A nurse working in the cardiac icu is caring for client with suspected left sided heart failure. For which clinical manifestation should the nurse assess for?

A) Women should start yearly mammograms at age 40:
Mammography is a key screening tool for breast cancer detection. According to guidelines from the American Cancer Society (ACS) and other leading health organizations, women should begin annual mammograms at age 40. This recommendation applies to average-risk women who are not showing any symptoms of breast cancer. Mammograms are effective in detecting early-stage breast cancer, which is crucial for better treatment outcomes.

B) Women should have a yearly clinical breast examination starting at age 50:
The clinical breast examination (CBE) is a physical exam performed by a healthcare provider to check for breast cancer. However, the recommendation is to have a clinical breast examination every 1-3 years for women in their 20s and 30s and annually for women 40 and older, not just beginning at age 50. It is not necessary to wait until age 50 to start yearly CBEs.

C) Clients should have fecal occult blood test every other year:
The fecal occult blood test (FOBT) is used to detect hidden blood in the stool, which may be a sign of colon cancer. However, this test is not typically performed every other year for all clients. The recommended schedule for colorectal cancer screening depends on risk factors. The American Cancer Society recommends annual FOBT or fecal immunochemical test (FIT) for clients over the age of 45 who are at average risk for colon cancer. More invasive tests, such as colonoscopy, are generally recommended for people at higher risk or after positive results from non-invasive tests like FOBT.

D) Clients should have a colonoscopy at age 40 and every 10 years thereafter:
The recommended age for the first colonoscopy is age 45 for individuals at average risk of colorectal cancer, not 40. Colonoscopies are typically performed every 10 years after the initial screening unless there are risk factors (e.g., family history, genetic conditions) that require earlier or more frequent screenings.

Unstable Supraventricular Tachycardia: Synchronized Cardioversion

Unstable Bradycardia: Transcutaneous Pacing

Ventricular Fibrillation: Defibrillation

Ventricular Tachycardia with No Pulse: Defibrillation

Unstable Atrial Flutter: Synchronized Cardioversion

Rationales:

Unstable Supraventricular Tachycardia – Synchronized Cardioversion:

Synchronized cardioversion delivers a timed electrical shock to the heart during the R wave, avoiding the vulnerable T wave, which minimizes the risk of inducing ventricular fibrillation. This intervention is preferred for unstable SVT unresponsive to medications, as it restores normal sinus rhythm effectively.

Unstable Bradycardia – Transcutaneous Pacing:

Transcutaneous pacing provides electrical impulses to stimulate the heart when intrinsic conduction is insufficient. It is the recommended treatment for symptomatic bradycardia that does not respond to medications, ensuring adequate cardiac output while awaiting more definitive treatment.

Ventricular Fibrillation – Defibrillation:

Defibrillation delivers an unsynchronized shock to depolarize the entire myocardium, allowing the heart to reset and resume an organized rhythm. It is the first-line intervention for ventricular fibrillation, as the chaotic electrical activity makes the heart incapable of pumping blood.

Ventricular Tachycardia with No Pulse – Defibrillation:

Pulseless ventricular tachycardia requires defibrillation, as the rhythm is life-threatening and the absence of a pulse indicates the heart is not effectively pumping. This unsynchronized shock interrupts the abnormal rhythm, allowing normal sinus rhythm to potentially resume.

Unstable Atrial Flutter – Synchronized Cardioversion:

Synchronized cardioversion is used for unstable atrial flutter to restore sinus rhythm by delivering a precisely timed electrical shock. It is effective when pharmacological measures have not worked or are inappropriate, especially in cases of hemodynamic instability.