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PERIPHERAL VASCULAR: 3+ peripheral edema extending to knees bilaterally; 2+ dorsalis pedal pulses bilaterally NEUROLOGIC: Awake, alert, and oriented to person, place, and timeDiagnostic results: Blood Work was drawn and the results are unknown at this time. The chest x-ray was ordered, and showed cardiomegaly, edema, and some haziness around the margins. The EKG results proved the patient was having cardiac events and not in NSR.Various assumptions are relied upon during the diagnoses. Inamdar & Inamdar (2016), postulatethat B type natriuretic peptide has clinical significance both as a diagnostic and a prognosticmarker of heart failure. Patients with a higher than 200pg/ ml of BNP have a 9% mortality ratewhile those with less than 200pg/ml have a mortality rate of 2%. Chest X-rays are used toevaluate the size of the heart and to find out if there is any alternative cardiopulmonary diseasethat could be causing the symptoms in the patient. An echocardiogram will assess the size, wallmotion and thickness, and valve function. It also shows the ejection fraction of the heart, whichis useful in therapy selection. Cardiac MRI (Magnetic Resonance Imaging) and CT are importantdiagnostic tests. An MRI will give high anatomical resolution to all aspects of the heart and thestructures surrounding it.A.
Differential DiagnosesPrimary Diagnosis/Presumptive Diagnosis: Congestive Heart FailureCongestive Heart FailureCongestive Heart Failure presents with symptoms including shortness of breath, persistent coughing, edema, fatigue, nausea, or high heart rate (AHA, 2017). The patient present with all ofthese excluding the nausea. The x-ray and EKG were both indicative of CHF as well. The suddenweight gain with edema and ascites throw red flags, as well. Pulmonary EmboliShortness of breath is one of the most common symptoms of pulmonary embolism (Duru et al.,2014). Although the patient does not have hypotension and hypoxemia, it is important to querypulmonary embolism especially in a patient who has risk factors predisposing him to thecondition.Kidney FailureChronic kidney disease is accompanied by high blood pressure and edema (Razmaria, 2016).