Question

The nurse is caring for a client with decreased cardiac output secondary to heart failure with fluid volume overload. Which signs/symptoms are an indication to the nurse that treatment goals have not been met?

1. Diuresis
2. Dyspnea on exertion
3. Persistent cough
4. Warm, dry skin
5. Heart rate irregular at 118/min
6. Alert and oriented

Answer 1

Treatment goals for a heart failure patient with fluid volume overload have not been met if the patient shows signs of dyspnea on exertion, persistent cough, and an irregular heart rate of 118/min, as these indicate the heart is still overstressed.

Step-by-step explanation:

The nurse monitoring a client with heart failure and fluid volume overload should consider that treatment goals have not been met if the patient exhibits symptoms like dyspnea on exertion, persistent cough, and a heart rate irregular at 118/min. These symptoms suggest that the heart is still under stress from excess fluid, which can contribute to worsening heart failure. Diuresis, on the other hand, would indicate that fluid is being successfully removed from the body. A warm, dry skin can be a sign of effective treatment, and being alert and oriented is generally a positive sign, not indicative of unmet treatment goals.

Conditions such as hypervolemia and circulatory shock illustrate the critical balance of fluid volume and heart function. Hypervolemia, caused by conditions like heart failure or liver cirrhosis, leads to symptoms such as edema and pulmonary edema, whereas circulatory shock, specifically hypovolemic shock, is characterized by rapid heart rate, low blood pressure, reduced urine output, and can lead to a decrease in cardiac output and potential collapse.