A nurse is providing care for a group of clients who have coronary artery disease who are all scheduled for coronary artery bypass grafts (CABG). Which of the following clients is at the highest risk for complications following the surgical procedure?
A.
A client who has coronary artery disease (CAD) and Bell’s palsy
B.
A client who has coronary artery disease (CAD) and chronic diverticulitis
C.
A client who has coronary artery disease (CAD) and chronic allergies
D.
A client who has coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD)
The Correct Answer and Explanation is:
The correct answer is:
D. A client who has coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD).
Explanation:
Coronary artery bypass graft (CABG) surgery is a major procedure performed to improve blood flow to the heart in clients with severe coronary artery disease (CAD). While all clients undergoing CABG are at risk for postoperative complications, certain comorbid conditions increase this risk. Among the options provided, the client with CAD and COPD is at the highest risk for complications following the surgical procedure. Here’s why:
- COPD and Respiratory Complications:
COPD is a chronic respiratory condition that impairs lung function and gas exchange, leading to decreased oxygenation. Postoperative complications for clients with COPD include a higher risk of respiratory failure, pneumonia, and prolonged mechanical ventilation. General anesthesia used during CABG surgery can further compromise lung function, making it difficult for COPD patients to recover respiratory function quickly after the procedure. Reduced pulmonary reserve in COPD patients can also lead to difficulties with weaning off mechanical ventilation. - Impact of Poor Oxygenation:
Clients with COPD often have chronic hypoxemia (low blood oxygen levels), which places extra strain on the heart. CAD patients already have compromised heart function, and any further reduction in oxygenation can increase the workload on the heart, leading to complications such as heart failure, arrhythmias, or ischemia during the recovery period. - Inflammation and Immune Response:
Chronic inflammation associated with COPD may contribute to a higher risk of infections post-surgery, including pneumonia or wound infections. Additionally, COPD patients often take medications like corticosteroids, which can weaken the immune system and impair healing, making them more susceptible to infections.
In contrast, the other conditions listed—Bell’s palsy, chronic diverticulitis, and chronic allergies—do not significantly impact lung function or increase the risk of respiratory complications to the extent that COPD does. Therefore, clients with these conditions are generally at a lower risk of developing severe postoperative complications compared to a client with CAD and COPD.