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you are working in the emergency department today your next patient is a 65 year female whos brought in by a family due to severe shortness of breath on arrival she is sitting upright her vital signs include blood pressure of 180 over 90 heart rate of 120 rest rate of 34 and oxygen saturation of 80 percent on room air your nurse quickly put her into a monitor bed they also put a 100 oxygen on her by non-rebreather they quickly establishes too large for iv when you speak to the patients family they describe the patient has been having one week of increasing shortness of breath and leg swelling in terms of the shortness of breath it is worse when she lies down and when she exerts herself because of the shortness of breath when she lies down the patient has been needing two to three pillows to sleep she has not traveled anywhere she does not have fever or cough in terms of her previous history she has a history of a myocardial infarction five years ago and a history of congestive heart