Mr. S is an 84-year-old Hispanic with congestive heart failure (CHF). He comes into the clinic with complaints of lower extremity edema and shortness of breath that began three days ago
His weight today is 186 pounds, an increase of 12 pounds in 12 days. He has 1+ pitting edema in both lower extremities that extends to the knees. The nurse inquires about any variation in his daily routine and he informs her that his wife has been sick for about one week, and he has been making canned soup or sandwiches for their meals. The nurse suspects the problem is related to: 1. Inactivity due to his wife's illness.
2. Excess sodium from the canned soup and lunch meat.
3. Worsening cardiac ejection fraction due to age.
4. Water retention due to increased protein intake.
2
Rationale: The sudden onset of weight gain and development of edema points to an increased consumption of dietary sodium resulting in water retention and worsening heart failure. The likely cause of the increased sodium is canned soups and processed meat which both have high sodium levels. Worsening cardiac ejection fraction due to age is unlikely given the sudden onset of symptoms. Water retention is caused by sodium rather than an increase in dietary protein.
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