A 68-Year-Old Man Is Evaluated in the Cardiac Care Unit

question 72

Multiple Choice

A 68-year-old man is evaluated in the cardiac care unit for confusion and agitation 3 days after coronary artery bypass grafting.  Other than blood transfusion for perioperative bleeding, the surgery was uncomplicated.  After initial difficulty weaning, the patient was successfully extubated on postoperative day 2.  His pain has been well controlled with IV morphine, and he was calm throughout the day.  This evening, the patient suddenly became anxious and started to pull his IV catheter.  Medical history is significant for type 2 diabetes mellitus, dyslipidemia, and peripheral artery disease.  He does not drink alcohol.  Temperature is 37.1 C (98.8 F) , blood pressure is 138/86 mm Hg, pulse is regular at 96/min, and respirations are 18/min.  Pulse oximetry is 96% on room air.  The patient is oriented to person but not place or time.  During examination, he tries to grab the bed rails and sit up but calms down easily with reorientation.  The patient states that he is frightened by small animals hopping around his bed.  He has no apparent focal weakness.  Laboratory studies are normal.  What is the best initial intervention to help prevent self-harm in this patient?

• A)Apply soft wrist restraints only at night
• B)Discontinue all analgesics for pain
• C)Employ a professional sitter at bedside
• D)Restrict daytime interactions to maximize rest
• E)Schedule nighttime lorazepam for sleep

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Definitions:

Individualism

A cultural orientation that emphasizes personal freedom, self-reliance, and the importance of individual goals over group objectives.

Systems Theory

A conceptual framework that examines phenomena in terms of whole systems, acknowledging interactions, interdependencies, and patterns among components.

Wholeness

Pertains to the state of being complete, entire, or undivided; often used in the context of personal development or health.

Organization

Organization refers to a structured group of people with specific roles and responsibilities working towards common goals, or the act of arranging elements in a systematic way.