A patient with congestive cardiac failure experiences dyspnoea due to?

SCTIMST Staff Nurse - 2015 (Set-A)

Medical Surgical Nursing

Medium

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

In left-sided heart failure, the left ventricle's inability to pump effectively causes blood to back up into the pulmonary circulation.
This backup increases hydrostatic pressure in the pulmonary capillaries, forcing fluid to leak from the blood vessels into the lung tissue.
The fluid first fills the interstitial spaces and then floods the alveoli (air sacs), a condition known as pulmonary edema.
This fluid in the alveoli directly interferes with the exchange of oxygen and carbon dioxide, causing the patient to feel short of breath (dyspnea).

Option B: This describes the pathophysiology of obstructive lung diseases like asthma or COPD, which involve airway inflammation and bronchoconstriction, not the fluid overload state of heart failure.
Option C: A pulmonary embolism is a blockage of a pulmonary artery by a thrombus. While it causes acute dyspnea, it is a distinct vascular event and not the chronic or progressive mechanism of dyspnea seen in CCF.
Option D: This option is imprecise. While pulmonary congestion and cardiomegaly are features of CCF, the direct cause of dyspnea is the consequence of this congestion—the fluid filling the alveoli. Option A provides a more specific and accurate physiological explanation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of Dyspnea in Congestive Cardiac Failure (CCF) to guide bedside assessment, documentation, and the next nursing action.
A key nursing assessment for a patient with CCF is to auscultate the lungs for crackles (or rales), which are sounds produced by air moving through fluid-filled alveoli. The presence of crackles is a hallmark sign of pulmonary edema.
Immediate nursing interventions for acute dyspnea in CCF include placing the patient in a high-Fowler's position (sitting upright) with legs dependent to reduce venous return to the heart and decrease lung congestion.
Nurses are responsible for administering prescribed diuretics (e.g., furosemide) to remove excess fluid and monitoring the patient's response, including urine output, daily weight, and improvement in breathing.

How to Approach the Question

First, identify the core concepts in the question: the condition is 'congestive cardiac failure' and the symptom is 'dyspnoea'.
The question asks for the cause ('due to'), so you need to recall the pathophysiology linking the condition to the symptom.
Think about how heart failure, particularly left-sided failure, affects the lungs. The key is the 'backup' of blood.
Evaluate each option for its physiological accuracy in the context of CCF.
Option A describes pulmonary edema, the classic cause of dyspnea in CCF. Options B and C describe different diseases (COPD/asthma and PE). Option D is less specific than A.
Select the option that describes the most direct and precise mechanism for impaired breathing in CCF.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 pp. 28-30, 41-43

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 45-47