A client is diagnosed with emphysema and cor pulmonale. Which findings are characteristic of cor pulmonale?

DHS Staff Nurse - 2018 (Shift-2nd)

Medical & Surgical Nursing

Medium

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Cor pulmonale is defined as right-sided heart failure resulting from a primary lung disorder like emphysema.
The failure of the right ventricle causes blood to back up into the systemic venous circulation, leading to systemic congestion.
The classic signs of this systemic congestion are oedema in dependent areas like the lower extremities and distended neck veins (Jugular Venous Distention or JVD).
These signs directly reflect the increased pressure in the body's venous system due to the failing right heart.

Option A: These are general symptoms of the underlying respiratory disease (emphysema) and are not specific to the development of right-sided heart failure (cor pulmonale). Shortness of breath is more characteristic of left-sided heart failure if due to pulmonary congestion.
Option B: Heart failure typically causes weight gain from fluid retention, not weight loss. Increased RBC count (polycythemia) is a compensatory mechanism for chronic hypoxia from emphysema, not a direct sign of heart failure. Fever is a sign of infection.
Option C: Rales (crackles) are a hallmark sign of pulmonary congestion due to left-sided heart failure. Cor pulmonale is, by definition, right-sided heart failure. This option incorrectly mixes signs of left-sided and right-sided failure.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and clinical manifestations of Cor Pulmonale as background academic context rather than a clinical decision trigger.
Nurses must be able to differentiate between the signs of the underlying lung disease and the signs of developing cor pulmonale, as it indicates a worsening prognosis and requires different management strategies.
Key nursing assessments for cor pulmonale include checking for jugular venous distention, assessing for pitting oedema in the lower extremities, monitoring daily weights for fluid retention, and assessing for liver enlargement (hepatomegaly).
What if? If the patient with cor pulmonale also developed crackles (rales) in the lungs, it would suggest the development of biventricular failure (both right and left sides of the heart are failing), which is a severe complication requiring immediate medical attention.

How to Approach the Question

First, identify the core concept: The question asks for the specific signs of 'cor pulmonale'.
Recall the definition: Cor pulmonale is right-sided heart failure caused by a lung problem.
Think about the pathophysiology: Right-sided failure means blood backs up into the body (systemic circulation), while left-sided failure means blood backs up into the lungs (pulmonary circulation).
Analyze the options based on this principle. Look for signs of systemic fluid overload.
Eliminate options that describe symptoms of the lung disease itself (like hypoxia) or signs of left-sided heart failure (like rales/crackles).
Select the option that lists the classic signs of systemic venous congestion: peripheral oedema and distended neck veins.

Concept Tested & Keywords

Concept Tested: Pathophysiology and clinical manifestations of Cor Pulmonale.
Stem keywords: emphysema, cor pulmonale, findings, characteristic
Lead-in keywords: Which findings
Clinical cues: The diagnosis of both emphysema and cor pulmonale is a key cue, indicating the question is about the cardiac complication of the lung disease.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 29-31

E6 Medicine Davidson Principles Practice 24e p. 567-569