CABG (Coronary artery Bypass Grafting)ATUL LAWRENCEM.Sc Nsg. 2ND YEAR

Definition of CABGCoronary artery bypass graft surgery is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the leg, arm, or chest.

PURPOSES Restore blood flow to the heartRelieves chest pain and ischemiaImproves the patient's quality of life Enable the patient to resume a normal lifestyle and to lower the risk of a heart attack

IndicationsPatients with blockages in at least three major coronary arteries Patients with angina Patients who cannot tolerate PTCA and do not respond well to drug therapy.

ContraindicationsAcute Cerebral vascular Accident

Bleeding disorders

Types of CABGON-PUMP

CABG surgeon to open require the chest bone (sternum),stop the patient's heart, and place the patient on a This lung machine.-heart machine takes over the function of the patient's heartdelivering oxygenated blood through out the body and brainwhile the bypass is performed.OFF PUMP

CABG pump method eliminates the off need for the surgeon to stop the heart and to place the . The patient on bypass surgeon operates directly on the beating heart, reducing the risk for peri-operative bleeding and stroke associated with the on-pump procedure

NURSING MANAGEMENTPreoperative Nursing Management.

Intra operative Nursing Management.

Postoperative Nursing Management.

PREOPERATIVE NURSING MANAGEMENT

PREOPERATIVE ASSESSMENT

HistoryPhysical examinationRadiographic examinationElectrocardiogramLaboratory analysisTyping and cross-matching of blood.Assessing patients functional levelPsychosocial assessment.Family support system

PHYSICAL EXAMINATIONGeneral appearance and behaviorVital signsNutritional and fluid status, weight & HeightInspection and palpation of heartAUSCULTATION OF HEARTJVP (JUGULAR VEIN PRESSURE)PERIPHERAL PULSES.PERIPHERAL EDEMA.

PSYCHOSOCIAL ASSESSMENTMeaning of surgery to patientCoping mechanisms being used.Anticipated changes in lifestyleSupport system in effectFear regarding present & futureKnowledge & understanding of surgical procedure

NURSING DIAGNOSISFear related to surgical procedure, its uncertain outcome, and the threat of well-being.

Goal: To reduce fear.Encourage the patient to

talk about the fear of dying.Patient should be reassured

and misconceptions should be corrected.

NURSING DIAGNOSISKnowledge deficit regarding the surgical procedure and the postoperative course.

Goal: To provide the knowledge regarding surgeryPatient and family teaching aboutHospitalizationSurgeryLength of surgeryExpected pain and discomfort Critical care phaseRecovery phase

PATIENT TEACHINGPhysical preparation before surgeryMedications before surgeryInformation regarding equipments, tubes that will be present postoperativelyTeaching the postoperative exercises.Outcome of the surgery

NURSING DIAGNOSISPotential for complications related to the stress of impending surgery (Angina, Severe anxiety, Cardiac arrest)

Goal: To monitor and manage the complications

Assess for complicationsAngina: oxygen therapy and nitroglycerine therapy.Severe anxiety: emotional supportCardiac arrest: cardiac life support

INTRAOPERATIVE NURSING MANAGEMENTAssisting in surgical procedureContinuous monitoringMonitoring for complications: dysrhythmias, hemorrhage, MI, CVA, embolization etc.

THE PROCEDURE

POST OPERATIVE NURSING MANAGEMENTASSESSMENT:Neurological statusCardiac statusRespiratory statusPeripheral vascular statusRenal functionFluid & electrolyte status

POST-OP ASSESSMENT ContdPainAssessment of equipments and tubing'sPsychological and emotional status as patient regains consciousnessAssessing for complications.

NURSING DIAGNOSISDecreased cardiac output related to blood loss and compromised myocardial function

Goal: To restore cardiac outputMonitor cardiovascular statusAssess arterial pressure every 15 min. until stableAscultate for heart sounds and rhythmsAssess all peripheral pulsesHemodynamic monitoringECG monitoring

NURSING DIAGNOSISRisk for impaired gas exchange related to trauma of extensive chest surgeryMaintain proper ventilationMonitor ABG, tidal volumes,

peek inspiratory pressures chest physiotherapy as prescribedPromote deep breathing coughing and

turning, use of incentive spirometer.Teach incisional splinting with a cough

pillow to decrease discomfortSuction tracheobronchial secretions.

NURSING DIAGNOSISRisk for alteration in fluid volume and electrolyte balance related to alteration in blood volume

Goal: To maintain fluid and electrolyte balanceMaintain intake and output chartAssess the following parameters: BP, CVP, weight, electrolyte levels, hematocrit, JVP, tissue turgor, breath sounds, urinary output etc.Measure post operative chest drainageBe alert to serum electrolyte levels

NURSING DIAGNOSISPain related to operative trauma

and pleural irritation caused by chest tubes Goal: To relieve painRecord nature, type, location and durationProviding comfortable positionAssist patient to differentiate between

surgical &angina painAdminister prescribed pain medicationEncourage relaxation techniques

NURSING DIAGNOSISRisk for alteration in renal perfusion related to decreased cardiac output, hemolysis, or vasopressor therapy

Goal: To maintain adequate renal perfusionMeasure urine output strictlyMonitor renal function testsReport to physician if urine output lessAdminister medications as prescribed

NURSING DIAGNOSISRisk for hypothermia/hyperthermia related to cardiopulmonary bypass surgery, infections etc.Warm the patient gradually with warm

air or warm blankets or heat lampsAssess for elevated body temperatureAssess for infection.Meticulous care to be taken to prevent

contamination at the sites of catheter and tube insertion Care of the graft donor site.

NURSING DIAGNOSISKnowledge Deficit related to the Recovery, Treatment and follow up

Develop teaching plan for :DietActivity progressionExerciseDeep breathing, coughing exercisesMedication regimenFollow up