A nurse in the intensive care unit is caring for a postoperative cardiac transplant client. What intervention is most important to include in the plan of care?

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Clients receiving transplanted organs are prescribed lifelong immunosuppressive medications (eg, cyclosporine, mycophenolate) to prevent rejection. Posttransplant infection is the most common cause of death. Signs of infection may include fever >100.4 F (38 C), productive or dry cough, and changes in secretions; however, common signs of infection (eg, redness, swelling) may be absent due to immunosuppression. Critical postoperative infection control measures incorporate vigilant hand washing, aseptic technique for line/dressing changes, and possibly reverse isolation. (Option A) Sequential compression devices are one of the options available to prevent deep venous thrombosis (DVT) postoperatively. Ideally, anticoagulants are used to prevent DVT. Regardless, in the client's immunosuppressed state, infection prevention is the priority. (Option B) The newly transplanted heart is denervated from the autonomic nervous system and is unable to appropriately respond to physical demand (eg, increased heart rate with increased activity). The client is taught how to avoid orthostatic hypotension (eg, change positions slowly). However, the priority is careful hand washing and infection prevention. (Option C) Coughing, deep breathing, and incentive spirometry are important interventions to prevent atelectasis and pneumonia. However, infection prevention is the priority in immunosuppressed clients. Educational objective: Posttransplant infection is the most common cause of death due to immunosuppressive therapy. Strict hand washing and aseptic technique are critical to infection prevention. Symptoms of infection should be monitored and may include fever >100.4 F (38 C), productive or dry cough, and changes in secretions.

A Nurse in the Intensive Care Unit Is Caring for a Postoperative