Reference no: EM133845131

Question

Ms. L is a 58-year-old female patient who is post-op day 1 after coronary artery bypass graft surgery (CABG). Ms. 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, ultimately necessitating the CABG. She spent the first day in the ICU after surgery and has just been transferred to the cardiac step-down unit where she is placed on telemetry. The nurse admitting Ms. L to the unit performs an assessment after receiving report; she notes the following vital signs: HR 108 bpm and irregular, RR 18/ minute, BP 118/ 78 mmHg, O2 sat 98% on 1L O2 per nasal prongs. After connecting Ms. L to telemetry, the tech notes that she has an abnormal cardiac rhythm.

Upon assessment of the cardiac monitor, the nurse notes that Ms. L is having periods of atrial fibrillation.

1. Discuss the potential for development of atrial fibrillation during the post-op period after CABG.

2. What measures would the nurse take that would prevent this patient from developing atrial fibrillation?

The nurse notifies the physician about Ms. L's condition and receives an order for 4mg warfarin. After giving the medication, the nurse continues to monitor the patient's cardiac rhythms with her assessments.

3. What is the purpose of administering warfarin to a patient with atrial fibrillation?

4. In addition to regular hemodynamic monitoring of the patient's cardiac status, what other tests or measures should the nurse monitor while the patient receives warfarin therapy?

Ms. L remains on the same amount of O2 per nasal cannula but has been unable to wean to a lesser amount. Each time the nursing staff try to decrease the amount of oxygen, the patient's saturations drop to between 86 and 89 percent. The nurse has given Ms. L a nursing diagnosis of Ineffective Airway Clearance related to her inability to wean from supplemental oxygen.

5. What are the most appropriate interventions the nurse would employ with this nursing diagnosis?

6. Describe atelectasis and its effects on respiratory patterns during the post-op period.

The nurse recognizes that Ms. L is having complications because she has avoided getting out of bed or participating in any activities. Each time the nurse tries to get Ms. L to sit up on the edge of the bed, she states that she is in too much pain to move.

7. Describe the potential complications that this particular patient is at risk for because of immobility.

8. How would the nurse intervene to increase the patient's mobility and so avoid some potential complications?

9. Provide three other examples of nursing diagnoses for Ms. L that are related to her condition.