Coronary artery bypass grafting (CABG) is a surgical procedure that improves blood flow to the heart. During CABG, a healthy blood vessel is grafted to bypass blocked coronary arteries and restore blood flow to the heart muscle. The internal thoracic artery, radial artery, and saphenous vein are common graft conduits. The procedure requires general anesthesia and opening the chest via median sternotomy. Grafts are sewn to the coronary arteries above and below the blockages to reroute blood flow around them. Post-operative care focuses on monitoring for bleeding, arrhythmias, and other complications. Nursing care involves assessing the patient, providing wound care, managing pain, and educating on lifestyle changes and
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Nursing management of patient with cardiac surgeries.PrashantSalve10
It will be helpful to overview cardiac surgeries like CABG, Valvular surgeries and heart transplant. It also enumerates the nursing diagnoses and its brief description.
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Nursing management of patient with cardiac surgeries.PrashantSalve10
It will be helpful to overview cardiac surgeries like CABG, Valvular surgeries and heart transplant. It also enumerates the nursing diagnoses and its brief description.
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease.
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
This slide will provide illustrative information regarding coronary angioplasty . It also focus on practical area knowledge of cardiac catheterization which one should focus while caring patient with coronary angioplasty.
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
This slide will provide illustrative information regarding coronary angioplasty . It also focus on practical area knowledge of cardiac catheterization which one should focus while caring patient with coronary angioplasty.
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
3. Definition
“Procedure in which occluded coronary
arteries are bypassed with the patient’s
own venous or arterial blood vessels orown venous or arterial blood vessels or
synthetic grafts” (Ignatavicius &
Workman, 2010).
3
5. The major vessels of the coronary circulation
are the left main coronary that divides into left
anterior descending and circumflex branches,
and the right main coronary artery.
The left and right coronary arteries originate
at the base of the aorta from openings called
the coronary ostia located behind the aortic
valve leaflets.
5
6. The left and right coronary arteries and their
branches lie on the surface of the heart, and
therefore are sometimes referred to as the
epicardial coronary vessels.
These vessels distribute blood flow to
different regions of the heart muscle.
6
8. Purposes
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
Lower the risk of a heart attack
8
15. • Robotic-assisted coronary artery bypass grafting
is a minimally invasive procedure.
• The surgeon makes several small incisions
between the ribs, and then inserts a small
camera and small robotic arms through thecamera and small robotic arms through the
incisions.
• During the procedure, the surgeon sits at a
console and controls the robotic instruments.
• The camera that was inserted provides images
of the heart at a high magnification.
15
16. Common source grafts
Arterial Conduits.
Left Internal Thoracic (Mammary) Artery
(LIMA).
The ITA arise from subclavian artery just aboveThe ITA arise from subclavian artery just above
and behind the sternal end of the clavicle
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18. Radial Artery
The second artery that can be used as
arterial conduit for coronary graft is Radial
Artery (RA).
The RA arises from the bifurcation of theThe RA arises from the bifurcation of the
brachial artery in the cubital fossa and
terminates by forming the deep palmar arch
in the hand.
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20. Ulnar Artery
• when surgeons do not have other choice
they use Ulnar Artery as arterial conduit.
20
21. Gastroepiploic artery
The Gastroepiploic artery is sometimes used as
an arterial graft when the IMA cannot reach the
posterior surface of the heart or when other
conduits are not availableconduits are not available
21
22. Greater Saphenous Vein (GSV)
• The Greater Saphenous Vein (GSV) of the
lower extremity is the best choice.
GSV is harvested in two different ways:
Directly through multiple incisionsDirectly through multiple incisions
tunnelling over the vein along the medial
thigh and leg
Endoscopic vein harvest two small
incisions are made, one above the knee, and
the second upper thigh for this type of
harvest. 22
24. Procedure
• An endotracheal tube is inserted and secured by
the anaesthetist and mechanical ventilation is
started. General anaesthesia is maintained by a
continuous very slow injection of Propofol.continuous very slow injection of Propofol.
• The chest is opened via a median sternotomy
and the heart is examined by the surgeon
involves creating a 6 to 8 inch incision in the
chest (a thoractomy) .
24
26. • The bypass grafts are harvested – frequent
conduits are the internal thoracic arteries, radial
arteries and saphenous veins.arteries and saphenous veins.
• When harvesting is done, the patient is given
heparin to prevent the blood from clotting.
26
27. • "on-pump", the surgeon sutures cannulae into
the heart and instructs the perfusionist to start
cardiopulmonary bypass (CPB).
• Once CPB is established, the surgeon places
the aortic cross-clamp across the aorta and
instructs the perfusionist to deliver
cardioplegia to stop the heart and slow its
metabolism
27
30. when there is concern about multiple anastomoses on aorta,
surgeon can construct two or more distal anastomoses with a
single vein graft.
Sequential Distal Vein Graft Anastomoses
30
31. • Chest tubes are placed in the mediastinal and
pleural space to drain blood from around the heart
and lungs.
• The sternum is wired together and the incisions
are sutured closed.
• The patient is moved to the intensive care unit
(ICU) to recover.
31
32. • Nurses in the ICU focus on recovering the patient by
monitoring blood pressure, urine output and
respiratory status as the patient is monitored for
bleeding through the chest tubes.bleeding through the chest tubes.
• If there is chest tube clogging, Thus nurses closely
monitor the chest tubes and under take methods to
prevent clogging so bleeding can be monitored and
complications can be prevented.
32
34. Nursing Management
• Pre operative Phase• Pre operative Phase
• Intra operative Phase
• Post operative Phase
34
35. Patient History
• Patient history of major illness, previous
surgery, medications, and usage of drugs and
smoking and drug history
• A systematic assessment of all systems
performed ,with emphasis on cardiovascular
functioning
35
36. Physical Examination
Functional status of the cardiovascular system
determined by reviewing the patient symptoms,
including past and present experience
Chest pain, hypertension, palpation, cyanosis,
breathing difficulty, leg pain that occur withbreathing 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 ).
36
37. Physical Examination continued…..
General appearance and behavior.
Vital signs
Nutritional and fluid status ,weight, height.
Inspection and palpation of the heart, noting theInspection and palpation of the heart, noting the
point of maximal impulses ,abnormal pulsation.
Auscultation of the heart ,noting pulse rate, rhythm
and quality S4 and S3 , murmur, and friction rib
Jugular venous pressure
Peripheral pulses
Peripheral edema
37
38. 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.
38
39. Nursing Diagnoses
• Acute pain
• Decrease cardiac output
• Risk for infection
• Risk for alteration in fluid volume & electrolyte
imbalanceimbalance
• Risk for impaired gas exchange
• Risk impaired renal perfusion
• Impaired skin integrity
• Anxiety
• Fear
39
42. Discharge Planning & Teaching
What to expect at home
Pain in your chest around the incision area
Swelling in the leg at harvest site
Itchiness or tingling feeling at incision site
Weakness
Cardiac rehabilitation
Lifestyle & diet modification
Smoking cessation
Cardiac diet (Low salt, low cholesterol, low fat)
42
43. Discharge Planning & Teaching continued…
Activity
No driving for at least 4 to 6 weeks
Walking / climbing stairs are good exercise
Light household chores (folding clothes, setting tables
Self careSelf care
Shower & wash incision gently with soap and water
Do not use hot tubs until incision is completely healed
Adhere to all medication regimen
Have someone stay with you in your home for at least
first 1-2 weeks
43
