A patient is scheduled for catheter ablation therapy.

When describing this procedure to the patient’s family, what aspect of the treatment should the nurse address?

Choice A rationale:

Sinus bradycardia with a heart rate of 48 is a potentially life-threatening condition that requires immediate assessment and intervention. The heart rate is significantly below the normal range of 60-100 beats per minute, which means that the heart is not pumping enough blood to meet the body's needs. This can lead to symptoms such as dizziness, lightheadedness, fatigue, shortness of breath, chest pain, and even syncope (fainting). In severe cases, it can progress to cardiac arrest and death.

The patient is awaiting pacemaker placement, indicating that the bradycardia is severe and not responding to other treatment measures. This further underscores the urgency of assessment and intervention.

The nurse needs to assess the patient immediately for signs of hemodynamic instability, such as hypotension, altered mental status, and decreased urine output. The nurse should also obtain a 12-lead ECG to confirm the diagnosis of sinus bradycardia and to rule out other potential causes of the bradycardia, such as AV block or medication effects.

Prompt intervention is crucial to prevent further deterioration of the patient's condition and to avoid potentially lifethreatening complications.

Choice B rationale:

Atrial fibrillation is a common heart rhythm disorder that is characterized by rapid and irregular beating of the heart's upper chambers (atria). It can cause symptoms such as palpitations, shortness of breath, fatigue, and lightheadedness.

Diltiazem is a calcium channel blocker that is often used to control the heart rate in patients with atrial fibrillation. While it is important to monitor patients who are newly started on diltiazem for potential side effects, such as hypotension and bradycardia, it is not as urgent as assessing a patient with severe sinus bradycardia.

Choice C rationale:

Thrombophlebitis is an inflammation of a vein that is often caused by a blood clot. It can cause pain, redness, swelling, and warmth in the affected area.

IV heparin is an anticoagulant medication that is used to prevent blood clots from forming or getting larger. While it is important to monitor patients who are receiving IV heparin for potential side effects, such as bleeding, it is not as urgent as assessing a patient with severe sinus bradycardia.

Choice D rationale:

End-stage, right-sided heart failure is a serious condition that is characterized by the inability of the heart to pump blood effectively from the right ventricle to the lungs. It can cause symptoms such as shortness of breath, fatigue, edema, and abdominal swelling.

Hospice care is a type of care that focuses on providing comfort and quality of life for patients who are nearing the end of life. While it is important to provide supportive care for patients who are on hospice care, it is not as urgent as assessing a patient with severe sinus bradycardia.

Choice A rationale:

Calling "all clear" once before discharging the defibrillator is crucial for safety, but it's not the primary action that ensures effective defibrillation.

The purpose of calling "all clear" is to alert everyone in the vicinity to stay clear of the patient and avoid accidental shock.

However, even with a clear announcement, it's essential for the nurse to visually confirm that no one is touching the patient or bed before discharging the defibrillator.

Choice B rationale:

Maintaining firm contact between the paddles and the client's skin is essential for delivering the defibrillation shock effectively.

Here's a detailed breakdown of why this contact is so critical:

Maximizes energy transfer: Firm contact minimizes the impedance (resistance) between the paddles and the skin, allowing for the maximum amount of electrical energy to be transferred to the heart.

Reduces arcing: Arcing occurs when electrical energy jumps through the air instead of passing through the intended path (between the paddles and the heart). This can cause skin burns and reduce the effectiveness of the shock. Firm contact helps prevent arcing by ensuring a direct connection.

Ensures consistent current flow: Consistent contact ensures that the electrical current flows evenly across the chest, reaching all areas of the heart muscle. This increases the likelihood of successful defibrillation.

Minimizes energy loss: Any gaps or poor contact between the paddles and skin can lead to energy loss, reducing the shock's strength and effectiveness.

Choice C rationale:

Sync mode (synchronized cardioversion) is used for specific heart rhythm disturbances, such as atrial fibrillation or atrial flutter, where the shock needs to be timed with the QRS complex on the ECG.

Ventricular fibrillation, however, is a chaotic rhythm without distinct QRS complexes, so sync mode is not appropriate.

Using sync mode in ventricular fibrillation could delay the shock and potentially decrease its effectiveness.

Choice D rationale:

Water is not an appropriate conducting agent for defibrillation.

It can actually increase the risk of burns and decrease the effectiveness of the shock.

Approved conducting agents, such as gel pads or paste, should be used to ensure optimal energy transfer and patient safety.