Medical Surgical Myocardial Infarction #7

Question

The nurse is caring for a client with severe left ventricular dysfunction and understands the client is at risk for sudden cardiac death. The nurse anticipates which medical intervention?

Answers

  1. Insertion of an implantable cardioverter defibrillator
    • Rationale:

      This answer is correct because clients who have reduced left ventricular ejection fraction (LVEF) and dysfunction (especially if they experienced MI) are at increased risk of sudden cardiac death (SCD) related to lethal arrhythmias. Implantable cardioverter defibrillator (ICD) provides significant survival benefit since it monitors the heart rhythm, detects irregular heart rhythms, and delivers a shock, if needed.

  2. Insertion of an implantable atrial pacemaker
    • Rationale:

      This answer is not correct because an atrial pacemaker is not needed. Something that addresses the problems associated with a ventricular problem, including ventricular tachycardia or ventricular fibrillation, which are lethal arrhythmias that need to be shocked with a defibrillator. Therefore, an implantable cardioverter defibrillator (ICD) provides significant survival benefit since it monitors the heart rhythm, detects irregular heart rhythms, and delivers a shock, if needed.

  3. Administration of thrombolytic agents
    • Rationale:

      This answer is not correct because administration of thrombolytic agents is not indicated since the client does not have a known clot with left ventricular dysfunction. With left ventricular dysfunction, the left ventricle does not contract effectively enough to pump blood to perfuse the body and give adequate cardiac output. Clients who have reduced left ventricular ejection fraction (LVEF) and dysfunction (especially if they experienced MI) are at increased risk of sudden cardiac death (SCD) related to lethal arrhythmias. Therefore, an implantable cardioverter defibrillator (ICD) provides significant survival benefit since it monitors the heart rhythm, detects irregular heart rhythms, and delivers a shock, if needed.

  4. Cardioversion under light anesthesia
    • Rationale:

      This answer is not correct because cardioversion under light anesthesia is not a treatment for ventricular dysfunction and sudden cardiac death risk. Clients who have reduced left ventricular ejection fraction (LVEF) and dysfunction (especially if they experienced MI) are at increased risk of sudden cardiac death (SCD) related to lethal arrhythmias. Therefore, implantable cardioverter defibrillators (ICD) provide significant survival benefits since it monitors the heart rhythm, detects irregular heart rhythms, and delivers a shock, if needed.

Overview

A client with left ventricular dysfunction is at increased risk of sudden cardiac death related to lethal cardiac rhythms. Therefore, use of an implantable cardioverter defibrillator (ICD) provides significant survival benefit since it monitors the heart rhythm, detects irregular heart rhythms, and delivers a shock, if needed.

Explanation

Learning Outcomes

Left ventricular dysfunction is when the left ventricle does not contract effectively enough to pump blood to perfuse the body and give adequate cardiac output. Clients who have reduced left ventricular ejection fraction (LVEF) and dysfunction (especially if they experienced MI) are at increased risk of sudden cardiac death related to lethal cardiac rhythms. Therefore, use of an implantable cardioverter defibrillator (ICD) provides a significant survival benefit since it monitors the heart rhythm, detects irregular heart rhythms, and delivers a shock, if needed. Lethal arrhythmias the ICD would defibrillate include ventricular tachycardia and ventricular fibrillation.

Test Taking Tip

Understanding that the only thing to help avert death is defibrillation is important to remember.

Video Rationale