Myocardial Infarction & Peripheral Vascular Diseases Q 34 - Gyan Darpan : Learning Portal
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Monday, 25 April 2022

Myocardial Infarction & Peripheral Vascular Diseases Q 34

A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation?
     A. Encourage the client to cough and deep breathe.
     B. Premedicate the client with an analgesic.
     C. Provide the client with a walker.
     D. Remove telemetry equipment because it weighs down the hospital gown.

Correct Answer: B. Premedicate the client with an analgesic.

The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation. Before performing the exercises, the patients will be asked to quantify their pain and, if they describe an intensity of more than three on the visual analog scale (VAS), a prescription of analgesics (containing moderate opioids) will be requested from their physician and a break will be taken at that moment until the sensation of pain gets better.

Option A: The combination of the complexity of the procedure and the use of cardiopulmonary bypass (CB) has had a very positive association with the incidence of complications in the postoperative period. The CB produces a systemic inflammatory response through the release of substances that impair immune response and that are widely known to increase capillary permeability and its deleterious effects.
Option C: A walker will not help in tolerating ambulation. The deleterious effects of immobility include decreased protein synthesis, increased proteolysis, and loss of muscle mass and strength, compromising functional capacity and ability to perform activities of daily living.
Option D: Removal of telemetry equipment is contraindicated unless prescribed. Physical therapy is also associated with decreased respiratory complications following cardiac surgery, reduced loss of muscle strength, decreased morbidity and mortality, improved cognitive conditions, and an increase in the number of days free of mechanical ventilation.

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