Based on the progress note documentation, which priority intervention does the nurse anticipate? Click on the exhibit button for additional information
Exhibit
Progress notes
2000 Client admitted to CCU #4, reporting vise-like chest pain and shortness of breath. Pulmonary artery (PA) catheter inserted by the health care provider via right internal jugular vein without difficulty. Central venous pressure (CVP) 18 mm Hg, pulmonary artery wedge pressure (PAWP) 25 mm Hg and coarse crackles auscultated bilaterally. --------------- RN
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating increased systemic circulation volume and increased right ventricular preload. Pulmonary artery wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop diuretic that will decrease both left and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg, methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right ventricular preload and left ventricular preload.
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating increased systemic circulation volume and increased right ventricular preload. Pulmonary artery wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop diuretic that will decrease both left and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg, methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right ventricular preload and left ventricular preload.