If a patient is complaining of orthopnoea, it is best to make him?

GMCH Chandigarh - 2022

Medical Surgical Nursing

Easy

Appeared in: GMCH Chandigarh - 2022

Explanation

Orthopnea is defined as shortness of breath that occurs when an individual is lying in a flat (supine) position.
Placing the patient in an upright sitting position (Fowler's position) is the correct and immediate nursing intervention.
This position utilizes gravity to lower the diaphragm, which increases the thoracic cavity's volume, allowing for maximum lung expansion.
Sitting upright also reduces venous return from the lower body to the heart and lungs, which decreases pulmonary congestion and makes breathing easier, especially in patients with heart failure.

Option A: Lying down straight (supine) is the position that induces or worsens orthopnea. It causes abdominal contents to press against the diaphragm and increases fluid return to the lungs, making breathing more difficult.
Option C: Walking around is a form of exercise that increases the body's oxygen demand. For a patient in respiratory distress, this would exacerbate their symptoms and could be dangerous.
Option D: This option is incorrect because patient positioning is a critical and specific therapeutic intervention for managing orthopnea. It is not a matter of random choice or comfort alone.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Dyspnea and Patient Positioning to guide bedside assessment, documentation, and the next nursing action.
Positioning is a fundamental, non-invasive, and rapid nursing intervention to alleviate respiratory distress. It should be one of the first actions a nurse takes when a patient reports orthopnea.
The number of pillows a patient uses to sleep (e.g., 'two-pillow orthopnea') is a classic way to quantify the severity of the condition and should be documented.
What if the patient is also hypotensive? The nurse must balance relieving dyspnea with maintaining blood pressure. A full upright position might worsen hypotension. In this case, a modified Semi-Fowler's position (30-45 degrees) might be used, with continuous monitoring of blood pressure and oxygen saturation.

How to Approach the Question

First, identify the key clinical term in the question: 'orthopnoea'.
Recall the definition of orthopnea: difficulty breathing specifically when lying down.
Understand the underlying pathophysiology: gravity's effect on the diaphragm and fluid distribution in the body.
Evaluate each option based on this understanding. The goal is to choose a position that counteracts the negative effects of lying flat.
An upright position works with gravity to improve lung expansion and reduce pulmonary congestion.
Eliminate options that would clearly worsen the condition (lying flat, exercising) or are non-therapeutic (any position).

Concept Tested & Keywords

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