A nurse caring for a client in one room is told by another nurse that a second client has developed severe pulmonary edema. On entering the 2nd client’s room, the nurse would expect the client to be:
A. Slightly anxious
B. Mildly anxious
C. Moderately anxious
D. Extremely anxious
Correct Answer: D. Extremely anxious
Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning, suffocation, or smothering. People with severe anxiety typically score higher on scales of distress and lower on functioning. Symptoms of severe anxiety are frequent and persistent and may include increased heart rate, feelings of panic, and social withdrawal.
Option A: 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.
Option B: Although often described as sub-clinical or clinically non-significant, mild anxiety can impact emotional, social, and professional functioning. Mild anxiety symptoms may present as social anxiety or shyness and can be experienced in early childhood through to adulthood. If left unaddressed, mild anxiety can lead to maladaptive coping strategies or more severe mental conditions.
Option C: People with moderate levels of anxiety have more frequent or persistent symptoms than those with mild anxiety, but still have better daily functioning than someone with severe anxiety or panic disorder. For example, people with moderate anxiety may report experiencing symptoms such as feeling on edge, being unable to control their worrying, or being unable to relax several days or the majority of days in a week, but not every day.
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