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Cabg Teaching
 

Cabg Teaching

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    Cabg Teaching Cabg Teaching Presentation Transcript

    • NURSING MANAGEMENT OF CABG PATIENT
      • Harmeet Kaur Kang
      • Lecturer
    • CORONARY ARTERY BLOCKAGE
    •  
    • CORONARY ARTERY BYPASS GRAFTING
    •  
    • NURSING MANAGEMENT
      • Preoperative Nursing Management.
      • Intraoperative Nursing Management.
      • Postoperative Nursing Management.
    • 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.
    • PREOPERATIVE ASSESSMENT
      • History
      • Physical examination
      • Radiographic examination
      • Electrocardiogram
    • PREOPERATIVE ASSESSMENT
      • Laboratory analysis
      • Typing and cross-matching of blood.
      • Assessing patient’s functional level
      • Psychosocial assessment.
      • Family support system
    • PHYSICAL EXAMINATION
      • General appearance and behavior
      • Vital signs
      • Nutritional and fluid status, weight and Height
      • Inspection and palpation of heart
    • PHYSICAL EXAMINATION
      • Auscultation of heart
      • JVP
      • Peripheral pulses.
      • Peripheral edema.
    • 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.
    • NURSING DIAGNOSIS
      • Fear related to surgical procedure, its uncertain outcome, and the threat of well-being.
      • Goal: To reduce fear.
    • 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.
    • COMMUNICATION
    • INTERVENTIONS
      • Encourage the patient to talk about the fear of dying.
      • Patient should be reassured and misconceptions should be corrected.
    • NURSING DIAGNOSIS
      • Knowledge deficit regarding the surgical procedure and the postoperative course.
      • Goal: To provide the knowledge regarding surgery
    • INTERVENTIONS
      • Patient and family teaching about
      • Hospitalization
      • Surgery
      • Length of surgery
      • Expected pain and discomfort
      • Critical care phase
      • Recovery phase
    • PATIENT TEACHING
    • 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
    • NURSING DIAGNOSIS
      • Potential for complications related to the stress of impending surgery (Angina, Severe anxiety, Cardiac arrest)
      • Goal: To monitor and manage the complications
    • INTERVENTIONS
      • Assess for complications
      • Angina: oxygen therapy and nitroglycerine therapy.
      • Severe anxiety: emotional support
      • Cardiac arrest: cardiac life support
    • INTRAOPERATIVE NURSING MANAGEMENT
      • Assisting in surgical procedure
      • Continuous monitoring
      • Monitoring for complications: dysrhythmias, hemorrhage, MI, CVA, embolization etc.
    • INTRAOPERATIVE MANAGEMENT
    • POST OPERATIVE NURSING MANAGEMENT
      • ASSESSMENT:
      • Neurological status
      • Cardiac status
      • Respiratory status
      • Peripheral vascular status
      • Renal function
      • Fluid & electrolyte status
    • POST OPERATIVE ASSESSMENT Contd…
      • Pain
      • Assessment of equipments and tubings
      • Psychological and emotional status as patient regains consciousness
      • Assessing for complications.
    • ASSESSMENT
    • NURSING DIAGNOSIS
      • Decreased cardiac output related to blood loss and compromised myocardial function
      • Goal: To restore cardiac output
    • 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
    • INTEREVENTIONS
      • Assess cardiac enzymes
      • Monitor urinary output
      • Observe for persistent bleeding
      • Observe for cardiac temponade
      • Observe for cardiac failure
      • Observe for myocardial infarction.
    • NURSING DIAGNOSIS
      • Risk for impaired gas exchange related to trauma of extensive chest surgery
      • Goal: To maintain adequate gas exchange
    • 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
    • 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
    • EARLY AMBULATION
    • NURSING DIAGNOSIS
      • Risk for alteration in fluid volume and electrolyte balance related to alteration in blood volume
      • Goal: To maintain fluid and electrolyte balance
    • 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
    •  
    • NURSING DIAGNOSIS
      • Pain related to operative trauma and pleural irritation caused by chest tubes
      • Goal: To relieve pain
    • 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
    • PAIN MEDICATION
    • NURSING DIAGNOSIS
      • Risk for alteration in renal perfusion related to decreased cardiac output, hemolysis, or vasopressor therapy
      • Goal: To maintain adequate renal perfusion
    • INTERVENTION
      • Measure urine output strictly
      • Monitor renal function tests
      • Report to physician if urine output less
      • Administer medications as prescribed
    • NURSING DIAGNOSIS
      • Risk for hypothermia/hyperthermia related to cardiopulmonary bypass surgery, infections etc.
      • Goal: To maintain normal body temperature
    • 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
    • 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.
    • CARE OF THE GRAFT DONOR SITE RADIAL ARTERY
    • CARE OF CHEST TUBE
    • NURSING DIAGNOSIS
      • Risk for sensory- perceptual alterations related to sensory overload
      • Goal: to prevent postcardiotomy syndrome
    • 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
    • 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
    • NURSING DIAGNOSIS
      • Knowledge deficit about self care activities
      • Goal: to help the patient in the performance of self care activities
    • INTERVENTIONS
      • Develop teaching plan for patient and family specifically about:
      • Diet
      • Activity progression
      • Exercise
      • Deep breathing, coughing exercises
      • Medication regimen
      • Follow up
    •  
    • Thank You