CABG final.docx

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Elham Ali Ahmed Ali
Holds a Bachelor's degree
in Nursing,
Ain Shams University,
holds a diploma in therapeutic nutrition
approved by the Arab Studies Center and accredited by the
foreign consulate,
and
holds a diploma in a medical quality
foreign consulate
and
holds a diploma in an infection control
foreign consulate
and
holds a Mini master’s in Medical administration
foreign consulate.

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subject
 Introduction
 Reviewabout coronary vein
 Definition CABG
 Propose of CABG
 Indication of CABG
 Contraindication ofCABG
 Coronary artery bypass graft sides
 Types of CABG
Traditional
procedure
Off pump
Minimally invasive CABG
MIDCAB
Port-access coronary artery bypass
Robot-Assistedtechnique
 Complication
 Diagnosis evaluation
 Recovery
 Recovery at hospital
 Recovery at home
 Followup
 rehabilitation
 Nursing management for CABG
Preoperative
Intraoperative
Postoperative
 Nurse care plan
 Summary
 Reference
Introduction
The heart is amazing organ and have amazing power and
the functions of its many parts.

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How is the organs in your body nourished?
By the blood carry oxygen and minerals that needed it
How is arrive blood to organs?
By circulatory system
What is circulatory system?
Is pulmonary circulation and systemic circulation through
cardiovascular system.
Cardiovascular system
Arteries in the body:-
 Carry oxygenationblood from aorta to organs.
Veins in the body:-
 Carry deoxygenationblood from body to inferior and superior
vena cava.
How is the heart nourished?
By coronary circulation.
What is coronary circulation and how is nourished
the heart?
Pulmonary circulation
Enter Deoxygenationblood toinferior and superior vena cava to
RT atrium RT ventricle pulmonary artery
lung (change gases)
Systemic circulation
Exit oxygenation blood from lung to LT atrium LT
ventricle Aorta to all system tissuesfrom head to toe.

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 The coronary circulation ispart from of the systemic
circulatorysystem
 that suppliesblood to the heart through coronaryartery
 Provide drainage from tissuesof the heart is coronary veins.
Coronary artery
 Coronary arteries arise from the ascending aorta,
immediately above aortic valve
 The coronary arteriesand their branches runon the surface of
the heart
 Lying withinthe sub pericardial fibber fattytissue
The heart content on coronary artery and coronary vein
Coronary arteries:-
 is responsible for supplies oxygenationblood to heart
muscle
Coronary veins:-
 is responsible for drainage deoxygenationblood to RT
atrium.

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 Anatomically coronaryarteriesare not end-arteries
But functionally they like end arteries.
Why is anatomically the coronary arteries are not
end-arteries but functionally they like end arteries?
Because the coronary artery content on anastomoses
The coronary artery divide to RT coronary artery
and LT coronary artery
Anastomoses
is connectionbetweenterminatesofartery with terminates
another artery
but
functionboth arteries have functionespecialto hem.

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Right coronary artery
Origin:-

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 Arise from the anterior aortic sinus of ascending aorta,
immediately above the aortic valve.
Course:-
 After arising from ascending aorta the right coronary artery
first run forwardsbetween pulmonary trunk and the right
auricle
 thenit almost ventricle into the right atrioventricular groove (
also called the right anterior coronarysulcus)
 Up to junctionof the right and inferior borders of the heart at
the inferior bordersof the heart
 Thenturn posteriorly
 Run up to the posterior atrioventricular groove and
terminatesby anastomosingwith the left coronary artery.
Branches and distribution:-
 Right couns artery :-
 It supplies the anterior surface of the pulmonary couns
 Anterior ventricularbranches :-
 They are two or three and suppliesthe anterior of the right
ventricle
 The marginal artery :-
 Is the largest and sup lies along the lower marginof the
sternal surface to reach the apex

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 Atrial branches :-
 They supply the atria
 The Sino atrial node artery:-
 Is one of atrialbranches,
 supplies the SA node in the 60% of cases in 40% of individuals
it is arisesfrom the left coronary artery.
 Posteriorventricular branches :-
 they are supply the diaphragmaticsurface ofright and left
ventricles
 Posteriorinterventricularartery :-
 It runs in the posterior interventricular groove up to the apex
 It supplies the posterior part of the interventricular septum,
AV node in 60% casesand RT and LT ventricles.
Left coronary artery
Origin:-

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 Arise from the posterior aortic sinusof ascending aorta,
immediately above the aortic valve.
Course:-
 After arising from ascending aorta the left coronary artery
run forwardsbetween pulmonary trunk and the left auricle.
 It then divide in to an anterior interventricular artery(also
called left anterior descending) and circumflex artery
 left anterior descending isrun downward in the anterior
interventricular groove tothe apex of the heart
 thenpasses posteriorly around the apex of the heart
 To enter the posterior interventricular groove toterminate by
anastomosing with the posterior interventricularartery a
branch from right coronary artery.
 the circumflex artery:-
 passes around the left margin of the heart and continuesin left
posterior coronary sulcus
 Up to the posterior atrioventricular groove where it
terminatesby anastomosingwith rightcoronary artery.
Branches and distribution:-
 anterior interventricularartery ( also called left anterior
descending artery ) :-
 it supply anterior interventricularseptum

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 greater part of the left ventricle and
 part of the right ventricle , and
 a part of left bundle branch .
 circumflex artery :-
 it givesa left marginalartery that suppliesthe left marginof
the left ventricle up to the apex of the heart
 diagonal artery :-
 it may arise directly from the trunk of left coronary artery.
 Couns artery :-
 it suppliesthe pulmonary couns
 Atrial branches :-
 they supply the left atrium
Over time, these arteriescanbecome narrowed and hardened by
the build-up of fatty depositscalled plaques.
 Thisprocess is knownas atherosclerosis.
 People with atherosclerosisofthe coronary arteriesare said to
have coronary heart disease.
How does the heart maintain its normal
function?
 Regulate the timing of heart beat.
 Keep the heart muscle healthy.
 Keep blood flowing efficiently.

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 It happenswhen the supply of oxygen-rich blood tothe heart
becomes restricted.
 Risk associated with coronary heartdisease isthe possibility of
one of the plaques in the coronary artery rupturing (splitting),
creating a blood clot.
 If the blood clot blocks the blood supply to the heart, it can trigger
a heart attack.
A coronary artery bypass graft may be recommended
To reduce your chances of having a heart attack.
Definition
A coronary artery bypass graft (CABG)
A surgicalprocedure used totreat coronary heart disease.
 It divertsblood around narrowed or clogged partsof the major
arteriestoimprove blood flow and oxygensupply to the heart.

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CABG-CORONARY ARTERY BYPASS GRAFTING
 A cardiothoracicsurgeon doesthe surgery with support from
an anesthesiologist, perfusionist (heart-lung bypassmachine
specialist), other surgeons, and nurses.
 There are several typesof CABG .
Propose
1. Restore blood flow to the heart.
2. Relieve chest pain& ischemia.
3. Improves the patient’squalityoflife.
4. Enables the patient toresumea normal life cycle.
5. Lower the risk of a heart attack.
Indication
1. Left mainarterydiseaseor equivalent

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2. Triplevessel disease
3. AbnormalLeft Ventricularfunction.
4. Failed PTCA.
5. Immediatelyafter MyocardialInfarction(tohelp perfusionof the
viablemyocardium).
6. Life threatening arrhythmiascaused bya previousmyocardial
infarction.
7. Occlusionof graftsfrom previous CABG.
Contraindication
1. Abdominalaortic aneurysm
2. Hemorrhagediseases
3. congenitalheart diseases
4. Lower extremitiesedema
5. Severe hypertension
6. Uncontrolled arrhythmias
7. patient refusal
8. coronaryarteriesincompatiblewith grafting
9. The absenceof viablemyocardium tograft.
Coronary artery bypasses graft sites
 Internal mammaryarteries
 Radialarteries
 Greater saphenousveins

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 The number of blood vessels used will depend on how severe a
coronary heart disease isand how many of the coronary blood
vessels have become narrowed.
 If you need 2, 3 or 4 grafts, you may hear the operationreferred
to as a double, triple or quadruple bypass.
Double bypass means twocoronary arteriesare
bypassed (e.g. the left anterior descending (LAD) coronary
artery and right coronary artery (RCA)

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Triple bypass meansthree arteriesare bypassed (e.g.
LAD, RCA, left circumflex artery(LCX)
Quadruple bypass meansfour vessels are bypassed
(e.g. LAD, RCA, LCX, first diagonalartery of the LAD)
 One of the graft vessels is usually takenfrom your chest (internal
mammary artery).
 Surgeonsprefer to use thisvessel because it doesn't narrow over
time, unlike the blood vessels takenfrom your leg or arm.
Types of CABG
Traditional Coronary Artery Bypass Grafting
 On-pump CABG
Nontraditional Coronary Artery Bypass Grafting
 off-pump CABG
 Minimally invasive CABG.
Uncommonly type
 MIDCAB procedure.
 Port-access coronaryartery bypass
 Robot-assisted technique

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Traditional Coronary Artery Bypass Grafting
On-pump CABG
 the heart is stopped, and a heart-lung bypassmachine isused .
 Thisis the most commontype of coronary artery bypassgrafting
(CABG).
 It's used whenat least one major artery needsto be bypassed.
Procedure
 Thistype of surgery usually lasts 3 to 5 hours, depending on the
number of arteriesbeing bypassed.
 Numerousstepstake place during traditionalCABG.
 The pt will' be under general anesthesia for the surgery.
 During the surgery, the anesthesiologist checksyour heartbeat,
blood pressure, oxygenlevels, and breathing.
 A breathing tube isplaced and the tube is connected toa
ventilator (a machine that helpsyou breathe).
 An incisionis made down the center of the chest, at least 6 to 8
incheslong.
 The chest bone is thencut and the ribcage isopened so that the
surgeoncan get to the heart.

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 Medicinesare used to stop the heart, which allowsthe surgeonto
operate on it while it's not beating.
 The pt also given medicinestoprotect your heart function during
the time that it'snot beating.
 A heart-lung bypassmachine keepsoxygen-rich blood moving
throughout your body during the surgery.
 An artery or vein is taken from your body—for example, from
your chest or leg—and prepared to be used as a graft for the
bypass.
 In surgery with severalbypasses, both artery and veingraftsare
commonly used
 After the grafting is done,
 Blood flow to the heart isrestored.
 Usually, the heart startsbeating againonitsown.
 In some cases, mild electric shocksare used to restart the heart.
 The pt thendisconnected from the heart-lung bypassmachine.
 Tubesare inserted intothe chest to drainfluid.
 The surgeon uses wiresto close your chest bone (much like how a
brokenbone is repaired).
 The wiresstay in your body permanently.
 After your chest bone heals, it will be as strong as it wasbefore
the surgery.
 Stitchesor staplesare used to close the skin incision.
 The breathing tube isremoved whenyou're able to breathe
without it

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Off-pump CABG
 Thistype of CABG is similar to traditionalCABG because the
chest bone is opened to accessthe heart.
 However, the heart isn't stopped, and a heart-lung bypass
machine isn't used.
 Off-pump CABG is sometimes calledbeating heart bypass
grafting.
 A member of the surgicalteam uses a device to stabilize just the
portionof the heart where the bypassis needed, while the
remainder ofthe heart keepspumping and circulatingblood to
the body.
 With a particular area of the heart steadied, a surgeonis able to
bypassthe blocked artery in a controlled environment.

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Minimally Invasive Coronary Artery Bypass Grafting
 There are several typesof minimally invasive coronary artery
bypassgrafting.
 These typesof surgery differ from traditionalbypasssurgery.
 They only require small incisionsrather thanopening the chest
bone to get to the heart.
 These proceduressometimes use a heart-lung bypassmachine.

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MIDCAB
 Thisprocedure isused when only one or two coronary arteries
need to be bypassed.

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 A seriesof small incisions is made betweenyour ribs on the left
side of your chest, directly over the artery tobe bypassed.
 The incisionsusually are about 3 incheslong.
 A heart-lung bypassmachine isn't used during thisprocedure.
Port-access coronary artery bypass procedure
 Thisprocedure isdone through smallincisions(ports) made in
the chest.
 Artery or vein graftsare used.
 A heart-lung bypassmachine isused during thisprocedure

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Robot-assisted technique
 Thistype of procedure allows for even smaller, keyhole-sized
incisions.
 A small video camera isinserted in one incision toshow the
heart,
 Whilethe surgeon uses remote-controlled surgicalinstruments
to do the surgery.
 A heart-lung bypassmachine issometimesused during this
procedure.

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Types of CABG
traditi
onal
Non-
traditi
onal
Non-
traditional
uncommon
On-
pump
CABG
off-
pump
CABG
Minimally
invasive
CABG.
MIDCAB Port-access
coronary
artery
bypass
Robot-
assisted
technique
incision Made
center
of
chest
at least
6 to 8
inches
Made
center
of
chest
at least
6 to 8
inches
Small
incision
about 3
inchesin
heart
located
Small
incision
about 3
inchesin
heart
located
And
Many of
small
incision
(ports)
Many of
small
incision
(ports)
Many of
small
incision
(ports)
Heart-lung
bypass
machine
used Isn`t
used
sometimes Isn`t
used
used sometimes

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Complication
Although complications from coronary artery bypass
grafting (CABG) are uncommon,
Risk to complication also is higher if you have other
diseases or conditions, such as diabetes, kidney disease,
lung disease, or peripheral arterial disease
Or
If the pt older than 60, or if and have a history of smoking
 Wound infection
 bleeding
 Reactionsto
anesthesia
 Decrease C/O
 Bradycardia
 Electrolyte
imbalance
 Arrhythmia
 Heart failure
 Fever
 Stroke
 Pleuraleffusions )develop fluid buildup
around the heart)
 Renal failure
 Pain
 heart attack
 death
 Some patientsdevelop a fever
associated with chest pain, irritability,
decreased appetite
 Thisis due to inflammationinvolving
the lung and heart sac.

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Diagnostic evaluation
 PhysicalExam and Diagnostic Tests-
Complete blood count (CBC)
Chem 7 blood chemistrypanel
 Blood urea nitrogen(BUN)
 Carbondioxide
 Creatinine
 Glucose
 Serum chloride
 Serum potassium
 Serum sodium
Liver functionpanel (liver functiontests, LFTs)
Kidney functionpanel (kidney functiontests, KFTs)
PT/PTT/INR (coagulationstudy)
Arterialblood gas (ABG)
 ECG (Electrocardiogram)
 MRI
 Echocardiography
 Coronary Angiography
 Cardiac stresstest
 Echocardiogram
 Pulmonary functiontests

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Recovery
Recovery in the Hospital
 After surgery, the pt will typically spend 1 or 2 days in an
intensive care unit (ICU).
 Assess heart rate, blood pressure, and oxygenlevels will be
checked regularly during thistime.
 An intravenousline (IV) will likely be inserted intoa vein in your
arm.
 Through the IV line, may get medicines to
 controlblood circulationand blood pressure and
 manage pain
 And lower cholesterol
 and medicationtoreduce the risk of blood clots forming
 and medicationmanage diabetes;
 Or treat depression.
 Also will likely have a tube in the bladder to drainurine and a
tube to drainfluid from the chest.
 May receive oxygentherapy (oxygengiventhroughnasalprongs
or a mask or connect with ventilation) and a temporary
pacemaker while inthe ICU.
(A pacemaker is a small device that's placed in the chest or
abdomen to help control abnormal heart rhythm)
 Doctor may recommend that wear compressionstockingsonthe
legs as well.
(These stockingsare tight at the ankle and become looser as they
go up the leg)

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(This creates gentle pressure up the leg)
(The pressure keeps blood from pooling and clotting)
 While in the ICU, the pt will also have bandageson your chest
incision (cut) and on the areaswhere an artery or vein was
removed for grafting.
 After the pt leave the ICU, the pt will be moved to a less intensive
care area of the hospitalfor 3 to 5 daysbefore going home.

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Recovery at Home
 the doctor will give to pt specific instructionsfor recovering at
home, especially concerning:
 How to care for healing incisions
 What is medicationtotaken
 How to recognize signsof infectionor other
complications
 Whento call the doctor right away
 Whento make follow up appointments
 And also may get instructionsonhow to deal with
commonside effectsfrom surgery.
 The doctor will tell to whenhe canstart physicalactivityagain.
 It varies from person to person, but there are some
typicaltimeframes.
 Most people can resume sexual activitywithinabout 4
weeksand driving after 3 to 8 weeks.
 Returning to work after 6 weeks is commonunless your
job involves specific and demanding physicalactivity.
 Some people may need to find less physically demanding
typesof work or work a reduced schedule at first.
Follow up

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 Care after surgery may include periodic checkupswith doctors.
 During these visits, testsmay be done to see how the heart is
working.
 Testsmay include ECG (electrocardiogram), stresstesting,
echocardiography, and cardiacCT.
 CABG is not a cure for coronary heart disease (CHD), coronary
heart disease is a chronic disease.
Must be maintaintake the medicationafter surgery.
 The pt and the doctor may develop a treatmentplanthat includes
lifestyle changesto help the pt stay healthy and reduce the chance
of CHD getting worse.
 Lifestyle changesmay include making changesto the diet,
quitting smoking, doing physicalactivityregularly, and lowering
and managing stress.
 The doctor also may refer you to cardiac rehabilitation(rehab).
Rehabilitation

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(Cardiac rehab is a medically supervised program that helps
improve the health and well-being of people who have heart
problem)
 Rehab programsinclude exercise training, educationonheart
healthy living, and counseling to reduce stressand help you
returnto an active life.
 Doctorssupervise these programs, which may be offered in
hospitalsand other community facilities.
 Talk to your doctor about whether cardiac rehabmightbenefit
you.
 Taking medicinesasprescribed alsois an important part of care
after surgery.
 The doctor may prescribe medicinestomanage painduring
recovery;
 lower cholesteroland blood pressure;reduce the risk of blood
clots forming;
 Manage diabetes;or treat depression.
NURSING MANAGEMENT OF CABG PATIENT
NURSINGMANAGEMENT
 Preoperative Nursing Management.
 Intraoperative NursingManagement.
 Postoperative NursingManagement

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PREOPERATIVE NURSING MANAGEMENT
 The preoperative nursing management
 Usually beginsbefore hospitalization.
 Patientswith non-acute heartdisease
 may be admitted tohospitalthe day
 Before or the day of their surgery.
PREOPERATIVE ASSESSMENT
 History Physicalexamination
 Radiographicexamination
 Electrocardiogram
 Laboratory analysis
 Typing and cross-matching ofblood.
 Assessing patient’sfunctionallevel
 Psychosocialassessment.
 Family support system
PHYSICAL EXAMINATION
 Generalappearance and behavior
 Vitalsigns
 Nutritionaland fluid status, weight and Height
 Inspectionand palpationof heart
 Auscultationofheart
 JVP
 Peripheralpulses.
 Peripheraledema.
PSYCHOSOCIAL ASSESSMENT
 Meaning of surgery to patient
 Coping mechanismsbeing used.
 Anticipated changesinlifestyle
 Support system ineffect
 Fear regarding present & future

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 Knowledge & understanding ofsurgicalprocedure
INTRAOPERATIVE NURSINGMANAGEMENT
 Assisting in surgicalprocedure
 Continuousmonitoring
 Monitoring for complications:dysrhythmias, hemorrhage,
MI, CVA, embolizationetc.
POST OPERATIVE NURSINGMANAGEMENT
ASSESSMENT:
 Neurologicalstatus
 Cardiac status
 Respiratory status
 Peripheralvascular status
 Renal function
 Fluid & electrolyte status
 Pain
 Assessment of equipment and tubing
 Psychologicaland emotionalstatusas patient regains
consciousness
 Assessing for complications.
Nurse care plan
NURSINGDIAGNOSIS
 Fear related to surgicalprocedure, itsuncertainoutcome, and
the threat of well-being.
Goal:

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 To reduce fear.
INTERVENTIONS
 Allowing patient and family to expresstheir fears.
 Explainthe patient regarding surgeryand sensationsthat are
expected during and after the surgery.
 Reassuring the patient that fear of painis normal and explain
that some pain will be experienced but certainmeasureswill
help to relieve the pain.
COMMUNICATION
INTERVENTIONS
 Encourage the patient totalk about the fear of dying.
 Patient should be reassured and misconceptionsshould be
corrected.
NURSINGDIAGNOSIS
 Knowledge deficit regarding the surgicalprocedure and the
postoperative course.
Goal:
 To provide the knowledge regarding surgery
INTERVENTIONS
 Patient and family teaching about
 Hospitalization
 Surgery
 Length of surgery
 Expected painand discomfort
 Criticalcare phase
 Recovery phase
PATIENT TEACHING
INTERVENTIONS
 Physicalpreparationbefore surgery

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 Medicationsbefore surgery
 Informationregarding equipment, tubesthatwillbe present
postoperatively
 Teaching the postoperative exercises.
 Outcome of the surgery
NURSINGDIAGNOSIS
 Potentialfor complicationsrelated tothe stress of impending
surgery (Angina, Severe anxiety, Cardiacarrest)
Goal:
 To monitor and manage the complications
INTERVENTIONS
 Assess for complicationsAngina:oxygentherapyand
nitroglycerinetherapy.
 Severe anxiety:emotionalsupport
 Cardiac arrest:cardiaclife support
NURSINGDIAGNOSIS
 Decreased cardiac output related toblood loss and
compromised myocardialfunction
Goal:
 To restore cardiac output
INTEREVENTIONS
 Monitor cardiovascularstatus
 Assess arterialpressure every 15 min. untilstable
 Auscultate for heart sounds and rhythms
 Assess all peripheralpulses
 Hemodynamic monitoring
 ECG monitoring

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 Assess cardiac enzymes
 Monitor urinary output
 Observe for persistent bleeding
 Observe for cardiac temponade
 Observe for cardiac failure
 Observe for myocardialinfarction.
NURSINGDIAGNOSIS
 Risk for impaired gasexchange related totrauma of
extensive chest surgery
Goal:
 To maintainadequategasexchange
INTERVENTIONS
 Maintainproper ventilation
 Monitor arterialblood gases, tidalvolumes, peek inspiratory
pressuresand extubationparameters
 Auscultate chest for breath sounds
 Provide chest physiotherapyasprescribed
 Promote deep breathing coughing and turning, use of
incentive spirometer.
 Teach incisionalsplinting with a cough pillow to decrease
discomfort during deep breathingand coughing
 Suctiontracheobronchialsecretionsasneeded, using aseptic
technique
EARLY AMBULATION
NURSINGDIAGNOSIS
 Risk for alterationin fluid volume and electrolyte balance
related to alterationinblood volume
Goal:
 To maintainfluid and electrolyte balance
INTERVENTIONS

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 Maintainintake 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
NURSINGDIAGNOSIS
 Painrelated to operative trauma and pleuralirritation
caused by chest tubes
Goal:
 To relieve pain
INTERVENTION
 Record nature, type, locationand duration
 Providing comfortable position
 Assist patient to differentiatebetweensurgicaland angina
pain Administerprescribed painmedication
 Encourage relaxationtechniques
PAIN MEDICATION
NURSINGDIAGNOSIS
 Risk for alterationin renal perfusionrelated to decreased
cardiac output, hemolysis, or vasopressor therapy
Goal:
 To maintainadequaterenalperfusion
INTERVENTION
 Measure urine output strictly
 Monitor renal functiontests
 Report to physicianifurine output less
 Administer medicationsasprescribed
NURSINGDIAGNOSIS

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 Risk for hypothermia/hyperthermiarelated to
cardiopulmonarybypasssurgery, infectionsetc.
Goal:
 To maintainnormalbody temperature
INTERVENTIONS
 Warm the patient gradually with warmair or warm
blanketsor heat lamps
 Assess for dysrhythmiasdue tohypothermia
 Assess for elevated body temperature
 Assess for infection( lungs, urinary tract, incisionsand
intravascular catheter
 Use the aseptic technique while dressing and other
procedure
 Using proper hand washing technique Meticulouscare tobe
takento prevent contaminationat the sites of catheterand
tube insertion
CARE OF THE GRAFT DONOR SITE RADIAL ARTERY
CARE OF CHEST TUBE
NURSINGDIAGNOSIS
 Risk for sensory- perceptualalterationsrelated tosensory
overload
Goal:
 to prevent postcardiotomysyndrome
INTERVENTIONS
 Explainall proceduresto patient
 Plan nursing care to provide for periodsof uninterrupted
sleep with day-night pattern
 Decrease sleep preventing environmentalstimuli asmuch
as possible
 Promote continuityofcare from nurse to nurse

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 Orient the patient totime, place and person.
 Encourage the family to visit at regular times
 Teach relaxationand divisionaltechniques
 Observe for signs of pericardiotomy syndrome
NURSINGDIAGNOSIS
 Knowledge deficit about self-care activities
Goal:
 to help the patient in the performance of self-care activities
INTERVENTIONS
 Develop teaching planfor patient and family specifically
about:
 Diet
 Activity progression
 Exercise
 Deep breathing, coughing exercises
 Medicationregimenand Follow up

52 | P a g e
Reference
https://www.cincinnatichildrens.org/health/h/components
https://www.nottingham.ac.uk/nursing/practice/resources/c
ardiology/function/anatomy.php
https://healthblog.uofmhealth.org/heart-health/anatomy-of-
a-human-heart
https://en.wikipedia.org/wiki/Coronary_circulation
https://www.slideshare.net/khaled_mahajna/cabg-
15830423?next_slideshow=1
https://www.slideshare.net/harmeet_dad/cabg-teaching
COCHIN CARDIAC CLUB: CORONARY ANGIOPLASTY AND
BYPASS SURGERY
https://www.futuremedicine.com/doi/10.2217/fca-2019-0050
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAH
A.111.052571
https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.05.063

53 | P a g e
https://www.ahajournals.org/doi/full/10.1161/01.cir.00001202
92.65143.f5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179773/
https://amj.amegroups.com/article/view/5479/html
https://www.nice.org.uk/guidance/ipg128
https://www.nice.org.uk/guidance/ipg494/ifp/chapter/What-
has-NICE-said
https://www.nice.org.uk/guidance/IPG377
https://www.icrjournal.com/articles/performing-and-
interpreting-fractional-flow-reserve-measurements-clinical-
practice-expert
https://www.ncbi.nlm.nih.gov/books/NBK549786/
https://pubs.rsna.org/doi/10.1148/rg.321115014
https://www.kenhub.com/en/library/anatomy/blood-supply-
of-the-heart
http://www.vhlab.umn.edu/atlas/coronary-system-
tutorial/coronary-venous-anatomy.shtml
https://www.britannica.com/science/coronary-vein

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