The nurse is assessing a patient for heart failure (HF). Which early findings would indicate decreased cardiac output and a potential for fluid overload from heart failure?
1. Orthopnea, peripheral edema, crackles
2. Dizziness, syncope, palpitations
3. Pallor and/or cyanosis of extremities
4. PAWP of 12 and CVP of 6
1
Rationale 1: These symptoms reflect decreasing perfusion and accumulation of fluid in the pulmonary system, which is not being effectively circulated by a failing heart.
Rationale 2: Dizziness, syncope, and palpitations are symptoms of end-organ hypoperfusion, not fluid overload. These symptoms represent later symptoms of hypoxia from less blood being carried to distal organs, especially the brain and the heart. The pulmonary backup of fluid occurs before the hypoxia.
Rationale 3: Pallor and/or cyanosis are seen in end-organ hypoperfusion, not a fluid overload situation. Distal areas do not receive adequate arterial blood flow and the tissue becomes hypoxic quickly, which causes the pallor or cyanosis from venous stasis.
Rationale 4: Pulmonary arterial wedge pressure and central venous pressure would increase with fluid overload because the pressure of additional fluids must be overcome to circulate the blood.
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