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Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
Cabg Teaching
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Cabg Teaching

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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

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