The nurse is caring for a client with sternal wires following a coronary artery bypass graft (CABG). The client complains of severe pain when coughing and deep breathing. What nonpharmacological measures can the nurse take to increase client comfort? Select all that apply.

  • apply hot packs to the sternum
  • give morphine PRN for pain before client coughs
  • suggest using audio books or relaxing music as a distraction
  • teach the client how to use a pillow to splint the chest when coughing
  • encourage the client to engage in prayer, meditation, or other activities
  • properly position the head of the bed to minimize pressure on the sternum
Numbers 3, 4, 5, and 6 are correct.
Listening to audio books or music can take the client’s focus off the pain. Distraction is a useful tool to shift focus away from pain and also includes music therapy and art therapy when appropriate for the client. Splinting the sternum when coughing is one of the most important things post-CABG clients can do to increase their comfort. If the client engages in prayer, meditation, or other rituals at home, he should be encouraged to continue those practices in the hospital. This is respectful to the client and his beliefs and/or culture and allows him to have some measure of control on maintaining normal routines. The bed should be positioned so as to not increase pressure on the sternum. Hot or cold packs should not be used on the sternum, as this area is a fresh post-op site and should be kept clean. Also, the packs may place pressure on the sternum and cause more discomfort. Warm, not hot, heat packs may be used on the back to relieve aches from bed positioning if approved by the health care provider. Morphine is a pharmacological method of pain relief.