Question

Group 2 Scenario:

C.L. is a 58-year-old female post op day 1 following coronary artery bypass graft (CABG). C.L. has a history of coronary heart disease and angina; she recently had a coronary angiogram, which indicated that she had several blocked coronary arteries. A traditional CABG was scheduled due to the finding of the angiogram.

C.L. is transferred to the ICU after surgery with mediastinal chest tubes. Hemodynamic monitoring lines are in place for the first day. After 4 hours the patient was extubated from the mechanical vent. The oncoming night shift nurse performs an assessment after receiving report; she notes the following vital signs: HR 108 and irregular, RR 18/min, BP 118/78, O2 sat 98% on 2L oxygen NC. The nurse assesses C.L.s rhythm and notes she is having periods of atrial fibrillation.

1. What are the manifestations of tamponade C.L. should be monitored for post op?
2. Post op CABG patients are at risk for sternal wound infection. What teaching would you provide to C.L. to prevent infection of her incision?
3. Besides wound infection and tamponade noted above, discuss the other complications should nurses monitor for with a post-op CABG patient?
4. Why is early ambulation important for C.L.?
5. The provider orders warfarin for the a-fib. What teaching points are appropriate for patients prescribed warfarin for a-fib?
6. Math practice question: The provider has prescribed nitroprusside 225mcg/min IV. The IV bag contains 100mg in 250mL of D5W. The patient weighs 190 pounds. What rate (mL/hr) should the IV pump be set to infuse this med? Show your calculation and round to nearest whole number.

Use Iggy as a scholarly reference and cite in APA format with page number(s) where information was accessed.

Answer 1

Manifestations of tamponade:

• tachycardia
• Tachypnea
• Dyspnea
• Oliguria
• hypotension
• Confusion
• Restlessness

C.L should be educated about

• Follow of hygienic measures
• Do not scratch on the wound site.
• Do not apply powder or lotions on the wound site.
• Maintain dryness on the incision site.
• Intake of protein-rich diet for early wound healing.

The nurse should monitor for complications

• Respiratory failure
• Myocardial dysfunction
• Pulmonary hypertension
• Renal failure
• Vasoplegia
• Pneumonia
• dysrhythmias

Early ambulation is necessary for C.L because

• It promotes blood circulation and prevents blood clotting.
• It increases oxygen flow and promotes wound healing.
• It improves the multi-system function and increases appetite.
• It improves coordination and muscle strength.
• It promotes self-esteem and gives way for discharge sooner.
• It minimizes the risk of complication.

The teaching points of warfarin include

• Warfarin is prescribed to prevent blood clots.
• The blood test of PT, INR should be checked periodically.
• The dose should be adjusted according to the INR level.
• The major side effect of warfarin is bleeding.
• Do not change or miss the dose.
• Avoid intake of vitamin K rich food.
• Avoid the intake of alcohol, grapefruit juice