What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of

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What data from the histories are RELEVANT and must be
interpreted as clinically significant by the nurse? (Reduction of
Risk Potential) RELEVANT Data from Presentation
Current Assessment: General Appearance: Calm, body relaxed, no
grimacing, appears to be slightly anxious. Respiratory: Breath
sounds clear with equal aeration bilaterally ant/post, non-labored
respiratory effort Cardiac: Pink, warm & dry, slight ankle
edema, heart sounds regular with no abnormal beats, pulses strong,
equal with palpation at radial, brisk cap refill Neuro: Alert and
oriented to person, place, time, and situation (x4) HEENT: Normal
cephalic Chest: Breasts tender on palpation, areola darkened and
occasional veins present Abdomen: Soft; no masses, uterus palpable
above umbilicus, mild indenting with palpation, fetus is in LOA
position by palpation Extremities: Mild spider varicose veins on
medial aspect of left leg, deep tendon ref
What data from the histories are RELEVANT and must be
interpreted as clinically significant by the nurse? (Reduction of
Risk Potential) RELEVANT Data from Presentation