The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?
A. Clubbing of nail beds
B. Hypertension
C. Peripheral edema
D. Increased appetite
Correct Answer: C. Peripheral edema
Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Right heart failure is most commonly a result of left ventricular failure via volume and pressure overload. Clinically, patients will present with signs and symptoms of chest discomfort, breathlessness, palpitations, and body swelling.
Option A: Clubbing of nail beds is associated with conditions of chronic hypoxia. Clubbing is a medical condition first described by Hippocrates in which the fingers (and/or toes) have the appearance of upside-down spoons. It is caused by a build-up of tissue in the distant part of the fingers (terminal phalanges), that causes the end of the fingers to become enlarged and the nails to curve downward.
Option B: Hypertension is associated with left-sided heart failure. When hemodynamic instability is present, vasopressors are indicated. Norepinephrine is the pressor of choice to improve systemic hypotension and restore cerebral, cardiac and end-organ perfusion.
Option D: Clients with heart failure have decreased appetites. A poor appetite can also result from the accumulation of fluid in the liver and digestive system. Fluid accumulation, edema, is a common symptom of heart failure. The accumulation of fluid that is responsible for the abdominal swelling can decrease the appetite and result in nausea as well as discomfort from the weight gain.
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