Examkin

Question

Difficulty: HardBasic Care and Comfort

A client is admitted to the medical-surgical unit with acute decompensated heart failure and is experiencing severe orthopnea and significant bilateral peripheral edema. The nurse is planning care to optimize the client's respiratory status and physical comfort. Which of the following positioning strategies is most appropriate?

  1. Assisting the client to sit on the edge of the bed while leaning forward with their arms supported on a padded overbed table.Answer
  2. B
    Maintaining the client in a high-Fowler's position while elevating both legs on pillows above the level of the heart.
  3. C
    Encouraging the client to rest in a left lateral recumbent position with the knees slightly flexed toward the chest.
  4. D
    Placing the client in a flat, supine position with a supportive lumbar roll for a maximum of two hours to allow for sleep.

Answer

The most appropriate positioning strategy is to assist the client to sit on the edge of the bed, leaning forward with arms supported on a padded overbed table.
The orthopneic position (sitting up and leaning forward over a supported surface) is the optimal intervention for severe orthopnea. It utilizes gravity to shift abdominal organs away from the diaphragm, maximizing lung expansion and allowing effective use of accessory respiratory muscles. Furthermore, having the client sit on the edge of the bed keeps the legs dependent, which intentionally pools blood in the lower extremities, thereby reducing venous return (preload) to the right side of the heart and alleviating pulmonary congestion.

Step-by-Step Solution

1
Analyze the client's clinical presentation.
The client has acute decompensated heart failure with severe orthopnea (difficulty breathing when lying flat) and peripheral edema.
Understanding the pathophysiology of heart failure is essential for selecting the correct comfort measures.
2
Evaluate the hemodynamic impact of various positioning strategies.
Positions that increase venous return (preload) will worsen pulmonary congestion, while positions that decrease venous return will alleviate symptoms.
Nursing interventions for heart failure must balance respiratory support with fluid dynamic management.
3
Select the position that maximizes lung expansion and minimizes preload.
The orthopneic position (leaning forward over a table with legs dependent) achieves both goals.
This position allows gravity to pull abdominal organs downward, freeing the diaphragm for maximum excursion, while dangling the legs deliberately reduces venous return to the failing heart.

Key Concept

Orthopneic Positioning in Heart Failure
Rate this question

Topics

Basic Care and Comfort

More questions from this topic