Orthopnea

Definition

Orthopnea is dyspnea that occurs when a patient is lying flat and is relieved by sitting or standing. It is classically associated with heart failure and measured by the number of pillows needed to sleep comfortably ('2-pillow orthopnea').

Causes

• Heart failure (most common)
• Pulmonary edema
• Severe COPD
• Obesity hypoventilation syndrome
• Diaphragmatic paralysis

Mechanism

In heart failure, lying flat redistributes fluid from lower extremities to pulmonary circulation, worsening pulmonary congestion.

Nursing Interventions

Elevate HOB to semi- or high-Fowler's position (30 to 90°). Administer oxygen as ordered. Assess for crackles and other CHF signs. Educate patient to sleep with HOB elevated or in recliner, such as daily weights, fluid and sodium restriction, diuretic therapy.

NCLEX Relevance

Classic CHF assessment finding. Elevate HOB.