A client who has anorexia nervosa (AN) with associated purging behaviors presents to the emergency department with dizziness and syncope. The client's vital signs are temperature 98.3° F (36.8° C), heart rate 52 beats/minute, respirations 21 breaths/minute, and blood pressure 79/41 mm Hg. A specimen for serum electrolyte levels is obtained with an electrocardiogram (ECG) pending. Which result should the nurse expect to see on the ECG?

Brief introduction:

Cardiac catheterization is an invasive diagnostic procedure used to evaluate coronary artery patency and intracardiac pressures. The introduction of catheters into the heart chambers can irritate the myocardium and conduction system, potentially triggering ectopic beats or lethal electrical instabilities during the immediate post-procedural recovery phase.

Rationale:

A. Maintaining NPO status until the return of bowel sounds is typically reserved for patients recovering from abdominal surgery involving general anesthesia. Since cardiac catheterization is performed under conscious sedation, the client can usually resume oral intake once they are fully awake and their gag reflex is confirmed.

B. Monitoring telemetry is a priority because the heart is highly irritable following mechanical stimulation from the catheter. The nurse must watch for PVCs, ventricular tachycardia, or conduction blocks that could result from myocardial trauma or contrast-induced changes in electrolyte balance within the cardiac myocytes.

C. Ambulating the client as soon as vital signs are stable is contraindicated due to the risk of arterial hemorrhage. To ensure the integrity of the femoral access site and prevent the formation of a hematoma or pseudoaneurysm, the client must remain on strict bedrest for 2 to 6 hours.

D. Applying a sequential compression device (SCD) to the affected leg is avoided because the limb must remain completely immobile. The pressure and movement associated with the inflation cycles of an SCD could disturb the fibrin plug at the puncture site, leading to significant retroperitoneal bleeding.

Brief introduction:

Preoperative anxiety is a common psychological response characterized by feelings of tension, apprehension, and autonomic nervous system activation before a surgical procedure. In the context of pain management, a client's emotional state can significantly impact their physiological perception of pain postoperatively. When a client expresses a total lack of coping confidence and exhibits emotional distress (crying), the nurse must prioritize the immediate psychological barrier that is interfering with the client’s wellbeing and readiness for surgery.

Rationale:

A. Acute pain is not the priority problem because the client is currently in the preoperative phase and is not yet experiencing physical pain from the procedure. While pain management is the topic of the session, the client’s current distress is a psychological reaction to a future event. Nursing care must address the existing emotional crisis before the physical pain occurs.

B. The client has just completed a teaching session, so the "Knowledge Deficit" has been addressed by the nurse. The crying and statements of inability to handle pain suggest that the issue is no longer a lack of information, but rather an emotional inability to process or accept the information provided. Simply providing more facts will not resolve the client's fear.

C. Anticipatory grieving involves the intellectual and emotional responses to a perceived loss (such as loss of a body part or function). While it can occur preoperatively, the client's specific statement about handling the pain points more directly toward fear of the unknown and distress regarding a specific symptom rather than a grief process related to loss.

D. Anxiety is the priority because the client is demonstrating an overwhelming emotional response to the upcoming surgery. Severe anxiety can lead to increased heart rate, elevated blood pressure, and a lower pain threshold postoperatively. Addressing the client's fears through therapeutic communication and reassurance is the most critical intervention to ensure a stable induction of anesthesia and a smoother recovery.