A nurse is caring for a client in the emergency department. Exhibits Click to highlight the findings that require immediate follow-up. To deselect a finding, click on the finding again. Day 1, 1100: S: Client reports fatigue over the last several months. Client reports intermittent epigastric discomfort upon exertion. Client reports experiencing occasional nausea and heart palpitations. B: Client is a 60-year-old female. History of smoking 1 pack per day for the past 30 years. Past medical history of type 2 diabetes mellitus, systemic lupus erythematosus, hypertension, and hyperlipidemia. The Father died at age 50 with coronary artery disease. A: Alert and oriented to person, place, and time. Bilateral breath sounds clear and equal. Denies shortness of breath. Respirations are even and unlabored. S1, S2 auscultated. No abnormal heart sounds auscultated. Bowel sounds normoactive x4 quadrants. Abdomen nondistended and nontender. Peripheral pulses palpable 2+. Skin warm, dry, and pink. Client reports chest pain as 4 on a scale of 0 to 10 R: Suggest admitting to telemetry unit for further monitoring.

Rationale: Client reports chest pain as 4 on a scale of 0 to 10: Chest pain, even when moderate, is a red flag symptom for possible myocardial ischemia, especially in a high-risk client. Prompt evaluation is essential to rule out unstable angina or early myocardial infarction. Client reports fatigue over the last several months: Chronic fatigue may be an early and often overlooked symptom of cardiovascular disease in women. In the context of other cardiac risk factors, this requires further cardiac workup. Client reports intermittent epigastric discomfort upon exertion: Epigastric discomfort on exertion may reflect angina equivalents, especially in women and diabetic patients. It may indicate myocardial ischemia and requires immediate attention. Client reports experiencing occasional nausea and heart palpitations: Nausea and palpitations may be atypical symptoms of cardiac ischemia or arrhythmias. These signs are concerning when paired with chest discomfort and cardiovascular history. History of smoking 1 pack per day for the past 30 years: Smoking is a major modifiable risk factor for coronary artery disease. Long-term tobacco use contributes to endothelial dysfunction and increases the risk of acute cardiac events. Past medical history of type 2 diabetes mellitus, systemic lupus erythematosus, hypertension, and hyperlipidemia: This cluster of comorbidities places the client at extremely high risk for cardiovascular complications. Each condition independently contributes to atherosclerosis and cardiac event risk. Father died at age 50 with coronary artery disease: A strong family history of premature CAD significantly elevates this client’s cardiac risk. It intensifies the concern for hereditary predisposition to cardiovascular events.