A nurse is providing discharge teaching for a client following coronary artery bypass graft surgery. Which of the following information should the nurse include in the teaching?

Rationale:

A. Renal failure: The client has elevated creatinine levels (1.7 mg/dL), which suggests kidney impairment. This could be due to dehydration and osmotic diuresis associated with hyperglycemia, which is commonly seen in diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar state (HHS).

B. Hypotension: The client’s blood pressure is low (96/65 mm Hg), which can be attributed to dehydration caused by excessive urination and hyperglycemia. Hypotension can worsen as the client becomes more dehydrated, potentially progressing to shock.

C. Cerebral edema: Cerebral edema is a rare but serious complication of diabetic ketoacidosis (DKA), particularly in younger patients and those with severe electrolyte imbalances. The rapid correction of hyperglycemia can cause osmotic shifts that may lead to cerebral edema. The client’s altered fluid balance increases this risk.

D. Septic shock: Although the client has a history of bronchitis and pneumonia, there is no evidence of active sepsis at this time. Septic shock is characterized by signs of infection, such as fever and widespread infection leading to organ dysfunction. This client’s symptoms point more toward a metabolic complication rather than sepsis.

E. Respiratory alkalosis: Respiratory alkalosis occurs when there is excessive loss of carbon dioxide due to hyperventilation. In this client, there is no indication of Kussmaul respirations to suggest respiratory alkalosis. The client is more likely to develop metabolic acidosis due to the presence of ketones and a low pH (7.30).

F. Cardiac arrhythmias: Elevated potassium levels (5.5 mEq/L) and the potential for rapid fluctuations in electrolytes in a client with DKA or HHS can increase the risk of cardiac arrhythmias. Potassium imbalances hyperkalemia or hypokalemia, are closely linked to arrhythmias.

Rationale:

A. Strict I&O: Monitoring intake and output is essential due to decreased urination, flank pain, and impaired kidney function. The elevated BUN and creatinine levels suggest renal impairment, and strict I&O helps assess fluid balance.

B. Increase fluid intake: While hydration is important, increasing fluids should be done cautiously due to the client’s impaired kidney function. Given the elevated BUN and creatinine, the kidneys may not manage increased fluids without worsening fluid retention.

C. Encourage protein supplements: Protein supplements are not recommended in kidney dysfunction, as they can worsen renal strain. Elevated BUN and creatinine levels indicate kidney impairment, and protein intake may aggravate the condition.

D. Strain all urine: Straining all urine is necessary to capture any possible kidney stones, blood clots, or debris. The reddish-brown urine and positive blood in the urinalysis suggest hematuria, which may need further investigation.