An older adult who has cardiac disease awakens abruptly during the night with coughing, diaphoresis, and palpitations. Which action should the nurse implement to manage the pa-tient's signs and symptom?
a. Obtain a 12-lead electrocardiogram (ECG).
b. Administer an antianxiety medication.
c. Raise the head of the bed to 30 degrees.
d. Offer a cool cloth and refresh bed linens.
C
Feedback
A Incorrect. A 12-lead ECG can be a reasonable response if the patient experiences chest pain or pressure, if the nurse suspects myocardial ischemia, or the nurse finds evidence of ECG changes suggesting myocardial ischemia or injury.
B Incorrect. A sedative or hypnotic is not indicated, and it is premature to admi-nister one; in addition, for this individual, antianxiety medications can aggravate the problem.
C Correct. The older adult is experiencing paroxysmal nocturnal dyspnea (PND). Associated with heart failure, it is caused by pulmonary edema and the resultant accumulation of fluid in the pulmonary vasculature. PND is also characterized by feelings of suffocation and a gallop rhythm. Balancing the individual's fluid status and pharmacological regimen for heart failure will help to reduce or eliminate PND.
D Incorrect. After the head of the bed is elevated and the patient stabilizes, fresh linens and a cool cloth can help to soothe the patient and facilitate rest and sleep.
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