A nurse is caring for a client diagnosed with a pulmonary embolism that is placed on a continuous heparin infusion. The nurse should notify the health care provider for which of the following findings?

Condition Most Likely Experiencing: Heart failure.

The client presents with signs and symptoms consistent with heart failure, including cardiomegaly, bibasilar pleural congestion on chest x-ray, elevated BNP level, and vital signs indicating hypertension (BP 146/98 mm Hg), tachycardia (pulse rate 106/min), and tachypnea (respirations 24/min). Additionally, the client is prescribed medications commonly used to manage heart failure, such as digoxin and carvedilol, and is receiving a diuretic (furosemide) to address fluid overload associated with heart failure.
Action to Take:

Elevate the head of the bed: Elevating the head of the bed helps reduce venous return to the heart, decreasing preload and potentially alleviating symptoms of heart failure, such as dyspnea and orthopnea. It can also help prevent aspiration in clients with compromised cardiac function. Encourage intake of a low-sodium diet: A low-sodium diet is essential in managing heart failure as it helps reduce fluid retention and edema by decreasing fluid volume overload. Sodium restriction helps minimize fluid accumulation, which is crucial in preventing exacerbations of heart failure.
Parameter to Monitor:

Urinary output: Monitoring urinary output is important in assessing fluid balance and response to diuretic therapy in clients with heart failure. Decreased urinary output may indicate worsening heart failure or inadequate response to diuretic therapy, whereas increased output may suggest over-diuresis or improvement in heart failure symptoms.
Blood pressure: Monitoring blood pressure helps assess the effectiveness of treatment in managing heart failure and controlling hypertension, a common comorbidity. Hypertension can exacerbate heart failure, so monitoring blood pressure trends helps guide adjustments in medication therapy to achieve optimal blood pressure control and improve cardiac function.

A. Poorly coordinated care and nosocomial infections are examples of errors: Poorly coordinated care, such as miscommunication between healthcare providers or lack of continuity in care, and nosocomial infections (infections acquired in the healthcare setting) are examples of errors that can compromise patient safety and contribute to adverse events.

B. Handoff errors are not causes of adverse events: Handoff errors, including miscommunication during transitions of care, are significant contributors to adverse events in healthcare settings. Improper handoffs can lead to misunderstandings, delays in treatment, and errors in medication administration.

C. Medication errors are intentional: Medication errors are unintended and can occur due to various factors, including human error, system failures, and communication breakdowns. They are not intentional acts.

D. As many as 10% of medication errors are preventable: Medication errors are often preventable with the implementation of safety measures such as barcode scanning, medication reconciliation, and standardized protocols. The percentage of preventable medication errors may vary depending on the healthcare setting and the effectiveness of safety initiatives.