Cardiovascular Subjective: Informant denies client history of cardiac diseases or disorders including congenital heart defects rheumatic fever,

heart murmurs, and blood transfusions. Furthermore, denies observation of dizziness, frequent falls, or evidence of chest pain. Informant states dyspnea upon exertion and coughing fits for approximately one week, increasing in severity and frequency; unable to verbalize an exact number, states getting worse. The informant states the usual activity level for the client is very active . Clients mother also states the clients recent activity level has decreased during the daytime; reports in the evening the client becomes restless and increasingly irritable as the night progresses. Informant denies changes in skin or lip color during shortness of breath episodes, which includes during coughing fits. Denies pink, frothy sputum. Clients mother denies edema, erythema, cyanosis and temperature changes to the extremities; reports as warm. Informant denies environmental exposure to second hand smoke or hazardous toxins. Clients mother denies family history of cardiac disease or unexpected loss relating to cardiovascular events; denies hypertension, blood disorders, stroke or hyperlipidemia. Informant denies use of herbal remedies, prescriptions, over the counter medications or supplements for the cardiovascular system. Objective: Facial features are symmetrical, without drooping. Lymph nodes are soft, palpable, non-tender, easily move and warm to the touch; no masses or edema present. In Fowlers position, there is no jugular neck vein distention. Apical heart rate in Fowlers position, assessed at the fifth intercostal space, mid-clavicular line is 124 beats per minute; apical rate is regular; rhythm is irregular. No murmurs or gallops. Capillary refill assessed on anterior chest wall is brisk; less

than three seconds. Peripheral pulses are easily palpable (+ 2); irregular rhythm, regular rate; no pulse deficit. Bilateral upper and lower extremities are warm to touch; free of edema, erythema, or cyanosis; skin is dry and intact. In Fowlers position, blood pressure at left brachial artery, antecubital space 91/80. A twenty-four gauge, intravenous infusion catheter is present to the right, mid-ventral forearm; cool to touch, free of edema, erythema or cyanosis. No infiltration evident. There is dextrose 5%, NaCL 0.3%, infusing at a rate of 20 milliliters (ml) per hour, in a 1000 ml bag, with 900 ml remaining.