A nurse is providing discharge teaching for a client who had a partial colectomy 2 days ago. Which of the following information should the nurse include in the teaching?

Anticipated:

• Metoprolol 5 mg every 2 to 3 min up to three doses
• Oxygen at 2 L/min via nasal cannula
• Draw electrolytes along with Hgb and Hct
• Morphine 6 mg IV bolus every 3 hr as needed for pain
• Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses

Nonessential:

• Obtain daily weight

Contraindicated:

• Atropine 0.5 mg IV bolus every 5 min up to 2 mg

Rationale:

• Metoprolol 5 mg every 2 to 3 min up to three doses: Beta-blockers reduce myocardial oxygen demand by decreasing heart rate and blood pressure, making them beneficial in acute coronary syndrome. They should be used cautiously in patients with signs of heart failure or bradycardia.
• Oxygen at 2 L/min via nasal cannula: Supplemental oxygen is recommended for clients with acute coronary syndrome when oxygen saturation is below 94% to optimize myocardial oxygen supply and prevent ischemia.
• Draw electrolytes along with Hgb and Hct: Electrolytes are critical in evaluating myocardial function, and hemoglobin/hematocrit levels help assess perfusion and oxygen-carrying capacity.
• Morphine 6 mg IV bolus every 3 hr as needed for pain: Morphine is used to relieve severe chest pain in myocardial infarction and reduce myocardial oxygen demand by decreasing anxiety and preload.
• Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses: Nitroglycerin dilates coronary arteries, improving oxygen delivery to the myocardium, and reduces preload and afterload, alleviating chest pain. It is a first-line treatment for angina and myocardial infarction but should be avoided in cases of hypotension.
• Obtain daily weight: Daily weight monitoring is primarily used for fluid balance assessment in conditions like heart failure rather than for acute myocardial infarction management.
• Atropine 0.5 mg IV bolus every 5 min up to 2 mg: Atropine is used to treat bradycardia. However, the client is tachycardic, so atropine would worsen the condition and is contraindicated.

A. Asystole: Synchronized cardioversion is ineffective for asystole because there is no electrical activity to reset. The appropriate intervention for asystole is immediate CPR and administration of epinephrine.

B. Ventricular fibrillation: Defibrillation, not synchronized cardioversion, is the appropriate treatment for ventricular fibrillation because it is a pulseless, chaotic rhythm that requires immediate high-energy shocks.

C. Pulseless ventricular tachycardia: Pulseless ventricular tachycardia is treated with defibrillation rather than synchronized cardioversion, as there is no coordinated cardiac activity to synchronize with. CPR and advanced cardiac life support (ACLS) protocols should be initiated.

D. Atrial fibrillation: Synchronized cardioversion is indicated for atrial fibrillation, particularly when it is associated with hemodynamic instability. Cardioversion helps restore a normal sinus rhythm by delivering a shock synchronized to the R wave of the QRS complex.