Shortness of breath.

A 65 year old Cuban male comes to the ED because of shortness of breath.  He notes that over the last 2-3 years he has had gradual worsening of his ability to exert himself without feeling out of breath, and it has been acutely worse for the past week, including a worsening productive cough.  On questioning, he reveals that he coughs almost every morning as well, and this has been going on for even longer, perhaps 4-5 years.  The cough is now productive of yellowish-brownish sputum.  He denies chest pain. He has no history of lower extremity edema.  He currently smokes. He states he has lost 15 lbs in the last year.

On exam, his BP is 144/88 mmHg, HR is 98, respiratory rate is 28 breaths per minute.  His temp is 97.6.  Oxygen saturation was 89% on RA  and increased to   93% on 2 L.   You find him sitting up, leaning forward.  He appears uncomfortable with labored breathing and prolonged expiration  and his lips are bluish. No JVD or carotid bruits noted .  Chest exam shows mild intercostal retractions seen around the anterolateral costal margins and barrel chest. Wheezes  present bilaterally but diminished BS without crackles.  Heart exam is unremarkable, though the heart sounds are distant.  Lower extremities show no cyanosis, clubbing or edema.

1. The client and his family member express concern on how to know when to seek medical attention or call healthcare provider. “I am short of breath all the time, when would they actually need to know?”. What is the nurse’s best response to this question? Please include at least 5 concerning symptoms in your education.

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