Which assessment finding indicates that a patient's heart failure (HF) is worsening?
1. An increase in O2 saturation to greater than 90%
2. A decrease in heart rate to 66 bpm
3. The onset of atrial fibrillation
4. Louder S1 and S2 heart sounds
3
Rationale 1: Oxygenation saturations will decline to less than 90% and not increase to more than 90%. Declining O2 saturation levels reflect deteriorating pulmonary status from a buildup of fluids with pulmonary edema.
Rationale 2: Tachycardia increases to compensate for the decreasing O2 levels by trying to circulate what cells are present, but at the same time increases the O2 demand by increased cardiac functioning.
Rationale 3: As heart failure continues to progress, less oxygenation occurs all over the body, especially the myocardium, which is sensitive to the hypoxia and will result in dysrhythmias such as ventricular ectopy or atrial fibrillation.
Rationale 4: The S1 and S2 sounds remain the same.
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