A nurse assesses a patient in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure?

Choice A reason: Complete bedrest for the duration of the treatment with subcutaneous enoxaparin is not the best approach for managing infective endocarditis. While bed rest may be recommended initially to reduce cardiac workload, long-term bed rest is not necessary and could lead to complications such as muscle atrophy or thromboembolism. Subcutaneous enoxaparin is used for prophylaxis against deep vein thrombosis, but it does not address the underlying infection.

Choice B reason: Long-term anticoagulant therapy with IV heparin followed by oral warfarin is not the standard treatment for infective endocarditis. Although anticoagulant therapy may be necessary in some cases, such as for patients with prosthetic valves or specific cardiac conditions, it is not the primary treatment for the infection itself. The focus should be on eradicating the infection with appropriate antibiotics.

Choice C reason: Administration of IV penicillin, followed by oral penicillin for 10 weeks, is not the typical treatment regimen for infective endocarditis. While penicillin may be part of the antibiotic therapy, the duration and route of administration need to be tailored to the specific causative organism and the patient's clinical condition. Usually, a combination of antibiotics and a specific treatment plan is developed based on culture and sensitivity results.

Choice D reason: Hospitalization for initial IV antibiotics, followed by continued IV antibiotics at home, is the best treatment approach for a client newly diagnosed with infective endocarditis. This allows for intensive management and monitoring during the critical initial phase of treatment, ensuring that the infection is adequately controlled. Transitioning to continued IV antibiotics at home provides the necessary long-term therapy while allowing the patient to recover in a familiar environment. This approach ensures compliance with the treatment regimen and reduces the risk of complications.

Choice A reason: Avoiding straining while having a bowel movement is important for patients with a low heart rate. Straining can stimulate the vagus nerve, which can lead to further bradycardia (slowing of the heart rate). By avoiding straining, patients can prevent additional vagal stimulation and help maintain a stable heart rate.

Choice B reason: Limiting the intake of caffeinated drinks to one a day is not directly related to avoiding further slowing of the heart rate. While excessive caffeine can have effects on heart rhythm and overall cardiovascular health, moderate caffeine intake is not typically associated with a significant risk of bradycardia.

Choice C reason: Ensuring that bath water is warm is not directly related to preventing further slowing of the heart rate. While warm water can promote relaxation and comfort, it does not have a direct impact on heart rate management for individuals with bradycardia.

Choice D reason: Modifying strenuous exercise such as running is a good general recommendation for individuals with heart conditions, but it is not specifically targeted at preventing further bradycardia. Exercise modification is more relevant for managing overall cardiovascular health and preventing tachycardia (increased heart rate).