A patient in the intensive care unit with acute decompensated ...

[codyclark]

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient.
 
  The nurse's priority action will be to
  a. give IV morphine sulfate 4 mg.
  b. give IV diazepam (Valium) 2.5 mg.
  c. increase nitroglycerin (Tridil) infusion by 5 mcg/min.
  d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

Question 2

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days.
 
  The nurse's priority action will be to
  a. have the patient recall the dietary intake for the last 3 days.
  b. ask the patient about the use of the prescribed medications.
  c. assess the patient for clinical manifestations of acute heart failure.
  d. teach the patient about the importance of restricting dietary sodium.

[Christopher]

Answer to Question 1

ANS: A
Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.

Answer to Question 2

ANS: C
The 5-pound weight gain over 3 days indicates that the patient's chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated.

[codyclark]

Excellent

[dantucker]

TYSM