Cabg Teaching

65,965 views

Published on

Published in: Health & Medicine
8 Comments
43 Likes
Statistics
Notes
No Downloads
Views
Total views
65,965
On SlideShare
0
From Embeds
0
Number of Embeds
123
Actions
Shares
0
Downloads
1,657
Comments
8
Likes
43
Embeds 0
No embeds

No notes for slide

Cabg Teaching

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

×