A nurse is caring for two patients who had a coronary artery stent placed yesterday.
What medication should the nurse expect to administer based on the patients’ daily medication administration record?

Choice A rationale:

Bleeding is a concern due to the recent surgery and heparin therapy, which can increase bleeding risk. However, wound dehiscence (wound separation) is less likely in a percutaneous insertion compared to open surgery.

Percutaneous insertion involves a smaller incision and less tissue disruption, reducing the chances of wound dehiscence.

While monitoring for bleeding is crucial, wound dehiscence may not be the most immediate concern in this specific scenario.

Choice B rationale:

Wound dehiscence and evisceration (protrusion of internal organs) are serious complications, but they are less likely to occur with percutaneous insertion compared to open surgery.

The smaller incision and minimal tissue disruption in percutaneous insertion lower the risk of these complications.

While vigilance for wound complications is essential, the priority in this case lies with bleeding and infection.

Choice C rationale:

Thrombosis (blood clot formation) is a potential complication of IVC filter placement, but it's not typically associated with the surgical site itself.

Infection is a concern for any surgical procedure, but it's not the most immediate risk in this scenario given the emphasis on bleeding and the patient's recent heparin therapy.

Choice D rationale:

Bleeding:

Heparin therapy, a blood thinner, increases the risk of bleeding.

The surgical site is a potential area for bleeding, as it involves disruption of blood vessels.

Meticulous monitoring for bleeding is essential to ensure prompt intervention if it occurs.

Infection:

Any surgical procedure carries a risk of infection.

The surgical site is a potential entry point for bacteria.

Close observation for signs of infection, such as redness, swelling, warmth, or drainage, is crucial for early detection and treatment.

Choice A rationale:

Increased afterload refers to the resistance against which the heart must pump to eject blood into the aorta. While increased afterload can contribute to chest pain in certain conditions like aortic stenosis, it's not the primary cause of angina.

Angina is typically triggered by exertion or emotional stress, which increase myocardial oxygen demand. Increased afterload doesn't directly cause this imbalance in oxygen supply and demand, making it less likely to be the primary driver of angina pain.

Choice B rationale:

Inadequate myocardial oxygenation is a key concept in understanding angina, but it's not the most precise answer to the patient's question about the cause of their pain.

It's important to explain the underlying reason for the inadequate oxygenation, which is coronary artery disease.

Choice C rationale:

Coronary artery disease (CAD) is the most common cause of angina. It's characterized by narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle.

When the heart's demand for oxygen exceeds the supply available through the narrowed arteries, it experiences ischemia (lack of oxygen), leading to the characteristic chest pain of angina.

This explanation directly addresses the patient's question about the cause of their pain, linking the symptom to the underlying disease process. Choice D rationale:

Increased preload refers to the amount of blood filling the ventricles before they contract. While increased preload can contribute to heart failure and pulmonary edema, it's not typically a direct cause of angina.