JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and

systolic heart failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%.

She presents to the emergency department (ED) for shortness of breath (SOB) the past three days. Her

shortness of breath has progressed from SOB with activity to becoming SOB at rest. The last two nights she

had to sleep in her recliner chair to rest comfortably upright. She is able to speak only in partial sentences and

then has to take a breath when talking to the nurse.She has noted increased swelling in her lower legs and has

gained six pounds in the last three days. She is being transferred from the ED to the cardiac step-down where

you are the nurse assigned to care for her.

Personal/Social History:

JoAnn is a retired math teacher who is unable to maintain the level of activity she has been accustomed to

because of theprogression of her heart failure the past two years. She has struggled with depression the past

two years and has been more withdrawn since her husband of 52 years died unexpectedly three months ago

from a myocardial infarction