A nurse is caring for a client on the first day postop after having minimally invasive direct coronary artery bypass (MIDCAB) grafting. The client thought that this surgery was supposed to have a much easier recovery and asks the nurse why it is so painful to take deep breaths. What is the best response by the nurse?

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11ecbb05_c94e_6026_b433_ad04f3a73010_MD0009_00 MIDCAB does not involve a sternotomy incision or placement on cardiopulmonary bypass. Several small incisions are made between the ribs. A thoracotomy scope or robot is used to dissect the internal mammary artery (IMA) that is used as a bypass graft. Radial artery or saphenous veins may be used if the IMA is not available. Recovery time is typically shorter with these procedures and clients are able to resume activities sooner than with traditional open chest coronary artery bypass graft surgery. However, clients may report higher levels of pain with MIDCAB due to the thoracotomy incisions made between the ribs. (Option A) The client may need pain medication, but this response does not answer the initial question. The nurse should first answer the client's question, then assess if pain medication is necessary. (Option B) Before calling the HCP for an increase in dosage, the nurse should assess the client's pain level and if pain medication has been effective. However, this should be done after answering the client's question. (Option C) The client needs to move, cough, breathe deeply, splint the chest, and use the incentive spirometer. However, the client is asking the nurse a question that should be addressed before reinforcing these teachings. Educational objective: The nurse should teach the client that incisional pain from thoracotomy incisions between the ribs may be very painful after MIDCAB surgery. The nurse should encourage the client to take pain medication before the pain is too intense. The client should also be instructed to cough, breathe deeply while splinting the chest with a pillow, and use the incentive spirometer routinely to reduce the incidence of postop complications.

A Nurse Is Caring for a Client on the First