A patient with hypertension and chronic heart failure has shortness of breath and edema. Which action is most appropriate to relieve dyspnea?

A patient with hypertension and chronic heart failure has shortness of breath and edema. Which action is most appropriate to relieve dyspnea?

• A. Elevate head of bed
• B. Administer IV fluids
• C. Instruct patient to lie flat
• D. Begin active ambulation immediately

Answer: (A)

Elevating the head of the bed helps relieve dyspnea in heart failure by reducing venous return (preload) to the heart and easing pulmonary congestion. Placing the patient in a semi- to high-Fowler position allows the lungs to expand more easily, lowers filling pressures in the left heart, and improves oxygenation, which quickly decreases the sensation of breathlessness. Giving IV fluids would increase preload and worsen edema and dyspnea. Instructing the patient to lie flat raises venous return and can worsen pulmonary edema. Beginning active ambulation during acute dyspnea increases oxygen demand and can exacerbate breathing difficulty. Elevating the head of the bed is the most immediate, beneficial response.

Elevating the head of the bed helps relieve dyspnea in heart failure by reducing venous return (preload) to the heart and easing pulmonary congestion. Placing the patient in a semi- to high-Fowler position allows the lungs to expand more easily, lowers filling pressures in the left heart, and improves oxygenation, which quickly decreases the sensation of breathlessness.

Giving IV fluids would increase preload and worsen edema and dyspnea. Instructing the patient to lie flat raises venous return and can worsen pulmonary edema. Beginning active ambulation during acute dyspnea increases oxygen demand and can exacerbate breathing difficulty. Elevating the head of the bed is the most immediate, beneficial response.