Problem: Patient is alert and oriented x 4, anxious reporting discomfort and hurts to take deep breaths. Patient states he can only sleep sitting up in a chair. Short of breath with minimal exertion. The nurse's initial clinical assessment findings include: Mark the assessment findings that require follow-up by the nurse. Alert & oriented x 4 Clear speech Follows simple commands Patient reports weight gain of 6 lbs. last week Temperature 97.6 Has sinus tachycardia, HR 134 Dry, flaky skin bilateral arms Respirations = 40 breaths/min Oxygen saturation = 84% (on room air) Breathing labored with use of accessory muscles Crepitus bilateral knee joints Hemoglobin = 10.8 g/dL Hematocrit = 33.4% White blood cell count = 19.6 mm3 K = 3.9. Need Assignment Help?