Coronary Artery Bypass Graft Surgery

Prepared by :Monirah AlBloushi 2007

Monirah Albloushi,KSU,

Content
CABG definition CABG indication Contraindication Nursing management preoperative Intraoperative Postoperative stage Discharge teaching
Monirah Albloushi,KSU,

Coronary 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.

Monirah Albloushi,KSU,

Restore blood flow to the heart. Relieves chest pain and ischemia, Improves the patient's quality of life Enable the patient to resume a normal lifestyle and to lower the risk of a heart attack

Monirah Albloushi,KSU,

 Patients 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.

Monirah Albloushi,KSU,

 Acute Cerebral vascular Accident Bleeding disorders.

Monirah Albloushi,KSU,

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

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

Monirah Albloushi,KSU,

Contraindication

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Patient history & Physical Examination (head to toe physical examination and diagnostic procedure

Psychosocial Assessment

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Patient history of major illness, previous surgery, medications, and usage of drugs and smoking and drug history.
A systematic assessment of all system is performed ,with emphasis on cardiovascular functioning.

Monirah Albloushi,KSU,

Functional status of the cardiovascular system determined by reviewing the patient symptoms , including past and present experience with chest pain ,hypertension, palpation ,cyanosis, breathing difficulty ,leg pain that occur with walking ,Orthopnea, peripheral edema .because alteration in cardiac function (cardiac out put can affect renal, respiratory, gastrointestinal , integumentary, hematological, and neurological functioning )
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General appearance and behavior. Vital signs Nutritional and fluid status ,weight, height Inspection and palpation of the heart ,noting the point of maximal impulses ,abnormal pulsation ,and thrills Auscultation of the heart ,noting pulse rate ,rhythm, and quality; S4 and S3 ,clicks, murmur, and friction rib Jugular venous pressure Peripheral pulses Peripheral edema

Monirah Albloushi,KSU,

Physical Examination
General appearance and behavior. Vital signs Nutritional and fluid status ,weight, height Inspection and palpation of the heart ,noting the point of maximal impulses ,abnormal pulsation ,and thrills Auscultation of the heart ,noting pulse rate ,rhythm, and quality; S4 and S3 ,clicks, murmur, and friction rib Jugular venous pressure Peripheral pulses Peripheral edema

Monirah Albloushi,KSU,

Psychosocial Assessment
Meaning of the surgery to the patient and family Coping mechanisms that are being used Measures used in the past to deal with stress Anticipated changes in life style Support system in effect Fears regarding the present and future Knowledge and understanding of the surgical procedure, postoperative course and long term rehabilitation
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NURSING DIAGNOSIS
Fear related to surgical procedure, its uncertain outcome, and threat to well being. Deficient knowledge regarding the surgical procedure and the postoperative course.

Monirah Albloushi,KSU,

Nursing Intervention
Explain all treatment and procedure done for the patient answering any question patient may have .present information at patient understanding level to reduce patient anxiety Orient patient to surrounding Assign the same nurse to care for patient when ever possible to provide consistency of care, enhance trust and reduce threat often associated with multiple care givers. Spend time with patient each shift to allow time for expression of feelings, provide emotional outlet and promote feeling of acceptance. Involve patient in planning and providing care to give patient some control over situation and restore sense of self esteem. Orient family to patient specific needs, allowing family members to participate in giving care. this help alleviate patient s state mental state by familiarizing the environment Arrange for family member or friends to stay with patient to help patient to cope with fear.
Monirah Albloushi,KSU,

Monirah Albloushi,KSU,

Monirah Albloushi,KSU,

Intraoperative Phase
Patient will receive general anesthesia, be intubated, and placed on mechanical ventilator, the preoperative nurse are responsible for the patient safety and comfort. Some of the areas of intervention include positioning, the skin preparation wound care, and emotional support to the patient and family. Before chest incision is closed, chest tubes are positioned to evacuate air and drainage from the media starnum and the thoracic cavity .pericardial pacemaker electrodes are implanted on the surface of the right atrium and the right ventricle .it used to pace the heart and to monitor it if for Dysrthythmias through atrial leads.
Monirah Albloushi,KSU,

Intraoperative complication
Possible Intraoperative complication includes Dysrthmyais, Hemorrhage, and MI, CVA, Emobilization and Organ failure from shock, embolus, or adverse drug reaction.

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GOAL: achieving or maintaining homodynamic stability and recovery form general anesthesia

Neurological system cardiac status Respiratory status Peripheral vascular status

Renal function Fluid and electrolyte Pain Monitor complication

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Nursing Diagnosis
Decrease cardiac output related to blood loss, compromised myocardial function & Dysrthythmias. Impaired gas exchange related to trauma of extensive chest surgery Risk for deficit fluid volume related to alteration in circulating blood volume. Disturbed sensory perception (visual and auditory related to excessive environmental stimuli and electrolyte imbalance Acute pain related to surgical trauma and pleural irritation caused by chest tube. Ineffective tissue perfusion (renal ,cerebral, cardiopulmonary ,gastrointestinal, peripheral )related to decrease cardiac output ,drugs, coagulation problems ineffective thermoregulation related to infection or post pericardiotomy syndrome, deficit knowledge about self care activities
Monirah Albloushi,KSU,

Monirah Albloushi,KSU,

Monirah Albloushi,KSU,

Monirah Albloushi,KSU,