post op CABG anorexia??

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My 69 y/o husband had CABg x3 with mitral valve repair 01/08/08 and post op day 1 was started on coumadin (loading dose of 10mg daily x3). That very first nite he complained of taste perversion (tooo strong of a taste or very bland, something he usually likes-now dislikes...) Tomorrow he will have been home 5 weeks and has lost a total of 40 pounds!!! -- Suffering from acute nausea, intensified gag reflex, diarrhea and simply no appetite. Is on reglan and lomotil/immodium prn which helps with the control of S & S but once anything in injested--immediate heaves!! We just d/c'd him from hospital; had EGD (neg), stool c/s & c. diff (neg), afebrile. We inserted a picc line & now is on TPN at home until we can figure out whats causing this?? Any ideas??? PDR lists ALL his signs & symptoms for coumadin so we have stopped it and started plavix. Our MD's are at a loss and the cv surgeon says it's beyond his scope!!

Any ideas or suggestions would be greatly appreciated!!!

Thanks!!

Mary Jean :o

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Have you explored the adverse side effects of any other meds he is on? How about his renal function- is that OK? Has he had a stool Cx?

Have you addressed this with an internal med Dr.?

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Thank you for your thoughts. We have had gastro and cardio involved and my husband is family practice himself. Liver enzymes were WNL except for alk. phos which initially on admission was 196, next day dropped to 165 then 135 & we just drew another today. GI thinks may have been related to dehydration on admission, but did fractionated level which indicates liver rather then bone. No abd pain, no jaundice... This am he tolerated a GLASSFUL of ice chips without nausea; now just tried one spoon of orange jello--instantly dry heaves--nothing came up, just heaves and the c/o of tooooo strong of an orange taste to the jello. We are scheduled for CT of abd to r/o anything malignant but we are all baffled, even as to what other specialty to see!!??

Thanks again, Mary Jean:nurse:

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Thank you for your thoughts. Liver enzymes WNL except alk phos. on adm was 196, then 185 then 165 & drawn again today. NO jaundice, abd pain...GI thought r/t dehydration on admission as decreasing but fractionated level indicated liver so we are sched. for ct abd. We have GI & Cardio and my husband/pt. is family practice himself so we really don't know who else to consult. This AM tolerated a glassful of ice chips; now just had on spoon of orange jello with INSTANT dry heaves-nothing came up!? Trying to think what is triggering the relfex so intently and quickly??? EGD negative as were stool cultures and c. dif.

Keep thinking!!

Thanks,

Mary Jean

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

It is definitely in your spouse's best interest that a licensed physician provide all of the recommendations and ideas regarding medical care and future interventions. The membership at http://www.Allnurses.com is not in the position to give any medical advice.

Let's hope for a good outcome for your husband. :saint:

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