A nurse is teaching a client who has acute pericarditis.
Which of the following statements should the nurse include in the client teaching to explain the cause of pericarditis?

Choice A rationale

This client is the highest priority due to significant cardiovascular instability evidenced by the implantable cardioverter defibrillator firing twice. This indicates the client experienced life-threatening ventricular arrhythmias, such as ventricular tachycardia or fibrillation, within the last shift. The administration of amiodarone, a Class III antiarrhythmic, further highlights the severity of the irritability in the ventricular myocardium. The nurse must assess for continued arrhythmias, electrolyte imbalances like potassium 3.5 to 5.0 mEq/L, and signs of decreased cardiac output.

Choice B rationale

New onset atrial fibrillation requires medical management to control the ventricular rate and prevent thromboembolism, but it is generally less immediately life-threatening than recurring ventricular arrhythmias. Scheduled IV diltiazem is a calcium channel blocker used for rate control. While the client needs assessment for hemodynamic stability and a heart rate usually kept below 100 beats per minute, they do not take precedence over a client whose heart recently required internal shocks to maintain a rhythm.

Choice C rationale

A client who is 2 hours post-electrophysiology procedure reporting constipation is the lowest priority. While post-procedure assessments are important to check the insertion site for hematoma or hemorrhage and peripheral pulses, a complaint of constipation is a non-urgent gastrointestinal issue. It does not indicate a compromise in the ABCs (Airway, Breathing, Circulation) or a complication of the cardiac procedure itself. This can be addressed after the unstable cardiac clients have been thoroughly assessed and stabilized.

Choice D rationale

Elective cardioversion is a controlled procedure used to restore a normal sinus rhythm. A heart rate of 115 beats per minute 1 hour post-procedure indicates tachycardia, which may mean the procedure was unsuccessful or that the client is experiencing anxiety or pain. While this requires follow-up assessment and potentially further intervention, the client is currently more stable than the client in Choice A, whose device had to fire autonomously to prevent sudden cardiac death from a ventricular rhythm.

Choice A rationale

Excessive stretching of the ventricles and impaired cardiac contraction are hallmarks of heart failure, specifically systolic dysfunction. This relates to the heart's ability to pump blood to the systemic circulation rather than an intrinsic problem within the peripheral arteries themselves. Peripheral arterial disease focuses on the conduit vessels rather than the central pump. Normal ejection fraction ranges from 55.

Choice B rationale

Peripheral arterial disease is primarily caused by atherosclerosis, where fatty deposits and calcium build up in the arterial walls. This narrowing reduces the diameter of the vessel, limiting the delivery of oxygenated blood to distal tissues, especially during exercise. This mismatch between oxygen supply and demand leads to ischemia and symptoms like intermittent claudication. Clinical findings often include diminished pedal pulses, cool skin temperature, and delayed capillary refill exceeding three seconds in the extremities.

Choice C rationale

Incompetent valves and increased venous pressure are the underlying mechanisms for chronic venous insufficiency, not arterial disease. In the venous system, valves prevent the backflow of blood as it returns to the heart. When these valves fail, blood moves backward and increases hydrostatic pressure, leading to edema and skin changes. This process involves the return of deoxygenated blood, whereas arterial disease involves the delivery of oxygenated blood to the tissues through the high-pressure system.

Choice D rationale

Blood pooling in the legs is a characteristic of venous stasis, often resulting from varicose veins or deep vein thrombosis. In arterial disease, the problem is a lack of blood reaching the lower extremities due to proximal obstructions. Pooling causes a dark, ruddy discoloration and significant edema, while arterial insufficiency typically results in pallor when the legs are elevated and rubor when they are dependent. The pathophysiology of pooling is entirely related to the low-pressure venous return system.