A nurse is caring for a client with moderate acute decompensated heart failure. The nurse should include which nursing intervention in the care plan?

Administer dobutamine as ordered.
Administer furosemide as ordered.
Reduce stress.

Explanation

• First-line therapy generally includes a loop diuretic such as furosemide, which will inhibit sodium chloride reabsorption in the ascending loop of Henle. Diuretics reduce circulating blood volume, diminish preload, and lessen systemic and pulmonary congestion.

• The most powerful way to increase contractility of the heart is to use inotropic medications. Principal inotropic agents include dobutamine, milrinone, dopexamine, and digoxin.

• Aside from improving ventricular pump performance and reducing myocardial workload, the client also needs to reduce physical and emotional stress.

• Even though the legs are edematous, they should not be elevated. Elevating the legs rapidly increases venous return to the heart.

• It is not necessary to restrict fluid intake in clients with mild or moderate heart failure. In more advanced cases, however, it is beneficial to limit water to 1000 mL/day.

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