An older man who has HF complains of increasing dyspnea over 2 days. Which of the following should the nurse assess to help determine whether the patient has adhered to his therapy? (Select all that apply.)

Question

a. Check for peripheral edema.
b. Ask about his bowel pattern.
c. Auscultate the lungs bilaterally.
d. Compare his weight to baseline.
e. Determine coughing frequency.
f. Assess his diet over last 48 hours.

Answer 1

A, C, D, F
Standard HF therapy includes taking medications as prescribed with a low-sodium diet to control total body fluids. Usually, dyspnea in a patient with HF is due to hypervolemia, which occurs after a lapse in adherence to the standard HF therapy. The nurse checks the patient's extremities for edema because peripheral edema is a clinical indicator of hypervolemia. If the patient is nonadherent with therapy, then the nurse is more likely to find peripheral edema than with an adherent patient. Hypervolemia can also be due to worsening HF. The nurse listens to the pa-tient's lungs to assess for pulmonary edema as a cause for the patient's dyspnea. Pulmonary edema can be caused by hypervolemia from nonadherence to therapy or from worsening HF. The nurse compares the patient's weight to his baseline to determine whether the patient has expe-rienced a sudden weight gain, which would be indicative of hypervolemia. Assessing the pa-tient's diet over the last 48 hours can provide clues about a potential cause of the patient's dysp-nea. If the patient increases the dietary sodium by eating pizza, pickles, and processed food, among others, the patient is likely to experience a sudden increase in total body fluid, which can cause the patient's dyspnea.
Although older adults with HF complain of anorexia, bowel habits are not as likely to be affected by hypervolemia as is the appetite. Coughing is a nonspecific, nonsensitive indicator of pulmonary edema.