Heart Failure & Valvular Diseases Q 41

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A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client’s medical history included DM, HTN, and heart failure. Which of the following disorders should the nurse suspect?

  

     A. Pulmonary edema

     B. Pneumothorax

     C. Cardiac tamponade

     D. Pulmonary embolism

    

    

Correct Answer: A. Pulmonary edema

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SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy sputum are late signs of pulmonary edema. Progressively worsening dyspnea, tachypnea, and rales (or crackles) on examination with associated hypoxia are the clinical features common to both cardiogenic and noncardiogenic pulmonary edema. Cough with pink frothy sputum noted due to hypoxemia from alveolar flooding and auscultation of an S3 gallop could suggest cardiogenic edema. Similarly, the presence of murmurs, elevated jugular venous pressure, peripheral edema may point towards a cardiac etiology.

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Option B: In primary spontaneous pneumothorax, the patient is minimally symptomatic as otherwise healthy individuals tolerate physiologic consequences well. The most common symptoms are chest pain and shortness of breath. The chest pain is pleuritic, sharp, severe, and radiates to the ipsilateral shoulder. In SSP, dyspnea is more severe because of decreased underlying lung reserve.

Option C: The classic physical findings in cardiac tamponade included in Beck’s triad are hypotension, jugular venous distension, and muffled heart sounds. Pulsus paradoxus, which is a decrease in systolic blood pressure by more than 10 mm Hg with inspiration is an important physical exam finding that suggests a pericardial effusion is causing cardiac tamponade.

Option D: The most common symptoms of PE include the following: dyspnea, pleuritic chest pain, cough, hemoptysis, presyncope, or syncope. Dyspnea may be acute and severe in central PE, whereas it is often mild and transient in small peripheral PE. In patients with preexisting heart failure or pulmonary disease, worsening dyspnea may be the only symptom.

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