A nurse is assessing a client's ECG strip and notes an irregular heart rate of 98/min with no clear P waves. Which of the following cardiac dysrhythmias should the nurse document?

Rationale:

• Troponin I level: An elevated troponin I level indicates myocardial cell injury and is a key diagnostic marker for MI. Even a value at the upper limit of normal (0.03 ng/mL) warrants concern, especially with accompanying symptoms.
• ECG result – sinus tachycardia: Sinus tachycardia is nonspecific but may occur in both MI and angina due to pain, anxiety, or sympathetic stimulation. However, more definitive MI-related changes like ST elevation or Q waves would provide clearer diagnostic value.
• Heart rate: A heart rate of 116/min is elevated and may represent the body’s response to pain, hypoxia, or stress. This can be seen in both angina and MI, though persistent or worsening tachycardia in MI may indicate hemodynamic instability.
• Heart palpitations: Palpitations are common during episodes of angina and are often due to increased sympathetic tone or transient arrhythmias. They are usually mild and resolve with rest or nitroglycerin in stable angina.
• Blood pressure: A blood pressure of 158/92 mm Hg indicates hypertension, a known trigger and risk factor for angina. Elevated BP increases myocardial oxygen demand, potentially precipitating chest pain in those with coronary artery disease.

Rationale:
A. "I can resume sexual intercourse in 48 hours.": Sexual intercourse should be avoided for approximately 3 to 4 weeks after a LEEP to allow proper healing of the cervix and reduce the risk of infection or bleeding. Resuming sexual activity too soon can disrupt tissue recovery.

B. "I can expect some heavy vaginal bleeding for 24 hours.": Heavy vaginal bleeding is not expected after a LEEP and should be reported promptly. Light spotting or a brownish discharge for a few days is normal, but significant bleeding can indicate complications.

C. "I can use tampons when my period comes in a week.": Clients are advised to avoid inserting anything into the vagina, including tampons, for several weeks post-procedure. This helps prevent infection and allows the cervical tissue to heal fully.

D. "I may have mild cramping for several hours.": Mild cramping for a few hours after the procedure is a common and expected response due to cervical manipulation. This symptom typically resolves on its own or with over-the-counter pain relief.