Mr. Y is a 66-year-old male who was discharged from the hospital six weeks

Mr. Y is a 66-year-old male who was discharged from the hospital six weeks ago after an emergency quadruple coronary artery bypass graft (CABG) surgery
Mr. Y is a 66-year-old male who was discharged from the hospital six weeks ago after an emergency quadruple coronary artery bypass graft (CABG) surgery. His post-op recovery was uneventful, and he was discharged ten days after the surgery. He returns to the chief surgeon’s private office on the tenth day post-discharge prior to readmission because the sterna incisional site is red and inflamed with an unusual odor form the site of the wound. He reports pain at the site during hygiene care and a temperature of 101.2 F during the five days prior to seeing the health care provider. Mr. Y believes the redness at the incisional site is normal after surgery. However, because of the unusual odor; he goes to the health care provider’s office to have the wound evaluated. Mr. Y is 5’8” and weighs 206 pounds. Case Study: Mr. Y is referred to the hospital for further evaluation. On initial interview his vital signs are: BP: 130/84 P: 78 and regular R: 20 T: 102.4 F The sternal incision is red, raised, and moderately warm to touch. There are no signs of dehiscence although the wound edges are not completely approximated. Mr. Y reports a 30-year history of cigarette smoking, three packs per week. His past medical history includes hyperlipidemia, stable angina, and past surgical history of left cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA) with stent two years ago. The following are Mr. J’s laboratory results: Red blood cell (RBC) count: 4.6/mm White Blood Cell (WBC) count: 12,000 cells/mm3 Hematocrit (Hct): 42% Hemoglobin (Hgb): 16g/dL Platelet count: 300,000 cells/mm3 Prothombin time (PT): 14 seconds, Control: 15.1 seconds Glucose: 130 mg/dL Blood urea nitrogen (BUN): 15 mg/dL Creatinine: 1.4 mg/dL Potassium (K+): 4.9 mEq/L Chloride: 100 mEq/L Sodium (Na): 142 mEq/L Calcium: 9mg/dL Cholesterol: 200 mg/dL Low-density lipoprotein (LDL): 130 mg/dL Medications brought to the hospital include: lovastatin (Mevacor), nitroglycerin (NTG) sublingual, isosorbidedinitrate (Isordil), warfarin sodium (Coumadin) 7.5 mg, and rabeprazole sodium (Aciphex). Mr. Y is transferred to a cardiac-thoracic unit. A computed tomography (CT) scan of the chest is done in the ED and there is no evidence of infection in the deeper structures of the thoracic cavity. On continued interview, Mr. Y reports self-medication with St. John’s Wort whenever he feels anxious. His sternal wound is inspected by the receiving nurse who documents and reports the finding. Wound specimen for culture and sensitivity, and blood for gram stain are done and sent to the lab. An electrocardiogram (EKG) and chest X-ray are done upon arrival to the unit, nursing assessment is completed,

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