What would be the primary goal of therapy for a client with pulmonary edema and heart failure?
A. Enhance comfort
B. Increase cardiac output
C. Improve respiratory status
D. Peripheral edema decreased
Correct Answer: B. Increase cardiac output
The primary goal of therapy for the client with pulmonary edema or heart failure is increasing cardiac output. Pulmonary edema is an acute medical emergency requiring immediate intervention. Preload reduction decreases pulmonary capillary hydrostatic pressure and reduces fluid transudation into the pulmonary interstitium and alveoli. Afterload reduction increases cardiac output and improves renal perfusion, which allows for diuresis in the patient with fluid overload.
Option A: Enhancing the client’s comfort is a goal of therapy but not an urgent one. The initial management of patients with cardiogenic pulmonary edema (CPE) should address the ABCs of resuscitation, that is, airway, breathing, and circulation. Oxygen should be administered to all patients to keep oxygen saturation at greater than 90%. Any associated arrhythmia or MI should be treated appropriately.
Option C: Respiratory status would improve following an increase in the cardiac output. Patients who remain hypoxic despite supplemental oxygenation and patients who have severe respiratory distress require ventilatory support in addition to maximal medical therapy.
Option D: Peripheral edema is a manifestation of cardiogenic pulmonary edema and right ventricular heart failure, but it is not a primary concern. In general, begin with oral vasodilator therapy, most commonly ACE inhibitors. If the patient was initially treated with inotropic medications, wean the patient off of these as soon as his or her condition is stable, to minimize adverse effects.