RSPT 2266-2267 Practicum

RSPT 2266-2267 Patient Sticker

CABG CASE STUDY

Student ____________________________________________ Date ___________________________

A. Describe a Coronary Artery By-Pass Graft (CABG) procedure. (Use back of page if necessary.)

B. Demographic Data

Age: Ht: Wt: Sex:

Occupation: Admission date:

Other:

C. Health History

1. What symptoms prompted this patient to seek medical attention?

2. History of present illness:

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3. Past medical history:

4. Family history:

D. Diagnostic Imaging

Date/Procedure Interpretation

E. ECG

Date/Time Interpretation

F. Pulmonary Function Studies

Normal Patient
Date/Test Values Result Interpretation

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G. Patient Assessment (post-op)

1. Breathing pattern:

2. Sensorium: Glascow Coma Scale

Eyes Opening (E) Verbal Response (V) Motor Response (M)

1 None None None
2 To pain Incomprehensible sounds Decerebrate posturing
3 To voice Utters inappropriate words Decorticate posturing
4 Spontaneous Confused, disorientated Withdraws to pain
5 Normal Localizes to pain
6 Normal

Total Glascow Coma Score (GCS) = E + V + M

Immediate
Post-op Hourly Post-op

GCS

3. Chest examination:

a. Auscultation:

1 Clear
2 Diminished
3 Absent
4 Wheezes
5 Rhonchi
6 Rales
7 Pleural rub

b. Size and shape of chest:

c. Excursion:

d. ETT size, route, depth:

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4. Physical observations:

Respiratory Peripheral Cough Sputum Sputum Sputum

Distress Cyanosis Edema Quality Amount Consistency Color Clubbing

None None None Clear None Thin Clear None

Mild Nail beds +1 Tight Small Thick White Mild

Mod. Fingers +2 Loose Mod. Viscid Yellow Mod.

Severe Lips +3 Croupy Large Frothy Green Severe

Tongue Harsh Brown

Toes Pink

Severe Bloody

5. Vital Signs:

Normal
Value Hourly Post-op

Date/Time

HR

RR

BP

Temp

SpO2

FiO2

Input

Output

CVP

PAP

PCWP

6. Other observations:

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H. Ventilator Checks

First
Post-op Hourly Post-op

Date/Time
FiO2
Mode
RR set
RR spont

RR total
VT set
VT mand
VT spont

IT
I:E
PEEP
PS
PIP
PPLAT
CDYN
Cs
PETCO2

I. Arterial Blood Gas Analysis

Baseline Post-op
Date/Time
pH
PaCO2
HCO3-
PaO2
SaO2
FiO2
Vent Settings
Interpretation

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J. Laboratory Studies

Normal
Value Admission Post-op

Date/Time

Hb

Hct

Na

Cl

Ca

WBC

Total protein

Albumin

Glucose

BUN

Creatinine

Bilirubin

Treponin
Creatine
Phosphokinase
(CPK, CK)

K. Other

Normal
Values Admission Post-op

Date/Time

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L. Pharmacology

1. List all drugs the patient has received. Describe the action, dosage and frequency of each drug. Also identify
possible cardiopulmonary side-effects of each drug.

Dosage/
Drug Route Freq Action Cardiopulmonary Side-Effects

M. Assessment

1. From your analysis of the subjective/objective information obtained, list all of the data that supports the need for
CABG surgery in this patient. Be specific and complete.

N. Post-Op Evaluation

1. Complete the following diagram of this patient’s grafts.

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2. Describe other procedures that, in some patients, may be an alternative to a CABG operation.

3. What is the purpose for deliberate hypothermia during the operative CABG procedure?

4. How does hypothermia affect the oxyhemoglobin dissociation curve? Include in your discussion, the effects on
hemoglobin affinity for oxygen, PaO2 and tissue oxygenation.

5. How is your patient being warmed in ICU?

6. Does your patient have a chest tube? Describe its purpose and location.

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7. How soon will this patient most likely be weaned from mechanical ventilator support?

8. What weaning parameters must be met before the ventilator is discontinued? Be specific (parameters and
normal values).

9. List potential complications that may arise from the CAB operation and the mechanical ventilation. What
respiratory care would be required to prevent/treat each potential complication? Include goals for each
respiratory care procedure described.

10. When will this patient be ambulated?

11. Describe the modifications this patient will need to make in his lifestyle (diet, exercise, stress levels, etc.) to
remain healthy.