Question

A patient is admitted with right- and left-sided heart failure. The nurse's assessment reveals that the patient has 3+ pitting edema on the sacrum, blood pressure of 176/98 mm Hg, and bilateral crackles in the lungs. The patient is experiencing shortness of breath and chest discomfort. On the basis of this information, how would the nurse evaluate the patient's preload status?

a. The patient is hypovolemic and has too little preload.
b. The patient is experiencing congestive heart failure (CHF) and has too little
preload.
c. The patient is experiencing heart failure and has too much preload.
d. The patient is hypertensive and the preload is not a factor.

Answer 1

The patient's symptoms indicate that they are experiencing excess preload due to right- and left-sided heart failure, resulting in pitting edema and pulmonary edema.

Step-by-step explanation:

The patient's symptoms, including the 3+ pitting edema on the sacrum, high blood pressure, and bilateral crackles in the lungs, along with shortness of breath and chest discomfort, suggest that the patient is experiencing excess preload.

Preload refers to the volume of blood in the ventricles at the end of diastole, just before they contract. In the case of heart failure, specifically with the symptoms presented, both the right and left sides of the heart are failing to pump efficiently, leading to a backlog of blood and a rise in venous pressure, which, in turn, causes increased preload. The excess fluid accumulates in tissues, such as the sacrum, causing edema, and in the air sacs of the lungs (pulmonary edema), leading to breathing difficulties and crackles upon auscultation.