A patient who had bladder surgery 2 days ago develops acute decompensated heart failure with severe dyspnea. Which action by the nurse would be indicated first?

• A. Review urinary output for the previous 24 hours.
• B. Restrict the patient's oral fluid intake to 500 mL/day.
• C. Assist the patient to a sitting position with arms on the overbed table.
• D. Teach the patient to use pursed-lip breathing until the dyspnea subsides.

Answer: (C)

Relief of severe dyspnea in acute decompensated heart failure starts with positioning that eases breathing by reducing preload and allowing better lung expansion. Having the patient sit up with the arms supported on the overbed table places the body in a position that gravity uses to decrease venous return to the heart, lowers pulmonary edema, and makes it easier for the diaphragm to move. This upright, forward-leaning position often provides rapid symptomatic relief while other treatments (oxygen, medications) are started.

Reviewing urinary output and fluid restriction are important for overall fluid status, but they don’t address the immediate breathing distress. Pursed-lip breathing can help with symptoms, but the most effective first action for severe dyspnea is the upright, supported position.