Patho Patho #29

Question

A client with left sided heart failure asks the nurse why it is so difficult for him to breathe while lying flat. What is the nurse’s best response?

Answers

  1. Instruct the client to take his diuretic as ordered.
    • Rationale:

      This answer choice is not correct as instructing the client to take his diuretic is not the nurse’s best response. The most effective way to relieve PND is to instruct the client to sleep while propped up as opposed to lying flat.

  2. Explain that with his condition, blood is backing up into the lungs and that it may help to sleep while propped on pillows.
    • Rationale:

      This answer is correct because the client is experiencing PND. The nurse gives a thorough explanation of why the client is experiencing dyspnea when lying flat as well as gives specific instructions on how to relieve this dyspnea at night.

  3. Explain that blood is backing up into the peripheral circulation and instruct the client on coughing and deep breathing.
    • Rationale:

      This answer choice is not correct because blood is not backing up into the peripheral circulation in the setting of left sided heart failure.

  4. Ask if the client suddenly wakes up with a feeling of breathlessness at night.
    • Rationale:

      This answer choice is not correct because the client is asking for direction on how to relieve his nocturnal dyspnea. While questioning the client about breathlessness at night may provide useful information, this is not the nurse’s best response on how to relieve the client’s symptoms of nocturnal dyspnea.

Overview

The focus of this question is asking the nurse to teach a client with left sided heart failure regarding nocturnal dyspnea. Left-sided heart failure causes blood to back up into the pulmonary circulation as the left ventricle is not pumping blood forward into the systemic circulation. Therefore clients are likely to experience dyspnea, especially when lying flat at night. The nurse should teach these clients to sleep while propped up to help ease the symptoms of dyspnea that occurs when lying flat.

Explanation

Learning Outcomes

Paroxysmal nocturnal dyspnea (PND) is a specific type of dyspnea experienced by clients with left sided heart failure. PND is worse when lying flat as blood backs up into the pulmonary circulation due to a left ventricle that does not pump blood forward out into the systemic circulation. Additional symptoms of left heart failure include, pulmonary edema, adventitious breath sounds such as crackles, and dyspnea upon exertion and at rest. To ease symptoms of PND, clients should be taught to sleep while propped on pillows to help ease the dyspnea that occurs when lying flat.

Test Taking Tip

Remember with left-sided heart failure, clients will experience signs/symptoms related to the lungs (Left= lung). With right sided heart failure, clients will experience signs/symptoms related to peripheral circulation.

Video Rationale