Question

An 80-year-old client with a history of coronary artery disease is admitted to the hospital for observation after a fall. during the night the client has an episode of paroxysmal nocturnal dyspnea. in what position should the nurse place the client to best decrease preload?

Answer 1

Orthopneic

The client's paroxysmal dyspnea was probably caused by sleeping in bed with the legs at the level of the heart; this position increases venous return from dependent body areas, increasing the intravascular volume. Sitting up and leaning forward while keeping the legs dependent slows venous return as well as increases thoracic capacity. Although the contour position elevates the client's head, it does not place the legs in a dependent enough position to substantially decrease venous return. The recumbent position is contraindicated. Venous return increases when the lower extremities are at the level of the heart. Also, the pressure of the abdominal organs against the diaphragm decreases thoracic capacity. The Trendelenburg position is contraindicated. Venous return increases when the lower extremities are higher than the level of the heart. Also, the pressure of the abdominal organs against the diaphragm decreases thoracic capacity.