Post on 13-Nov-2014
description
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