Pt post CABG changed in mental status

  1. [font='times new roman']hi. i'm a nurse tech at a cardiac hospital. yesterday, a pt, 50 years old, was transferred from icu to our unit post cabg three days ago. the pt is ao x3, but i saw him getting out of bed with his sequential teds on and nasal cannula, trying to walk around, doesn't seem to be aware that he is attached to the equipments. i immediately go in and asked him to have a seat. i told him he needs to use the call bell because he is unsteady and he cried "whah" and didn't say anything else.

    [font='times new roman']later his wife informed me that he had a reaction to the anesthesia from the surgery and ever since he has been acting like a different person and she doesn't even know him anymore. we put the bed alarm on him for safety and later that night he got out of bed, still very confused. i informed the nurse and she didn't do anything about this situation. i went to the charge nurse and she called the pa. when he came, he consoled the wife and told her this is normal.

    [font='times new roman']i would like to learn more about this if anyone has had this experience. i empathize for the wife because it would be puzzling to see my husband act like a completely different person three days post surgery.

    i have seen older adults become delusional after taking meds like ambien, morphine but the next day they are back to their old self. how common is this? what can be done to help this patient?



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  2. 16 Comments

  3. by   CRNAGAL
    Its unlikely that a change in mental status lasting three days after surgery would be caused by anesthesia. Did the patient go on cardiac bypass during the surgery, that can cause issues for patients. Being in the unit can cause people to become confused due to lack of sleep and day/nights mixed up. I would also question alcohol withdrawal.
  4. by   agent66
    I would agree with above poster with the on or off pump OR? We refer to this as "pump head" post op. Look up in the OR notes and see how long the surgery was and if indeed they were on pump. Again a few days in the cardiac SX ICU would do it too, with sleep deprivation etc, as well as just a bad reaction to the anesthetic. Perhaps he threw a few emboli as well during the surgery, what were the risks for that? You can certainly have people who are as you said A and O X 3 but quite inappropriate.
  5. by   leslie :-D
    the more invasive the surgery, the more se's i expect.
    i wouldn't be overly concerned just a few days post op.
    if it lasted longer than a week, i'd be pursuing more aggressive interventions.

    leslie
  6. by   cardiacRN2006
    Someone beat me to it! We do call that pump head. Most likely he will get over it, and not remember a thing about it.

    Quote from CRNAGAL
    I would also question alcohol withdrawal.
    Great idea! I've found that lots of older, cardiac pts drink etoh every day. Even missing just a few days out of their routine can make older pts confused.
    Last edit by cardiacRN2006 on Oct 20, '07
  7. by   woody62
    Quote from meimeiy
    hi. i'm a nurse tech at a cardiac hospital. yesterday, a pt, 50 years old, was transferred from icu to our unit post cabg three days ago. the pt is ao x3, but i saw him getting out of bed with his sequential teds on and nasal cannula, trying to walk around, doesn't seem to be aware that he is attached to the equipments. i immediately go in and asked him to have a seat. i told him he needs to use the call bell because he is unsteady and he cried "whah" and didn't say anything else.

    later his wife informed me that he had a reaction to the anesthesia from the surgery and ever since he has been acting like a different person and she doesn't even know him anymore. we put the bed alarm on him for safety and later that night he got out of bed, still very confused. i informed the nurse and she didn't do anything about this situation. i went to the charge nurse and she called the pa. when he came, he consoled the wife and told her this is normal.

    i would like to learn more about this if anyone has had this experience. i empathize for the wife because it would be puzzling to see my husband act like a completely different person three days post surgery.

    i have seen older adults become delusional after taking meds like ambien, morphine but the next day they are back to their old self. how common is this? what can be done to help this patient?


    it depends on how long the patient is under, his state of health prior to the surgery, what other medications he was on, if he was on bypass and for how long, what he is getting for pain management. the confusion can last any where from a few days to up to five or six days. when the patient is acting confused, he should be reoriented to time, place and person.

    my 80 year old father had surgery, under general, that was suppose to last less than one hour. it turned into a four hour procedure. he was confused for six days and i had to continously reorient him. and he did not drink, nor take any medications. for an 80 year old, he was in surprisingly good health until the gall stones he had decided to migrate.


    woody
  8. by   oramar
    I have read several studies on this condition. Sometimes it IS a stroke, meds, including anestetic or alcohol withdrawl. In the bulk of cases it is caused by a very mild anoxia brought on by being on the pump. Some people were found to take as much as 6 months to return to normal status. Most took about 6 to 8 weeks. I do believe there was a correlation noted between length of time on the pump and degree of mental status change as well as recovery time. Wish I could give you a link but I can merely remember reading the article, not who or where or when.
  9. by   time4meRN
    That far post op is concerning. He should be evaluated, sound like he has some risk factors for complications if he is that far po and still on 02 and sequentials. Most pt's are getting ready to go home by then. I wounder what reaction to anest. they are talking about ? Most anesthesia can cause complications but 3 days later for a routine CABG is unusual.
  10. by   CHATSDALE
    this is really quite common with cabg pts, being on 02 can also have an effect on orientations
    i have seen patients who reported problems memory and change of orientation a long time [think 1 year post op]
    one patient gave her husand the keys to her car when he went to work after she found herself about 50 miles away from home with no memory of how she got there
    i have not workedd with a lot of other type of surgery patients so i don't know if this is common among other surgery patients
  11. by   cardiacRN2006
    Quote from time4meRN
    Most anesthesia can cause complications but 3 days later for a routine CABG is unusual.

    No, it's not unusual at all. In fact, in the 10 years I spent working at a cardiac-only hospital, I'd say this is quite the norm for CABG pts.

    It's not just the anesthesia. It's all the things that all the PPs have mentioned. Sometimes, simply getting out of their routine can cause these types of problems. Not to mention simple ICU psychosis....
    Last edit by cardiacRN2006 on Oct 20, '07 : Reason: spelling, of course
  12. by   suanna
    Your patient is pretty average for post op CABG. I've worked post op CABG unit for 20+ years and 1 patient in 4 gets a little squirlly post op. If it happens first 24hrs post op you worry more about CVA but after 24hrs it is usually sleep deprivation, narcotic analgesic, or hyper/hypo natremia. There have been some intresting studies on using Celexa to treat this out of Europe but I don't know of anyone trialing it in the USA. If there are no other symptoms- lateralisation, facial droop, aphasia, etc the best treatment is limit narcotics and try to let them get 4-5 hours of uninterupted sleep. We commonly use Haldol IV to control aggitation since the benzos can make the confusion worse and can cause respiratory depression.
  13. by   Ruby Vee
    Quote from cardiacrn2006
    someone beat me to it! we do call that pump head. most likely he will get over it, and not remember a thing about it.



    great idea! i've found that lots of older, cardiac pts drink etoh every day. even missing just a few days out of their routine can make older pts confused.
    a 50 year old cabg patient is a "younger" patient, not and "older patient"! that said, it could easily be pump head, etoh withdrawal or withdrawal from other recreational or prescribed substances.

    it never ceases to amaze me how many patients who swear they don't drink still manage to have dts!
  14. by   2longasn
    Quote from meimeiy
    hi. i'm a nurse tech at a cardiac hospital. yesterday, a pt, 50 years old, was transferred from icu to our unit post cabg three days ago. the pt is ao x3, but i saw him getting out of bed with his sequential teds on and nasal cannula, trying to walk around, doesn't seem to be aware that he is attached to the equipments. i immediately go in and asked him to have a seat. i told him he needs to use the call bell because he is unsteady and he cried "whah" and didn't say anything else.

    later his wife informed me that he had a reaction to the anesthesia from the surgery and ever since he has been acting like a different person and she doesn't even know him anymore. we put the bed alarm on him for safety and later that night he got out of bed, still very confused. i informed the nurse and she didn't do anything about this situation. i went to the charge nurse and she called the pa. when he came, he consoled the wife and told her this is normal.

    i would like to learn more about this if anyone has had this experience. i empathize for the wife because it would be puzzling to see my husband act like a completely different person three days post surgery.

    i have seen older adults become delusional after taking meds like ambien, morphine but the next day they are back to their old self. how common is this? what can be done to help this patient?


    altered mental status is a cardinal sign that something needs to be investigated ( worked up). best guesses of the cause- is not prudent.
    evidenced based care ask that we find out why?. could be infection. could be dvt. could be a need for medication review. could be too soon to discharge.

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