Question

The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first?

1) A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV
2) A client who received elective cardioversion 1 hour ago and whose heart rate (HR) is 115 bpm
3) A client diagnosed with new onset of atrial fibrillation, requiring scheduled IV diltiazem
4) A client returned from an electrophysiology procedure 2 hours ago, reporting constipation

Answer 1

The client whose ICD fired twice on the prior shift should be assessed first due to potential life-threatening arrhythmias, followed by the client with new onset atrial fibrillation, and then the client post-cardioversion. The client with constipation is the lowest priority.

Step-by-step explanation:

The nurse should assess the clients based on the urgency of their conditions. In this case, the priority should be given to:

1. Client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, as the ICD firing indicates a life-threatening arrhythmia that has recurred, which may require immediate intervention.
2. Client diagnosed with new onset of atrial fibrillation, requiring scheduled IV diltiazem, since atrial fibrillation can lead to significant hemodynamic instability and increase the risk for stroke.
3. Client who received elective cardioversion 1 hour ago and whose HR is 115 bpm, as this client may be stabilized but requires ongoing monitoring post-procedure to ensure the heart rate remains in the desired range.
4. Client returned from an electrophysiology procedure 2 hours ago reporting constipation, as this condition is not immediately life-threatening and can be addressed after more critical patients have been assessed.

Using a defibrillator delivers a large charge in a short burst to correct arrhythmias like ventricular fibrillation. An ICD is a device programmed to administer such shocks automatically when life-threatening arrhythmias are detected. Immediate nursing assessment is critical to detect any complications post ICD firing and to provide timely management, thus it prioritises the client with the ICD over others.