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Gretchen is a 25-year-old female taken to the emergency room…

Gretchen is a 25-year-old female taken to the emergency room with tachypnea, tachycardia, wheezing on expiration, and a tight non-productive cough. Her CXR shows translucent lung fields, a flattened diaphragm, and an increased A-P diameter of chest.  Gretchen’s signs and symptoms are most consistent with:

Robert is a 72 yr old man admitted to the hospital diagnosed…

Robert is a 72 yr old man admitted to the hospital diagnosed with Congestive Heart Failure presenting with increased SOB, productive cough, 10# weight gain in past  2 weeks, 3+ pitting edema in LEs, fatigue and weakness.  PMH includes: L LE transtibial amputation, obesity, HTN, hyperlipidemia, MI x 2 (2008, 2011), PTCA with stent 2011.  Home meds include: metoprolol (Beta Blocker), lisinopril (ACE inhibitor), Lasix (diuretic), and aspirin (antiplatelet/anticoagulant). SH:  Married, lives in 2 story home with 2 STE without railing, bed/bath up 14 steps with railing on R side as you go up.  Has half bath on first floor.  Pt is retired.  Pt is independent with his prosthesis. Hobbies include golf, computer, reading, and going to grandchildren’s’ sporting events.  He wears glasses all the time and wears hearing aids bilaterally PT Evaluation:  UE/LE ROM WNL in available joints.  Strength = 4+/5 in available musculature except bilateral hip extension= 4-/5.  Pt presents with 3+ pitting edema in B LEs.  Sensation—pt with increased sensitivity to light touch and pressure in bilateral LE’s.  Functional Mobility:  Supine to sit with minimal assist, sit to stand with rolling walker with min assist, NWB L LE.  Pt is unable to wear his prosthesis due to edema.  Gait training with RW x 10’ with min A, NWB L LE.  Pt had 2 standing rest breaks x 20 seconds each due to fatigue and SOB.  Stairs not assessed due to SOB and fatigue. Vital signs: Pre-activity (sitting)                            BP  136/80 mmHg         HR 90 bpm                SpO2 on 2L  99% During activity (gait)                           BP  120/75 mmHg        HR  105 bpm            SpO2 on 2L  91%            RPE  5/10      Post-activity (sitting)                          BP  125/76 mmHg         HR  100 bpm            SpO2 on 2L  95% Line management: Foley catheter, oxygen 2 L per nasal cannula, IV R forearm   The primary barrier to Robert’s success at home is: