An older adult client’s assessment reveals the following data: Lying BP 144/82 mm Hg, sitting BP 121/69 mm Hg, standing BP 98/56 mm Hg. What nursing diagnosis should be identified in the client’s plan of care?

A rationale:

While a shellfish allergy is important information for the healthcare team to be aware of, it is not directly relevant to the cardiac angiogram procedure itself. Shellfish allergies typically involve reactions to iodine-containing contrast dyes, which are not commonly used in cardiac angiograms. The contrast dye used in cardiac angiograms is usually a gadolinium-based contrast agent, which has a different allergy profile.

It's essential to communicate any allergies to the healthcare team, but this information would not necessarily prompt an immediate notification to the physician in the context of a cardiac angiogram.

Choice B rationale:

The patient's last meal time is relevant for some procedures that require sedation or anesthesia, but it's not typically a major concern for a cardiac angiogram.

Patients are often instructed to have a light meal or snack several hours before the procedure, but an exact fasting time is not always necessary. Unless the physician has specifically ordered a strict fasting period for this patient, the nurse would not need to notify the physician immediately about a meal consumed the previous evening.

Choice C rationale:

This statement is the most concerning and would require immediate notification of the physician. Aspirin is a common antiplatelet medication that helps prevent blood clots. It's often prescribed to patients with heart disease to reduce the risk of heart attack and stroke.

Discontinuing aspirin therapy without medical guidance can increase the risk of blood clots, which could be dangerous during a cardiac angiogram. The procedure involves inserting a catheter into the heart's arteries, and there's a risk of clot formation during this process.

If a patient has not taken their aspirin as prescribed, the physician needs to be aware of this to assess the risks and benefits of proceeding with the angiogram and potentially consider alternative medications or interventions to manage the patient's clotting risk.

Choice D rationale:

Metformin is a medication used to treat type 2 diabetes. While it's important for patients to take their medications as prescribed, missing a single dose of metformin is not typically a major concern in the context of a cardiac angiogram.

The nurse would likely remind the patient to take their metformin as soon as possible, but this would not require immediate notification of the physician.

Choice A rationale:

Calling "all clear" once before discharging the defibrillator is crucial for safety, but it's not the primary action that ensures effective defibrillation.

The purpose of calling "all clear" is to alert everyone in the vicinity to stay clear of the patient and avoid accidental shock.

However, even with a clear announcement, it's essential for the nurse to visually confirm that no one is touching the patient or bed before discharging the defibrillator.

Choice B rationale:

Maintaining firm contact between the paddles and the client's skin is essential for delivering the defibrillation shock effectively.

Here's a detailed breakdown of why this contact is so critical:

Maximizes energy transfer: Firm contact minimizes the impedance (resistance) between the paddles and the skin, allowing for the maximum amount of electrical energy to be transferred to the heart.

Reduces arcing: Arcing occurs when electrical energy jumps through the air instead of passing through the intended path (between the paddles and the heart). This can cause skin burns and reduce the effectiveness of the shock. Firm contact helps prevent arcing by ensuring a direct connection.

Ensures consistent current flow: Consistent contact ensures that the electrical current flows evenly across the chest, reaching all areas of the heart muscle. This increases the likelihood of successful defibrillation.

Minimizes energy loss: Any gaps or poor contact between the paddles and skin can lead to energy loss, reducing the shock's strength and effectiveness.

Choice C rationale:

Sync mode (synchronized cardioversion) is used for specific heart rhythm disturbances, such as atrial fibrillation or atrial flutter, where the shock needs to be timed with the QRS complex on the ECG.

Ventricular fibrillation, however, is a chaotic rhythm without distinct QRS complexes, so sync mode is not appropriate.

Using sync mode in ventricular fibrillation could delay the shock and potentially decrease its effectiveness.

Choice D rationale:

Water is not an appropriate conducting agent for defibrillation.

It can actually increase the risk of burns and decrease the effectiveness of the shock.

Approved conducting agents, such as gel pads or paste, should be used to ensure optimal energy transfer and patient safety.