Final answer:
The patient statement that indicates a need for further instruction is the one mentioning that they should weigh themselves once a month instead of daily, as rapid weight changes can be indicative of worsening heart failure due to fluid retention. An obese patient's symptoms of swollen feet may result from a compromised skeletal muscle pump due to insufficient activity.
Step-by-step explanation:
The patient's statement that indicates a need for further instruction on their treatment regimen for heart failure is "I must weigh myself once a month and watch for fluid retention." Regular monitoring of weight is critical in managing heart failure because rapid weight gain can indicate fluid retention and worsening heart failure. Patients are usually advised to weigh themselves daily to detect such changes promptly. Furthermore, they need to strictly manage fluid intake and may be prescribed diuretics to help prevent fluid buildup. If the patient's weight increases by more than a few pounds in a matter of days, this could be a sign of fluid accumulation that requires immediate medical attention.
In the context provided, an obese patient with symptoms of swollen feet and ankles, fatigue, and shortness of breath may be experiencing effects from compromised venous return due to insufficient activity of the skeletal muscle pump. The skeletal muscle pump assists in the movement of blood back to the heart, especially in the veins of the legs. In a patient who stands all day with no additional physical activity, the pump is not efficiently used, which can lead to venous insufficiency and symptoms like edema (swelling) in the lower extremities.