The nurse is conducting patient teaching about cholesterol levels.

When discussing the patient’s elevated LDL and lowered HDL levels, which statement by the patient indicates an understanding of the significance of these levels?

Rationale for Choice A:

Monitoring the insertion site for hematoma and bleeding is crucial following cardiac angiogram with stent placement. Here's a detailed explanation:

Vascular Injury: The procedure involves accessing a major artery, usually the femoral artery in the groin. This creates a risk of bleeding or hematoma formation at the puncture site.

Anticoagulation: Patients often receive anticoagulant medications during and after the procedure to prevent blood clots from forming around the stent. These medications can increase the risk of bleeding.

Early Detection and Intervention: Prompt identification of bleeding or hematoma formation is essential to prevent complications such as hypotension, shock, or compartment syndrome.

Assessment: Regular assessment of the insertion site includes:

Visual inspection for swelling, bruising, or active bleeding.

Palpation for tenderness, firmness, or expanding hematoma.

Monitoring vital signs for tachycardia, hypotension, or signs of shock.

Interventions: If bleeding or hematoma is detected:

Apply direct pressure to the site.

Notify the healthcare provider immediately.

Implement additional measures as prescribed, such as reversal of anticoagulation or surgical intervention.

Rationale for Choice B:

Maintaining strict bedrest after cardiac angiogram with stent placement is no longer routinely recommended. Here's why:

Early Ambulation Benefits: Research has shown that early ambulation (usually within 6-8 hours) is associated with several benefits, including:

Reduced risk of deep vein thrombosis (DVT)

Improved circulation

Quicker recovery

Shorter hospital stays

Individualized Assessment: The decision regarding ambulation timing should be individualized based on patient factors such as:

Bleeding risk

Procedural complications

Overall health status

Comfort level

Balanced Approach: While early ambulation is encouraged, it's important to balance activity with rest to promote healing and prevent complications.

Rationale for Choice C:

Monitoring for dysrhythmias is essential following cardiac angiogram with stent placement due to several reasons:

Cardiac Irritation: The procedure involves manipulation of catheters and devices within the heart, which can potentially irritate the heart's electrical system.

Electrolyte Imbalances: Contrast dye used during the procedure can cause electrolyte imbalances, which can also trigger dysrhythmias.

Underlying Heart Disease: Patients undergoing angioplasty often have underlying heart disease, which already predisposes them to rhythm disturbances.

Early Detection and Intervention: Prompt identification of dysrhythmias allows for timely interventions to prevent hemodynamic instability, heart failure, or cardiac arrest.

Continuous Monitoring: Continuous ECG monitoring is typically used to detect dysrhythmias, and patients are closely observed for symptoms such as palpitations, lightheadedness, or chest pain.

Rationale for Choice D:

Assessing heart sounds is a crucial nursing intervention following cardiac angiogram with stent placement. Here's why:

Stent Placement Effects: The placement of a stent can alter blood flow patterns within the coronary arteries, which may be audible as changes in heart sounds.

Complication Detection: Heart sounds can provide valuable clues about potential complications such as:

Pericardial effusion (fluid around the heart)

Myocardial infarction (heart attack)

Valvular dysfunction

Baseline Assessment: It's important to establish a baseline assessment of heart sounds prior to the procedure to compare with post-procedure findings.

Regular Auscultation: Regular auscultation of heart sounds should be performed to monitor for changes and promptly report any concerns to the healthcare provider.

Choice A rationale:

Gently abrading the skin with dry gauze or cloth is not recommended prior to ECG electrode placement.

Research has shown that this practice can actually increase skin impedance and lead to poor signal quality.

It can also cause discomfort and skin irritation, particularly in patients with sensitive skin.

In some cases, it may even damage the skin, leading to infection.

Therefore, it is best to avoid abrading the skin before ECG electrode placement.

Choice B rationale:

Ensuring that the skin is dry is essential for optimal ECG signal quality.

Moisture on the skin can interfere with the electrical connection between the electrodes and the skin, leading to artifacts in the ECG tracing.

These artifacts can make it difficult to interpret the ECG and may even lead to misdiagnosis.

Therefore, it is important to dry the skin thoroughly before applying the electrodes. This can be done using a soft towel or cloth.

Choice C rationale:

Tincture of benzoin is a sticky substance that is sometimes used to improve the adhesion of electrodes to the skin.

However, it is not necessary for ECG electrode placement and can actually irritate the skin.

It is also important to note that tincture of benzoin is flammable and should not be used near open flames or electrical equipment.

Therefore, it is generally not recommended for use with ECG electrode placement.

Choice D rationale:

Povidone-iodine solution is an antiseptic that is used to cleanse the skin and reduce the risk of infection.

However, it is not necessary for ECG electrode placement and can actually interfere with the electrical connection between the electrodes and the skin.

Therefore, it is generally not recommended for use with ECG electrode placement.