Patient with acute pulmonary oedema should be provided with?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Medical & Surgical Nursing

Medium

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

The priority intervention is placing the patient in an upright position (High Fowler's) with legs dangling over the side of the bed.
This position uses gravity to decrease venous return to the heart (preload), which immediately reduces congestion in the lungs.
Sitting upright lowers the diaphragm, allowing for maximum lung expansion, which eases the work of breathing and improves oxygenation.
This is a rapid, non-invasive nursing action that provides immediate relief while other medical therapies are being initiated.

Option A: A ventilator is an advanced intervention used for patients in severe respiratory failure when less invasive measures have failed.
Option B: While essential, administering oxygen does not address the underlying mechanical problem of fluid overload in the lungs as immediately as proper positioning does. Positioning physically reduces the amount of blood returning to the lungs.
Option C: This option is too vague. While rest is important, the specific type of position is crucial for therapeutic effect. A supine or semi-Fowler's position would worsen the condition.

Clinical Relevance

Nursing practice connection: Use the key finding related to Priority nursing interventions for acute pulmonary edema to guide bedside assessment, documentation, and the next nursing action.
Acute pulmonary edema is a medical emergency. A nurse's ability to rapidly assess and implement priority interventions like positioning can be life-saving.
This demonstrates a key nursing principle: using non-pharmacological interventions (like positioning) to provide immediate patient relief and stability.
What if? - If the patient becomes severely hypotensive (e.g., systolic blood pressure below 90 mmHg), dangling the legs may worsen hypotension. In this case, the nurse should still keep the head of the bed elevated but may need to raise the legs to a neutral or slightly elevated position to support blood pressure, while immediately notifying the provider.

How to Approach the Question

First, identify the patient's condition: acute pulmonary edema. This is a life-threatening fluid overload in the lungs.
Recall the core problem: The heart's left ventricle is failing, causing blood to back up into the lungs, increasing pressure and forcing fluid into the alveoli.
Analyze the goal of immediate interventions: to reduce the workload on the heart and improve breathing.
Evaluate the options based on priority and immediacy. Ask yourself, 'What can I, as a nurse, do right now at the bedside that will have the fastest positive impact?'
Compare the actions: A ventilator (A) is an advanced, later step. Oxygen (B) is vital but doesn't reduce the fluid pressure. 'Position and rest' (C) is not specific. Placing the patient upright with legs down (D) uses gravity to immediately reduce blood return to the heart, directly addressing the cause of the congestion.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 42-44