The nurse notes that a patient with a history of a myocardial infarction is straining during defecation. Which response by the nurse is best?
a. "Be careful, you might get a headache when you push so hard."
b. "It is important that you not strain because it could cause damage to your heart."
c. "Your blood pressure gets very low when you strain like that and you could faint."
d. "Chronic constipation often causes a dilated colon, so it is good that you are staying empty."
ANS: B
Straining to have a bowel movement (Valsalva's maneuver) can result in cardiac, neurological, and respiratory complications. If the patient has a history of heart failure, hypertension, or recent myocardial infarction, straining can lead to cardiac rupture and death. A. C. D. These responses are not appropriate for the patient with a history of myocardial infarction who is straining with a bowel movement.
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