The nurse is caring for a client who had a central venous catheter placed in the right subclavian vein. Approximately 30 minutes after placement the client has become increasingly restless, has jugular vein distention, and a heart rate of 120 beats per minute. The nurse would assess for which possible complication?

A) Administer antiplatelet and anticoagulant medications to prevent further clot formation:
While antiplatelet and anticoagulant medications are essential in the management of STEMI to reduce the risk of further clot formation, they are not the primary goal of treatment in the immediate phase. These medications are typically administered before or during the procedure (such as during cardiac catheterization) to prevent new clots, but the primary objective is to restore blood flow to the heart muscle through reperfusion therapy, either by angioplasty or thrombolytics.

B) Relieve the blockage in the coronary artery and restore blood flow to the heart muscle:
This is the primary goal of treatment in STEMI. The most urgent intervention for a client with an ST elevation myocardial infarction (STEMI) is to relieve the blockage in the coronary artery and restore blood flow to the ischemic heart muscle. This is typically achieved through percutaneous coronary intervention (PCI) via cardiac catheterization, which involves either angioplasty (ballooning the artery) or stent placement. Restoring blood flow as quickly as possible reduces the extent of myocardial damage, improves the prognosis, and prevents complications like heart failure.

C) Provide pain relief and initiate cardiac rehabilitation:
Pain relief is important in the initial management of STEMI, typically with nitroglycerin and opioids for chest pain. However, the immediate goal in the ED is to address the underlying cause of the chest pain, which is the blockage of blood flow. Cardiac rehabilitation, while essential for long-term recovery, is not the immediate goal of treatment during the acute phase of a STEMI. The primary focus should be on restoring circulation to the affected myocardium.

D) Stabilize the client's blood pressure and administer thrombolytic therapy:
Stabilizing the client’s blood pressure is important, especially if the client is hypotensive, but it is not the main treatment goal. Thrombolytic therapy (clot-busting medications) is an option if PCI is not available or if it needs to be done within a certain time frame; however, the current best practice in STEMI is to perform PCI as soon as possible. Thrombolytics are typically used when PCI is not immediately available, but the ideal treatment is to restore blood flow through catheterization in a timely manner, as it is more effective than thrombolytic therapy at re-opening the blocked artery.

A. Speak slow and loud so that the client can understand speech:

While speaking slowly and clearly may help with communication in some patients with ALS, this approach is less effective as the disease progresses. As ALS advances, speech muscles become affected, and the client may be unable to speak at all, making this method inappropriate for end-stage ALS. Simply speaking louder does not address the communication needs of a client who can no longer use their voice.

B. Encourage the client to write questions on a white erase board:

While writing on a whiteboard may be an effective communication strategy in the early stages of ALS when the client still has adequate hand function, this becomes increasingly difficult as muscle weakness progresses. By the end-stage, clients may lose the ability to hold a pen or write legibly, making this method less viable as the disease advances. It is not the best option for clients with significant motor impairment.

C. Use pre-arranged eye signals because eye muscles remain intact: In clients with end-stage amyotrophic lateral sclerosis (ALS), muscle weakness and loss of voluntary control progressively affect motor functions, including the ability to speak, write, and move. However, the eye muscles are typically preserved until the later stages of the disease, allowing patients to communicate through eye movements. Pre-arranged eye signals, such as blinking for "yes" or "no" or using a system of eye movements to select letters or words, are effective ways to facilitate communication with clients who can no longer speak or write. This method respects the client's remaining abilities and allows for more effective communication, especially as the disease progresses to its final stages.

D. Have the client squeeze the nurse's hand when intubated and on the ventilator:

When a client is intubated and on a ventilator, their ability to squeeze the nurse's hand may be limited due to the sedation and ventilator settings, and they may not have sufficient motor control to respond consistently. Additionally, when intubated, respiratory effort is controlled by the ventilator, so relying on hand squeezing would not be an effective or reliable method of communication. Furthermore, ALS patients in the later stages may not have enough muscle control for this method to be practical.