Final answer:
The priority for a client with heart failure and decreased urine output would be to assess the fluid and electrolyte balance, along with renal function, as conditions like oliguria can suggest acute kidney injury which might require immediate management, such as intravenous fluids, diuretics, or vasopressors, and consultation with a nephrologist.
Step-by-step explanation:
When dealing with a client with heart failure with decreased urine output, the priority action is to assess their fluid and electrolyte balance, renal function, and perfusion status. Decreased urine output, also known as oliguria, may indicate that the kidneys are not functioning properly, which can be due to various factors including heart failure, where the heart is not pumping effectively and therefore renal blood flow might be compromised. In this scenario, there may be an acute concern for shock, indicated by the low blood pressure (70/45), confusion, and thirst, suggesting the patient may be in a hypovolemic state due to decreased blood flow leading to inadequate glomerular filtration and urine production.
Management would often involve ensuring hemodynamic stability through appropriate fluid management, possibly involving intravenous fluids or diuretics, depending on whether there is fluid overload or deficit. Monitoring of blood pressure, electrolytes, and renal parameters like blood urea nitrogen (BUN) and creatinine is critical to assess kidney function and guide treatment. Close monitoring for additional signs of heart failure exacerbation or complication is also crucial. In some cases, the use of vasopressors or inotropic agents might be indicated to support blood pressure and heart function. Consultation with a nephrologist might be necessary if there is significant concern for acute kidney injury.