions should be asked when completing your assessment for this patient?
Q.3. When assessing a patient’s complaint of feeling shortness of breath it is important to differentiate between dyspnea and breathlessness.  Dyspnea (a subjective complaint of true difficulty in breathing) and breathlessness (a response that follows a sudden burst of activity such as running up flights of stairs). To help with the differentiation, what questions are important to ask for this patient?
Q. 4. What are focused questions to ask when assessing past medical history?
Q.5. What are some CV risk factors with the patient scenario?
Q.6. Inspection, palpation, auscultation are key components of the physical examination. For this patient, what would you assess for each of these component?Another component of your objective assessment should also include what?
Q.7. Based on the information presented, highlight the “red flags” that indicates a possible cardiac issue.  Applying critical thinking, what condition would you anticipate the patient is experiencing?
Q8. What precautions should you keep in mind, regarding this patient’s age, when accessing his neck veins?
Q.9.  The objective assessment of a respiratory assessment should include what?
Q10.Part of your objective assessment is to complete auscultation of heart sounds. What is the best position when auscultating the precordium and identify the steps in a systematic auscultation of the heart.