Beth Ray, age 62, is admitted to the medical-surgical unit for treatment of heart failure. She called her physician when she started getting short of breath walking up her stairs and noticed that her ankles seemed swollen. Her past history includes an episode of rheumatic fever as a child with a resulting endocarditis. Her mitral valve was affected and she had been diagnosed as having mitral stenosis as a young adult.
Upon admission, the nurse notes that Ms.Ray has shortness of breath upon any exertion, and +3 edema in both left and right lower extremities from the knees down to the feet. Her vital signs include T 37.6 C, P 96/min, R 28/min BP 110/70 mmHg