A client with a history of heart failure is admitted to the progressive care unit. During the night shift, the client suddenly awakens with severe dyspnea, a productive cough with frothy pink sputum, and an oxygen saturation of 84% on room air. The nurse observes profound jugular venous distention and hears diffuse coarse crackles upon auscultation. Arrange the following nursing actions in the correct order of priority from first to last.
- 1Position the client in a high-Fowler's position with legs dependent.
- 2Apply high-flow oxygen via a non-rebreather face mask.
- 3Administer prescribed intravenous furosemide.
- 4Insert a prescribed indwelling urinary catheter.
Answer
The correct priority sequence is to first position the client upright with legs dependent, then apply high-flow oxygen, followed by administering intravenous furosemide, and finally inserting an indwelling urinary catheter.
In acute cardiogenic pulmonary edema, the priority is to immediately improve oxygenation and reduce cardiac workload. Positioning the client in a high-Fowler's position with legs dependent uses gravity to decrease venous return (preload) and allows the lungs to expand more fully. This is the fastest, most immediate independent nursing intervention. Next, applying high-flow oxygen addresses the severe hypoxemia caused by fluid in the alveoli. Once the client's airway and breathing are acutely supported, intravenous furosemide is administered to initiate rapid diuresis, thereby removing fluid and further reducing preload. Finally, inserting a urinary catheter is necessary to accurately track the massive diuresis expected from the furosemide, making it the logical final step in this sequence.
Step-by-Step Solution
Key Concept
Prioritization of care in acute cardiogenic pulmonary edema follows the principles of immediate preload reduction and airway management, beginning with physical positioning, followed by oxygenation, pharmacological diuresis, and precise fluid monitoring.