The patient is 12 hours postoperative for a CABG. The patient's vital signs include: T 103° F, HR 112, RR 22, BP 134/78 mm Hg, and O2 sat 94% on 3L/NC. The nurse suspects that the patient has developed
a. infection and notifies the physician immediately.
b. infection, which is common postoperatively, and monitors the patient's condition.
c. cardiac tamponade and notifies the physician immediately.
d. delirium caused by the elevated temperature.
A
Postoperative fever is fairly common after cardiopulmonary bypass. However, persistent temperature elevation to greater than 101° F (38.3° C) must be investigated. Sternal wound infections and infective endocarditis are the most devastating infectious complications, but leg wound infections, pneumonia, and urinary tract infections also can occur. A potentially lethal complication, cardiac tamponade may occur after surgery if blood accumulates in the mediastinal space, impairing the heart's ability to pump. Signs of tamponade include elevated and equalized filling pressures (e.g., central venous pressure, pulmonary artery diastolic pressure, pulmonary artery occlusion pressure), decreased cardiac output, decreased blood pressure, jugular venous distention, pulsus paradoxus, muffled heart sounds, sudden cessation of chest tube drainage, and a widened cardiac silhouette on radiographs. The risk of delirium is increased in cardiac surgery patients, especially elderly patients, and is associated with increased mortality rates
and reduced quality of life and cognitive function. Nursing staff can play a critical role in the prevention and recognition of delirium.
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