After open-heart surgery, a client develops a temperature of 102°F. The nurse notifies the physician because elevated temperatures:
A. Increase the cardiac output.
B. May indicate cerebral edema.
C. May be a forerunner of hemorrhage.
D. Are related to diaphoresis and possible chilling.
Correct Answer: A. Increase the cardiac output.
Temperatures of 102*F or greater lead to an increased metabolism and cardiac workload. Myocardial infarction following cardiac surgery is classified as type 5 myocardial infarction according to the universal classification of myocardial infarction. The incidence is between 5% to 10%. Diagnosing postoperative myocardial infarction is challenging since cardiac enzymes are routinely elevated due to manipulation during operation and symptoms are influenced by postoperative status.
Option B: Fever, edema, and increased inflammatory markers can be routinely observed in patients in the postoperative ward. Thus, it might be challenging to differentiate patients with true infection and evolving sepsis. The time course can give additional information. Signs and symptoms of infection after the second to the third day of operation should prompt investigation for infection.
Option C: Postoperative bleeding, hemorrhagic shock coagulation disorders such as heparin-induced thrombocytopenia are reasons why 10% to 20% of national blood products are consumed in cardiac surgery.
Option D: Perioperative antibiotic prophylaxis is used to reduce postoperative infections. Guidelines recommend cephalosporin prophylaxis during the 24 to 48-hour perioperative period. Deep sternal wound infection (DSWI) is a unique postoperative complication of cardiac surgery occurring with a frequency of 0.4% to 4%.
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