Influenza B

A nurse is caring for a 45-year-old female client in the medical-surgical unit who was admitted with a 2-day history of headache, muscle aches, fever, sore throat, and fatigue, and a throat culture positive for influenza B.

Based on the information in the EHR, which of the following actions should the nurse take? Select all that apply.

Choice A rationale

Aspirin exhibits analgesic properties by inhibiting prostaglandin synthesis, primarily through irreversible acetylation of cyclooxygenase enzymes (COX-1 and COX-2). This reduces the perception of pain stimuli. However, for a client with a history of MI, its primary therapeutic benefit extends beyond pain relief.

Choice B rationale

Aspirin acts as an anti-inflammatory agent by inhibiting prostaglandin production, which are key mediators of inflammation. This reduces vasodilation, increased vascular permeability, and leukocyte infiltration at sites of inflammation. While aspirin has anti-inflammatory effects, it's not the primary reason for its prescription in MI prevention.

Choice C rationale

Aspirin's antiplatelet aggregate action is crucial in MI prevention. It irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets, thereby preventing the synthesis of thromboxane A2 (TXA2). TXA2 is a potent vasoconstrictor and platelet aggregator, so its inhibition reduces the risk of clot formation in coronary arteries. This is the primary reason for its use in MI.

Choice D rationale

Aspirin possesses antipyretic effects by inhibiting prostaglandin E2 synthesis in the hypothalamus, which helps to reset the body's thermoregulatory set point during fever. While this is a known effect of aspirin, it is not the primary indication for its use in a client with a history of myocardial infarction.

Choice A rationale

Atrial fibrillation is characterized by an irregularly irregular rhythm, absence of discernible P waves (often replaced by fibrillatory waves), and an unmeasurable PR interval due to disorganized atrial activity. The QRS duration is typically normal if ventricular conduction is intact. The given ECG findings of irregular rhythm, absent P waves, and unmeasurable PR interval are classic for atrial fibrillation.

Choice B rationale

Sinus bradycardia is characterized by a regular rhythm with a heart rate below 60 beats per minute, distinct P waves preceding each QRS complex, a measurable and normal PR interval (0.12-0.20 seconds), and a normal QRS duration (0.06-0.12 seconds). The given heart rate of 92/min and irregular rhythm contradict this interpretation.

Choice C rationale

Supraventricular tachycardia (SVT) typically presents with a regular, rapid heart rate (often 150-250 beats per minute), often with P waves buried within or immediately after the QRS complex, making them difficult to identify or measure. The QRS duration is usually normal. While P waves might be indiscernible, the irregular rhythm and a heart rate of 92/min are not typical for SVT.

Choice D rationale

First-degree heart block is characterized by a regular rhythm, a P wave preceding every QRS complex, and a prolonged but consistent PR interval (greater than 0.20 seconds), with a normal QRS duration. The key diagnostic feature is the prolonged PR interval, which is unmeasurable in the given scenario due to absent P waves.