A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient
The nurse's priority action will be to
a. give IV morphine sulfate 4 mg.
b. give IV diazepam (Valium) 2.5 mg.
c. increase nitroglycerin (Tridil) infusion by 5 mcg/min.
d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.
ANS: A
Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.
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