Patient is suffering from dyspnea. Which position will you provide for patient to relieve?

AIIMS Delhi NO- 2019

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Delhi NO- 2019

Explanation

Fowler's position involves elevating the head of the bed to 45-60 degrees, creating a semi-upright sitting position.
This position utilizes gravity to lower the diaphragm and abdominal organs, which reduces pressure on the thoracic cavity.
The increased space allows for greater lung expansion, decreases the work of breathing, and provides immediate relief for a patient with dyspnea.
It is the standard and most effective non-invasive intervention for patients experiencing shortness of breath.

Option A: The supine (lying flat on the back) position causes abdominal organs to press against the diaphragm, restricting its movement and limiting lung expansion. This can significantly worsen the feeling of breathlessness.
Option B: The prone (lying on the stomach) position is not the initial choice for relieving general dyspnea. It can be uncomfortable and may not provide immediate relief.
Option C: The Trendelenburg position (head down, feet up) is contraindicated for dyspnea. It causes abdominal contents to shift upwards, severely compressing the diaphragm and lungs, which would make breathing extremely difficult.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient positioning for management of dyspnea to guide bedside assessment, documentation, and the next nursing action.
Positioning is a fundamental and rapid nursing intervention to manage respiratory distress. Placing a patient in Fowler's or High-Fowler's position should be one of the first actions when a patient complains of shortness of breath.
Always assess the patient's response after repositioning. Monitor oxygen saturation, respiratory rate, and the patient's subjective feeling of breathlessness to evaluate the effectiveness of the intervention.
What if the dyspneic patient is also hypotensive? The Trendelenburg position would help blood pressure but worsen breathing, while Fowler's helps breathing but may worsen hypotension. In this complex scenario, a modified position (e.g., Low-Fowler's) might be attempted while addressing the underlying causes of both issues, often requiring physician consultation and pharmacological support.

How to Approach the Question

First, identify the key clinical problem in the question stem: the patient has 'dyspnea' (difficulty breathing).
The question asks for an intervention to 'relieve' this problem. The options are all patient positions.
Think about the pathophysiology of breathing. To breathe easier, the lungs need to expand fully. Consider how each position would affect the movement of the diaphragm and the expansion of the chest.
Evaluate each option: Supine and Trendelenburg positions compress the chest due to pressure from abdominal organs. Prone is a specialized position. Fowler's position uses gravity to pull the diaphragm down, allowing the lungs to expand.
Conclude that Fowler's position is the only option that directly and effectively facilitates lung expansion to relieve dyspnea.

Concept Tested & Keywords

Concept Tested: Patient positioning for management of dyspnea.
Stem keywords: dyspnea, position, relieve
Lead-in keywords: Which position
Clinical cues: The primary symptom is dyspnea, which requires an intervention to improve respiratory function.

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E6 Nursing Fundamentals Taylor pp. 360-362, 723-725

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 253-255