An older female adult had coronary bypass graft surgery (CABG) 1 day ago. Which com-plication from immobility is the nurse's priority to prevent because of the type of surgery she had?
a. Pneumonia
b. Depression
c. Dehydration
d. Hypothermia
A
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A Correct. Pneumonia is the priority preventive issue for the nurse because of the patient's immobility. After CABG, female adults need to wear a bra or breast binder to prevent excessive pressure on the sternal wound from the weight of the breasts. A breast binder, and potentially a bra, can contribute to restricted di-aphragmatic excursion in an individual with limited mobility, leading to atelec-tasis and pneumonia. Immobility contributes to atelectasis and pneumonia be-cause it limits diaphragmatic excursion and promotes fluid accumulation in lungs; thus the nurse recognizes the importance of progressing this postoperative older female adult from bed rest to ambulation to promote mobilization of pul-monary secretions and chest expansion for coughing and deep breathing.
B Incorrect. Depression is a common postoperative characteristic of older adults after CABG, and it is a complication of immobility. However, mood disorders are second in importance to issues relating to breathing.
C Incorrect. Dehydration is a complication of immobility, but usually patients are hypervolemic on the first postoperative day after CABG.
D Incorrect. Although hypothermia is used during CABG, the patients are re-warmed in the immediate postoperative period; thus, this individual's tempera-ture should be normal.
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