CORONARY ARTERY

BLOCKAGE
CORONARY ARTERY
BYPASS GRAFTING
 CURRENT AND POTENTIAL
PROBLEM – Post Operative
Patient might experience these complications;
 Excessive bleeding after surgery.
 Myocardial infarction or heart attack.
 Respiratory insufficiency / pneumonia.
 Kidney failure.
 Heart arrhythmias, or irregular heartbeats.
 Infection of the breastbone or the sternum.
 Infection can affect incisions of the leg or the hands
 Stroke.
 Mood swings.
 Persisting pain in breastbone.
 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

 INTERVENTIONS

 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
 INTERVENTIONS

 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
 PATIENT HEALTH
EDUCATION
For post operative care;
I. Wound care
 Do not wet the wound (first 3 weeks after surgery).
 Keep forearm / leg wounds dry.
 If wound get wet, immediately dap with dry towel.
 Use antiseptic soap when bath (after 3 weeks