The nurse is caring for a client with advanced heart failure on an inpatient hospice unit. The client is having trouble breathing. Which comfort intervention should the nurse implement first?

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Dyspnea, difficulty breathing, is a common symptom in the client with advanced heart failure who is on hospice. The most common cause of dyspnea is fluid overload, and elevating the head of the bed is often an effective intervention that can be implemented quickly and easily. (Option A) Albuterol is a bronchodilator and is unlikely to relieve feelings of dyspnea caused by fluid overload. (Options B and D) Additional interventions for dyspnea in heart failure include the use of IV furosemide to promote diuresis to treat the fluid overload. The use of prn morphine can alleviate the sensation of dyspnea, but this would not be the first intervention; it should be used in combination with diuresis if the dyspnea is associated with fluid overload. Educational objective: The client with advanced heart failure on hospice is likely to have dyspnea associated with fluid overload. The first intervention should be to elevate the head of the bed and then assess for fluid overload, which would be treated with IV diuretics. Morphine can alleviate dyspnea associated with heart failure, but it should be used in combination with other nonpharmacologic and pharmacologic interventions.

The Nurse Is Caring for a Client with Advanced Heart