Heart Failure & Valvular Diseases Q 31 - Gyan Darpan : Learning Portal
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Thursday 28 April 2022

Heart Failure & Valvular Diseases Q 31

Which of the following positions would best aid breathing for a client with acute pulmonary edema?
     A. Lying flat in bed.
     B. Left side-lying.
     C. In high Fowler’s position.
     D. In semi-Fowler’s position.

Correct Answer: C. In high Fowler’s position

A high Fowler’s position promotes ventilation and facilitates breathing by reducing venous return. Gravity improves lung expansion by lowering diaphragm and shifting fluid to the lower abdominal cavity. Turn or reposition, and provide skin care at regular intervals. Decreases pressure and friction on edematous tissue, which is more prone to breakdown than normal tissue.

Option A: Lying flat on bed may worsen the patient’s breathing. Edema can be either a cause or a result of various pathological conditions reflecting four competing forces: blood hydrostatic and osmotic pressures and interstitial fluid hydrostatic and osmotic pressures. The dynamic interaction of these four forces allows fluid to shift from one body compartment to another. Edema may be generalized or localized in dependent areas. Elderly clients may develop dependent edema with relatively little excess fluid.
Option B: Left side-lying position worsens the breathing and increases the workload of the heart. Encourage adequate bed rest. Limited cardiac reserves result in fatigue and activity intolerance. Rest, particularly lying down, favors diuresis and reduction of edema.
Option D: Semi-Fowler’s position won’t reduce the workload of the heart as well as Fowler’s position will. Note the presence of neck and peripheral vein distention, along with pitting edema, and dyspnea. Signs of cardiac decompensation and heart failure. Auscultate lung and heart sounds. Adventitious sounds (crackles) and extra heart sounds (S3) are indicative of fluid excess, possibly returning in the rapid development of pulmonary edema.

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