In what position should an 80-year-old client with paroxysmal nocturnal dyspnea be placed to decrease preload?

The most effective position for a client experiencing paroxysmal nocturnal dyspnea is the orthopneic position. This position involves sitting upright, often with support from a bedside table or other surface, which allows for maximum lung expansion and decreases the workload on the heart by reducing venous return and therefore preload.

In conditions where fluid overload is contributing to symptoms, like dyspnea, reducing preload is critical. By sitting upright, the client experiences less pressure on the diaphragm from the abdominal contents, facilitating better lung function and allowing for easier breathing. This posture enhances ventilation and helps alleviate the feelings of breathlessness that can occur when lying flat, common in individuals with heart failure or other cardiac conditions.

In contrast, other positions like contour or recumbent can increase abdominal pressure on the diaphragm, exacerbating the client’s symptoms. The Trendelenburg position, which involves lying back with the legs elevated, can actually increase venous return to the heart and increase preload, potentially worsening the client's condition. The orthopneic position is hence particularly beneficial for improving the respiratory status and comfort for those experiencing episodes of paroxysmal nocturnal dyspnea.