A nurse admits a patient who is experiencing an exacerbation of heart failure. Drag and drop in order of priority actions.

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: Auscultating for irregular heart tones can provide useful information about the heart’s rhythm and potential arrhythmias. However, it is not the most specific or definitive assessment for diagnosing a myocardial infarction (MI).

Choice B reason: Assessing for ST elevations on continuous telemetry and 12-lead EKG is critical in diagnosing a myocardial infarction. ST-segment elevation is a key indicator of an acute MI, specifically indicating myocardial injury. Continuous telemetry and 12-lead EKG provide real-time and detailed views of the heart's electrical activity, helping to identify ischemic changes.

Choice C reason: Assessing for elevated Troponin levels is essential because Troponins are cardiac biomarkers that increase significantly when there is damage to the heart muscle, such as during an MI. Elevated Troponin levels are highly specific and sensitive indicators of myocardial infarction, making this assessment crucial.

Choice D reason: Assessing for low magnesium levels is not directly related to diagnosing a myocardial infarction. While magnesium levels are important for overall cardiac function, they do not specifically indicate an acute MI.

Choice E reason: Assessing the client's blood pressure is an important part of a comprehensive assessment and can provide information about the patient's hemodynamic status. However, it is not specific to diagnosing a myocardial infarction.

Choice F reason: Assessing if the pain radiates to the left arm is an important symptom of a myocardial infarction. However, while it supports the suspicion of an MI, it is not as definitive as ST elevation on an EKG or elevated Troponin levels.