Case Study 3: Acute Heart Failure 2026
Patient: Mr. James K., 68 years old
History: Hypertension, coronary artery disease, type 2 diabetes,
previous myocardial infarction.
Presentation:
Mr. K. arrives at the emergency department reporting worsening
shortness of breath for 3 days. He states that he cannot sleep lying
flat and has gained 3 kg over the past week. He has bilateral ankle
swelling and a persistent cough.
Assessment:
BP: 168/94 mmHg
HR: 108/min
RR: 28/min
SpO₂: 88% on room air
Temperature: 36.8°C
Crackles bilaterally
3+ bilateral lower-extremity edema
Jugular venous distention
Pink, frothy sputum
Laboratory findings:
, BNP: elevated
Sodium: 132 mmol/L
Potassium: 4.7 mmol/L
BUN: elevated
Creatinine: mildly elevated
Questions
1. Which finding requires the nurse's immediate attention?
A. Bilateral ankle edema
B. Weight gain of 3 kg
C. SpO₂ of 88% with respiratory distress
D. Sodium of 132 mmol/L
Answer: C. SpO₂ of 88% with respiratory distress
Hypoxemia and acute respiratory distress indicate impaired
oxygenation and possible pulmonary edema. Airway and breathing
take priority.
2. Which position should the nurse place the patient in?
A. Supine
Patient: Mr. James K., 68 years old
History: Hypertension, coronary artery disease, type 2 diabetes,
previous myocardial infarction.
Presentation:
Mr. K. arrives at the emergency department reporting worsening
shortness of breath for 3 days. He states that he cannot sleep lying
flat and has gained 3 kg over the past week. He has bilateral ankle
swelling and a persistent cough.
Assessment:
BP: 168/94 mmHg
HR: 108/min
RR: 28/min
SpO₂: 88% on room air
Temperature: 36.8°C
Crackles bilaterally
3+ bilateral lower-extremity edema
Jugular venous distention
Pink, frothy sputum
Laboratory findings:
, BNP: elevated
Sodium: 132 mmol/L
Potassium: 4.7 mmol/L
BUN: elevated
Creatinine: mildly elevated
Questions
1. Which finding requires the nurse's immediate attention?
A. Bilateral ankle edema
B. Weight gain of 3 kg
C. SpO₂ of 88% with respiratory distress
D. Sodium of 132 mmol/L
Answer: C. SpO₂ of 88% with respiratory distress
Hypoxemia and acute respiratory distress indicate impaired
oxygenation and possible pulmonary edema. Airway and breathing
take priority.
2. Which position should the nurse place the patient in?
A. Supine
