Client is a 68-year-old male admitted for worsening heart failure symptoms. Reports increasing shortness of breath with minimal exertion and awakening at night due to difficulty breathing. On assessment, fine crackles are auscultated in both lower lung fields. Client also reports new fatigue and decreased exercise tolerance. Vital signs: BP 138/84 mm Hg, HR 92 bpm, RR 24/min, SpO₂ 93% on room air. Abdomen is soft and non-tender. 2+ pitting edema noted in bilateral ankles. Jugular venous distention observed at 45 degrees. Client denies chest pain. Reports needing three pillows at night to sleep comfortably. Mild hepatomegaly noted on abdominal palpation. Capillary refill less than 2 seconds in upper extremities.