stuck on this med surg problem, help please

Nursing Students Student Assist

Published

A morbidly obese client is scheduled for an emergency coronary artery

bypass graft (CABG). The nurse knows

that this client is at risk for:(Select all that apply.)

Note: Credit will be given only if all correct choices and no

incorrect choices are selected.

a. Liver failure.

b. Drug dependency.

c. Shock and heart failure.

d. Wound dehiscence and delayed healing

I answered C and D and got it wrong. This was the rationale: The obese client is at increased risk for delayed wound healing,wound dehiscence, infection, pneumonia, atelectasis, thrombophlebitis,arrhythmias, and heart failure.

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Specializes in Vascular Surgery.

Sounds good to me. The question doesn't offer any evidence about being an Rx user, or having ETOH issues that would affect the liver.

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Specializes in SICU.

I would say C only. I was taught in school that if any art of the answer is wrong then it is wrong. A CABG is done via open heart sugery. They cut the sternum and then put it back together with wires. There will not be any dehiscence. I have seen/done chest compressions on a new open heart patient and it has never opened up. It may become unstable, they might have to go back to surgery and have it rewired but it wont come apart.

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Well I woulda put C and D too. But I'm just guessing the answer is only D... Because of the rationale. I'm sure the sternum won't come apart, but the skin might dehisce. Also it never mentioned anything about shock in the rationale. And it never defined what kind of shock.... Hypovolemic, cardiogenic? So I'm guessing D only.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

note: credit will be given only if all correct choices and no

incorrect choices are selected.

a. liver failure.

b. drug dependency.

c. shock and heart failure.

d. wound dehiscence and delayed healing

i worked in a step down that was next to a ccu where cabg patients went. never saw a dehiscence once unless they opened the chest again to do manual cardiac compressions if the patient coded. saw lots of heart failure and some shock from it. they are also liable to get kidney failure, but not liver failure.

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If I had to pick only ONE answer, it would be C. But I just said D because of their list in the rationale.

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Thank you guys so much!

My friends tried choosing just C alone and D alone and they both were also graded wrong. The question is from a computer software program my school recently began using so I emailed them the question... Hopefully, its just a glitch.

'precciate all your help :)

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Specializes in ICU/PACU.

I can definitely see why heart failure © and delayed wound healing (D), so it's good that you emailed the instructor because C and D should be the correct answers. Because of the increased adipose tissue that lack blood vessels, morbidly obese people are not able to heal as quick as people who aren't obese. And obviously being morbidly obese, you are putting stress on the heart.

:)

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