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
 
Thank You

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Cabg Teaching

  • 1. NURSING MANAGEMENT OF CABG PATIENT Harmeet Kaur Kang Lecturer
  • 3.  
  • 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.
  • 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
  • 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.
  • 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.
  • 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
  • 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
  • 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
  • 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.