When a patient is undergoing synchronized cardioversion, the nurse recognizes that cardioversion currents are synchronized with what part of the patient's ECG?

A. Loss of bowel control: Loss of bowel or bladder control is a late sign of spinal cord compression. Compression of sacral nerve roots impairs autonomic function, making this a critical symptom to assess and report immediately.

B. Sharp thoracic back pain: Localized, severe, or sharp back pain, especially in the thoracic region, is often the earliest symptom of spinal cord compression. It may worsen with movement or coughing and signals pressure on vertebral or spinal structures.

C. Inability to move arms: Arm paralysis occurs only if cervical spinal cord levels are affected. In metastatic cancer, compression is most commonly thoracic or lumbar, so upper extremity motor loss is less typical and not a consistent finding unless the lesion is cervical.

D. Progressive muscle weakness in legs: Weakness in the lower extremities is a hallmark early manifestation of thoracic or lumbar spinal cord compression. It typically progresses gradually, reflecting motor pathway involvement.

E. Paresthesia in lower extremities: Sensory changes, such as numbness, tingling, or burning sensations in the legs, occur as the spinal cord or nerve roots are compressed. Early recognition helps prevent permanent neurologic deficits.

A. Administer opioid analgesics every 4 hours: Opioids can reduce pain but do not address the positional component of pericardial pain, which often worsens with lying supine or deep inspiration. Opioids may be considered if NSAIDs or positioning strategies are insufficient, but they are not the first-line intervention for pain specifically caused by pericardial inflammation.

B. Increase fluid intake to reduce inflammation: While maintaining hydration is generally important, increasing fluid intake does not directly reduce pericardial inflammation or relieve the acute chest pain associated with pericarditis. This action has minimal impact on the patient’s immediate discomfort.

C. Place the patient in Fowler's position, leaning forward: Leaning forward and sitting upright relieves pericardial pain by decreasing pressure on the inflamed pericardial sac and reducing friction between pericardial layers. This position is a non-pharmacologic, evidence-based intervention specifically effective in alleviating pericarditis-related chest pain.

D. Encourage the patient to take deep, slow breaths: Deep breathing may exacerbate pericarditis pain because chest expansion increases friction of the inflamed pericardial layers. While breathing exercises are generally useful in other conditions, they are not recommended as a primary strategy for acute pericarditis pain relief.