A nurse is teaching a newly licensed nurse about reportable communicable diseases. Which of the following diseases should the nurse include in the teaching?

Rationale for Correct Choices:

• Pain level: The client is experiencing significant chest pain (7/10) radiating to the left arm, which is a classic sign of potential myocardial infarction (MI). Managing pain is the priority to reduce discomfort and prevent further cardiac stress while simultaneously stabilizing the patient.
• ECG results: The ECG findings of tachycardia with ST segment elevation and T wave changes indicate a possible acute myocardial infarction (STEMI). Immediate attention to the ECG results is critical for confirming the diagnosis and guiding the appropriate emergency interventions, such as the administration of thrombolytics or preparation for angioplasty.

Rationale for Incorrect Choices:

• Diaphoresis: Diaphoresis (excessive sweating) is a sign of myocardial infarction and should be addressed as part of the overall clinical assessment. However, addressing the pain and confirming the diagnosis with an ECG are more urgent initial steps.
• Nausea: Nausea is a common symptom in myocardial infarction, but it is not the immediate priority. Pain relief and stabilization of the heart's function should take precedence. Nausea can be managed after addressing the more critical issues.
• Cholesterol level: Elevated cholesterol levels, while important for long-term management of hyperlipidemia and cardiovascular risk, are not an immediate priority in this acute presentation.
• Pedal pulses: While weak pedal pulses are noted, they are not as urgent as managing the chest pain and confirming the diagnosis with an ECG. Pedal pulses can be monitored during ongoing assessment, furthermore the capillary refill is < 2 seconds indicating adequate perfusion.

Rationale:

A. Ventricular Tachycardia (VTach): Regular, very fast rhythm (150–250 bpm), Wide QRS complexes, No visible P waves. Interpretation: Life-threatening rhythm, not expected after pacemaker. Immediate intervention is needed.

B. Atrial Fibrillation (AFib): Irregularly irregular rhythm, No distinct P waves, Narrow QRS complexes. AFib can exist with or without a pacemaker, but not expected immediately post-insertion unless patient has pre-existing AFib.

C. Rhythm: Ventricular paced rhythm (normal post-pacemaker). Regular rhythm -60 bpm, Narrow QRS complexes following sharp pacing spikes, Pacing spikes appear just before QRS complexes. Expected ECG after permanent pacemaker insertion — it shows effective ventricular capture.

D. Irregular rhythm, Alternating normal and wide QRS complexes, Wide QRS possibly not preceded by pacing spike, not expected right after pacemaker insertion. Suggests poor pacer function or ventricular ectopy.