A client with acute coronary syndrome is receiving a continuous heparin infusion. The client is to receive 18 units/kg/hour. The client weighs 181.4 pounds. Based on the heparin concentration on the label, the nurse will set the infusion pump to deliver _______ mL/hr. Round to the nearest tenths place. Record numerical answers only.

 

A. Possible hypovolemia: A decreased CVP indicates reduced pressure in the right atrium and central veins, often reflecting a low circulating blood volume. Causes can include hemorrhage, dehydration, or excessive diuretic use. This finding suggests the right ventricle is receiving less venous return, which can compromise cardiac output if not corrected.

B. Right ventricular failure: Right ventricular failure typically results in elevated CVP due to impaired emptying of the right ventricle and venous congestion. A decreased CVP is inconsistent with right ventricular failure, as the pressure in the central veins would be increased rather than reduced.

C. Possible hypervolemia: Hypervolemia is characterized by increased circulating blood volume, which raises venous return and CVP. A decreased CVP suggests the opposite condition, indicating low intravascular volume rather than excess fluid.

D. Left ventricular failure: Left ventricular failure leads to pulmonary congestion and increased pulmonary venous pressure, which may eventually raise right-sided pressures, resulting in elevated CVP. A decreased CVP does not indicate left ventricular failure and suggests the right side is underfilled rather than overloaded.

A. A client who underwent coronary angioplasty yesterday who is requesting to sit in the bedside chair: Sitting in a chair is a routine activity and does not indicate an immediate change in clinical status. While safety and mobility should be assessed, this client is stable and does not require immediate priority over acute symptoms.

B. A client with dilated cardiomyopathy who developed dyspnea and agitation 1 hour prior to shift change: Dyspnea and agitation are signs of possible acute decompensated heart failure, hypoxia, or pulmonary edema. These symptoms indicate a potentially life-threatening change in condition and require immediate assessment to ensure airway, breathing, and hemodynamic stability. This client has the highest priority.

C. A client who is two days postoperative coronary artery bypass grafting and has a temperature of 100.6°F: A mild postoperative fever is relatively common and may reflect normal inflammatory response. While it should be monitored, it is not immediately life-threatening and is lower priority compared with acute respiratory distress.

D. A client with mitral valve stenosis who is scheduled for a balloon valvuloplasty later today: Preoperative assessment and preparation are important, but unless the client is unstable, this is not as urgent as new-onset dyspnea and agitation. Preprocedure evaluation can be addressed after assessing acute changes in other clients.