The nurse is caring for a client postoperatively after undergoing a coronary artery bypass graft. What intervention can the nurse provide to reduce the risk of the development of wound dehiscence?
A) Encourage oral fluids.
B) Assess lung sounds every 8 hours.
C) Suction the client every 2 hours.
D) Assist the client to splint with a pillow when coughing and deep breathing.
D
Feedback:
Instruct the client to press a pillow against the chest when deep breathing, coughing, and performing active exercise. Splinting promotes comfort and decreases the potential for dehiscence. Encouraging oral fluids will not prevent dehiscence. Lungs should be assessed every 4 hours or more frequently according to the client's condition. Suction should only be provided as needed.
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