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  • 1. NURSING MANAGEMENT OF CABG PATIENT
    • Harmeet Kaur Kang
    • Lecturer
  • 2. CORONARY ARTERY BLOCKAGE
  • 3.  
  • 4. CORONARY ARTERY BYPASS GRAFTING
  • 5.  
  • 6. NURSING MANAGEMENT
    • Preoperative Nursing Management.
    • Intraoperative Nursing Management.
    • Postoperative Nursing Management.
  • 7. PREOPERATIVE NURSING MANAGEMENT
    • The preoperative nursing management
    • usually begins before hospitalization.
    • Patients with nonacute heart disease
    • may be admitted to hospital the day
    • before or the day of their surgery.
  • 8. PREOPERATIVE ASSESSMENT
    • History
    • Physical examination
    • Radiographic examination
    • Electrocardiogram
  • 9. PREOPERATIVE ASSESSMENT
    • Laboratory analysis
    • Typing and cross-matching of blood.
    • Assessing patient’s functional level
    • Psychosocial assessment.
    • Family support system
  • 10. PHYSICAL EXAMINATION
    • General appearance and behavior
    • Vital signs
    • Nutritional and fluid status, weight and Height
    • Inspection and palpation of heart
  • 11. PHYSICAL EXAMINATION
    • Auscultation of heart
    • JVP
    • Peripheral pulses.
    • Peripheral edema.
  • 12. PSYCHOSOCIAL ASSESSMENT
    • Meaning of surgery to patient
    • Coping mechanisms being used.
    • Anticipated changes in lifestyle
    • Support system in effect
    • Fear regarding present & future
    • Knowledge & understanding of surgical procedure.
  • 13. NURSING DIAGNOSIS
    • Fear related to surgical procedure, its uncertain outcome, and the threat of well-being.
    • Goal: To reduce fear.
  • 14. INTERVENTIONS
    • Allowing patient and family to express their fears.
    • Explain the patient regarding surgery and sensations that are expected during and after the surgery.
    • Reassuring the patient that fear of pain is normal and explain that some pain will be experienced but certain measures will help to relieve the pain.
  • 15. COMMUNICATION
  • 16. INTERVENTIONS
    • Encourage the patient to talk about the fear of dying.
    • Patient should be reassured and misconceptions should be corrected.
  • 17. NURSING DIAGNOSIS
    • Knowledge deficit regarding the surgical procedure and the postoperative course.
    • Goal: To provide the knowledge regarding surgery
  • 18. INTERVENTIONS
    • Patient and family teaching about
    • Hospitalization
    • Surgery
    • Length of surgery
    • Expected pain and discomfort
    • Critical care phase
    • Recovery phase
  • 19. PATIENT TEACHING
  • 20. INTERVENTIONS
    • Physical preparation before surgery
    • Medications before surgery
    • Information regarding equipments, tubes that will be present postoperatively
    • Teaching the postoperative exercises.
    • Outcome of the surgery
  • 21. NURSING DIAGNOSIS
    • Potential for complications related to the stress of impending surgery (Angina, Severe anxiety, Cardiac arrest)
    • Goal: To monitor and manage the complications
  • 22. INTERVENTIONS
    • Assess for complications
    • Angina: oxygen therapy and nitroglycerine therapy.
    • Severe anxiety: emotional support
    • Cardiac arrest: cardiac life support
  • 23. INTRAOPERATIVE NURSING MANAGEMENT
    • Assisting in surgical procedure
    • Continuous monitoring
    • Monitoring for complications: dysrhythmias, hemorrhage, MI, CVA, embolization etc.
  • 24. INTRAOPERATIVE MANAGEMENT
  • 25. POST OPERATIVE NURSING MANAGEMENT
    • ASSESSMENT:
    • Neurological status
    • Cardiac status
    • Respiratory status
    • Peripheral vascular status
    • Renal function
    • Fluid & electrolyte status
  • 26. POST OPERATIVE ASSESSMENT Contd…
    • Pain
    • Assessment of equipments and tubings
    • Psychological and emotional status as patient regains consciousness
    • Assessing for complications.
  • 27. ASSESSMENT
  • 28. NURSING DIAGNOSIS
    • Decreased cardiac output related to blood loss and compromised myocardial function
    • Goal: To restore cardiac output
  • 29. INTEREVENTIONS
    • Monitor cardiovascular status
    • Assess arterial pressure every 15 min. until stable
    • Ascultate for heart sounds and rhythms
    • Assess all peripheral pulses
    • Hemodynamic monitoring
    • ECG monitoring
  • 30. INTEREVENTIONS
    • Assess cardiac enzymes
    • Monitor urinary output
    • Observe for persistent bleeding
    • Observe for cardiac temponade
    • Observe for cardiac failure
    • Observe for myocardial infarction.
  • 31. NURSING DIAGNOSIS
    • Risk for impaired gas exchange related to trauma of extensive chest surgery
    • Goal: To maintain adequate gas exchange
  • 32. INTERVENTIONS
    • Maintain proper ventilation
    • Monitor arterial blood gases, tidal volumes, peek inspiratory pressures and extubation parameters
    • Auscultate chest for breath sounds
    • Provide chest physiotherapy as prescribed
  • 33. INTERVENTIONS
    • Promote deep breathing coughing and turning, use of incentive spirometer.
    • Teach incisional splinting with a cough pillow to decrease discomfort during deep breathing and coughing
    • Suction tracheobronchial secretions as needed, using aseptic technique
  • 34. EARLY AMBULATION
  • 35. NURSING DIAGNOSIS
    • Risk for alteration in fluid volume and electrolyte balance related to alteration in blood volume
    • Goal: To maintain fluid and electrolyte balance
  • 36. INTERVENTIONS
    • Maintain intake and output chart
    • Assess the following parameters: LAP, BP, CVP, PAWP, weight, electrolyte levels, hematocrit, JVP, tissue turgor, breath sounds, urinary output etc.
    • Measure post operative chest drainage
    • Be alert to serum electrolyte levels
  • 37.  
  • 38. NURSING DIAGNOSIS
    • Pain related to operative trauma and pleural irritation caused by chest tubes
    • Goal: To relieve pain
  • 39. INTERVENTION
    • Record nature, type, location and duration
    • Providing comfortable position
    • Assist patient to differentiate between surgical and anginal pain
    • Administer prescribed pain medication
    • Encourage relaxation techniques
  • 40. PAIN MEDICATION
  • 41. NURSING DIAGNOSIS
    • Risk for alteration in renal perfusion related to decreased cardiac output, hemolysis, or vasopressor therapy
    • Goal: To maintain adequate renal perfusion
  • 42. INTERVENTION
    • Measure urine output strictly
    • Monitor renal function tests
    • Report to physician if urine output less
    • Administer medications as prescribed
  • 43. NURSING DIAGNOSIS
    • Risk for hypothermia/hyperthermia related to cardiopulmonary bypass surgery, infections etc.
    • Goal: To maintain normal body temperature
  • 44. INTERVENTIONS
    • Warm the patient gradually with warm air or warm blankets or heat lamps
    • Assess for dysrythmias due to hypothermia
    • Assess for elevated body temperature
    • Assess for infection ( lungs, urinary tract, incisions and intravascular catheter
  • 45. INTERVENTIONS
    • Use the aseptic technique while dressing and other procedure
    • Using proper hand washing technique
    • Meticulous care to be taken to prevent contamination at the sites of catheter and tube insertion
    • Care of the graft donor site.
  • 46. CARE OF THE GRAFT DONOR SITE RADIAL ARTERY
  • 47. CARE OF CHEST TUBE
  • 48. NURSING DIAGNOSIS
    • Risk for sensory- perceptual alterations related to sensory overload
    • Goal: to prevent postcardiotomy syndrome
  • 49. INTERVENTIONS
    • Explain all procedures to patient
    • Plan nursing care to provide for periods of uninterrupted sleep with day-night pattern
    • Decrease sleep preventing environmental stimuli as much as possible
  • 50. INTERVENTIONS
    • Promote continuity of care from nurse to nurse
    • Orient the patient to time, place and person. Encourage the family to visit at regular times
    • Teach relaxation and diversional techniques
    • Observe for signs of pericardiotomy syndrome
  • 51. NURSING DIAGNOSIS
    • Knowledge deficit about self care activities
    • Goal: to help the patient in the performance of self care activities
  • 52. INTERVENTIONS
    • Develop teaching plan for patient and family specifically about:
    • Diet
    • Activity progression
    • Exercise
    • Deep breathing, coughing exercises
    • Medication regimen
    • Follow up
  • 53.  
  • 54. Thank You