A client develops a temperature of 102 degree Fahrenheit following coronary artery bypass surgery. The nurse should notify the physician immediately because elevations in temperature?

1. A

   Increased cardiac output

2. B

   Indicate cardiac tamponade

3. C

   Decrease cardiac output

4. D

   Indicate graft rejection

Appeared in: DHS 2018 shift 1st

Explanation

• Fever induces a hypermetabolic state, increasing the body's overall metabolic rate and oxygen consumption.
• To deliver more oxygen to the tissues, the cardiovascular system responds by increasing heart rate and contractility.
• This compensatory response results in an increased cardiac output (Cardiac Output = Heart Rate × Stroke Volume).
• In a post-CABG patient, this increased cardiac workload puts significant strain on the healing myocardium and new grafts, increasing the risk of complications like ischemia or arrhythmias.

Why Other Options Were Wrong

• Option B: Fever is not a primary sign of cardiac tamponade. Cardiac tamponade is a mechanical compression of the heart by fluid accumulation.
• Option C: Fever increases metabolic demand, which leads to an increase, not a decrease, in cardiac output to meet the body's needs.
• Option D: Grafts used in CABG are autografts, meaning they are harvested from the patient's own body (e.g., saphenous vein, internal mammary artery). Therefore, there is no risk of immunological rejection.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Pathophysiological effects of fever in postoperative cardiac patients helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Promptly identifying and managing fever in post-CABG patients is a critical nursing responsibility to prevent life-threatening cardiac complications.
• Nursing interventions include administering antipyretics as ordered, implementing cooling measures, and investigating the source of the fever, which is often an infection (e.g., surgical site, respiratory, or urinary tract).
• What if? If the patient's temperature was only mildly elevated (e.g., 99.8°F or 37.7°C) without other signs of distress, the nurse might focus on hydration and continued monitoring, as a low-grade fever can be a normal inflammatory response to surgery. A spike to 102°F, however, signals a more serious issue requiring immediate intervention.

How to Approach the Question

• First, identify the key elements of the question: a patient who is postoperative from CABG and has a high fever (102°F).
• Next, recall the basic pathophysiology of fever. Fever increases the body's metabolic rate.
• Connect the pathophysiology to the organ system in question (the heart). An increased metabolic rate means increased oxygen demand from all tissues.
• Analyze how the heart compensates for increased oxygen demand. It must work harder, which means increasing cardiac output.
• Consider the patient's specific vulnerability (post-CABG). A healing heart cannot tolerate a significant increase in workload.
• Evaluate the options based on this chain of reasoning. 'Increased cardiac output' is the direct physiological consequence that creates danger for this patient.

Concept Tested & Keywords

• Concept Tested: Pathophysiological effects of fever in postoperative cardiac patients
• Stem keywords: temperature 102 degree Fahrenheit, coronary artery bypass surgery, postoperative
• Lead-in keywords: notify the physician immediately
• Clinical cues: High fever (102°F) indicates a significant systemic response.
• Clinical cues: Post-CABG status implies a vulnerable, healing heart with limited reserve.

Question ID

QGTS9sSlRd04w749Sq3ka5

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 195-197