THE NURSING CARE OF HYPOTENSION

ON POST CABG SURGERY

BY :
NOVIYANTIE
 INTRODUCTION
• 1200 cases of surgery, 36,7% are CABG
cases
• Problem that arise in the early postoperative
hours requiring immediate observation
• Common problem that can occur include
hypotension
 LITERATURE REVIEW
1. DEFINITION
• MAP of less 70 mmHg
• Hypotension can cause hypoperfusion of
vital organ system
2. CAUSE OF HYPOTENSION

BP = CO X SVR
CO= HR X SV
BP = HR X SV X SVR
 Cause of hypotension

1. Decrease preload
• absolute reduction in intravascular volume :
bleeding, inadequate replacement
• abnormal distribution of intravascular volume :
Gravitational forces, increased intrathoracic
pressure from mechanical ventilation, cardiac
tamponade, warming, right heart failure
2. Decrease contractility

3. Reduction in the systemic vascular resistance

4. Arrhythmias

5. Problem of health equipment

 DISCUSSION

a. Clinical manifestation
similar manifestation : disorientation, loss consciousness,
restlessness, tachypnea, oliguria, anuria

1. Decrease preload : CVP, PAP, PCWP, HR , pale skin

with mottling, dyspnea, dizziness, diaphoresis, in cardiac
tamponade present pulsus paradoxus, pericardial rubs
2. Decrease contractility : chest pain, ischemic or ST
elevation ECG change, CK-MB , CVP or no change,
PAP & PAWP , prolonged capillary

3. Reduction in SVR : CVP normal or ,tachycardia

b. Nursing intervention
1. Asses to determine causes of hypotension :
consciousness, pulse in arteries, peripheral perfusion,
chest tube for massive bleeding, recalibration, measure
CVP, PCPW, CI, SVR, accuracy of BP measurement,
infusion pump, ECG, ABGs, X-Ray.

2. Collaborative care : position, oxygen therapy, infusion

for hypovolemia, dobutamine& IABP for MI, chest tube
patency and reopened pericardium for cardiac
tamponade
3. Low cardiac output syndrome : ensure satisfactory O2 &
ventilation, optimize preload, inotrope & norepinephrin,
blood transfusion if Ht <26%
 CONCLUSIONS
- The possible causes of hypotension in second hours post
CABG are decrease preload, decrease contractility,
reduction in the SVR.
- Clinical manifestation and management of hypotension
depend on it causes
- Nurses requiring knowledge and ability to prevent
complication