Which signs should the nurse assess for in a client with suspected valvular heart disease?

Which signs should the nurse assess for in a client with suspected valvular heart disease?

• A. Orthopnea
• B. Paroxysmal nocturnal dyspnea
• C. Petechiae on the trunk
• D. Widening pulse pressure

Answer: (B)

When valve problems disrupt normal blood flow, the heart can start to back up into the lungs, causing pulmonary congestion and signs of left-sided heart failure. Paroxysmal nocturnal dyspnea is a classic indication of this process: sudden episodes of breathlessness that wake a person at night after lying down, as fluid shifts into the chest and pulmonary edema develops. This nocturnal dyspnea directly reflects the fluid buildup from a valvular issue and is a particularly telling sign to assess.

Orthopnea is also a sign of left-sided failure, but the nighttime, abrupt nature of paroxysmal nocturnal dyspnea makes it a more specific clue in this context. Petechiae on the trunk point more toward infectious endocarditis or embolic phenomena rather than a primary valvular dysfunction. Widening pulse pressure can occur with certain valve problems like regurgitation, but it’s less universally associated with valvular disease as a whole and not as informative about pulmonary congestion as nocturnal dyspnea. In practice, ask about nighttime breathlessness, how often it occurs, and how it affects sleep, while also noting other heart failure signs and auscultatory findings.