After undergoing a cardiac catheterization, a patient has a large puddle of blood under his buttocks.
What should be the nurse’s priority action?

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.

Atrial fibrillation (AF) is characterized by disorganized electrical activity in the atria, resulting in an irregular and often rapid heart rate.

On an ECG, AF typically presents with absent P waves, irregular R-R intervals, and a rapid ventricular rate (usually >100 beats per minute).

However, the rhythm in the question does not display these characteristic features of AF.

Key features of AF that are absent in the rhythm include:

P waves: AF lacks identifiable P waves, while the rhythm in question may have discernible P waves, although they may be irregular or abnormal.

Regularity: AF is typically irregular, while the rhythm in question is chaotic and without any discernible pattern.

QRS complexes: AF usually has narrow QRS complexes, while the rhythm in question often has wide and bizarre QRS complexes. Choice B rationale:

Ventricular tachycardia (VT) is a rapid heart rhythm originating from the ventricles, with a rate typically exceeding 100 beats per minute.

On an ECG, VT typically presents with wide QRS complexes (>0.12 seconds), a regular or slightly irregular rhythm, and a rate often exceeding 150 beats per minute.

While the rhythm in question is rapid and may have wide QRS complexes, it lacks the regular or slightly irregular pattern often seen in VT.

Key features of VT that distinguish it from the rhythm in question include:

Regularity: VT often has a regular or slightly irregular pattern, while the rhythm in question is chaotic and without any discernible pattern.

QRS morphology: VT typically has monomorphic (uniform) QRS complexes, while the rhythm in question often has polymorphic (varying) QRS complexes.

Choice D rationale:

Premature ventricular contractions (PVCs) are extra heartbeats originating from the ventricles, interrupting the normal heart rhythm.

On an ECG, PVCs appear as early, wide QRS complexes that are often followed by a compensatory pause.

The rhythm in question does not exhibit the characteristic pattern of PVCs, which typically occur as isolated beats or short runs of beats interspersed within a normal rhythm.

Key features of PVCs that are absent in the rhythm include:

Isolation: PVCs typically occur as isolated beats or short runs of beats, while the rhythm in question is sustained and chaotic.

Compensatory pause: PVCs are often followed by a compensatory pause, which is not a feature of the rhythm in question.