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Terms in this set (20)
_______ is a invasive surgical procedure performed to bypass an obstruction in one or more of the coronary arteries and is effective when the patient has sufficient ventricular function.
Coronary Artery Bypass surgery
What are some indications for a CAB surgery?
-over 50% blockage of the left main coronary artery with anginal episodes
-significant two-vessel disease with unstable angina
-Triple-vessel disease with or without angina
-Persistent ischemia or likely MI following coronary angiography
-HF or cardiogenic shock
-heart valve disease
What is the single most important form that the nurse must ensure is in the patient medical record before the CAB surgery?
Informed consent form
What are some medications that the nurse needs to administer as prescribed pre-op to CAB surgery?
-Anticholinergics to reduce secretions
List some patient teaching pre-op for a patient undergoing CAB surgery.
-provide instruction to the client and family about the procedure and post-op environment
-Inform client importance of C&DB to prevent complications
-Inform client to splint the incision when C&DB
-instruct patient to report any pain to the nursing staff
What should the nurse inform the client/family to expect post-operatively ?
-Endotracheal tube and mechanical vent for airway management
-inability to talk while the trach tubes are in place
-Sternal incision and possible leg incision
-one to two chest tubes
-hemodynamic monitoring devices
What medications should be discontinued prior to CAB surgery?
-Anticoagulants/aspirin 1 week prior
-diuretics 2-3 days prior
-Dig 12 hrs prior
What medications should the patient continue to take?
-scheduled antidysrhythmias such as amiodarone
-scheduled antihypertensives such as metoprolol
What nursing actions should the nurse anticipate post-operatively to a CAB surgery?
**Maintain airway: monitor resp rate and effort, auscultate, breath sounds, monitor SaO2, Document ventilator settings, suction as needed, assist with extubation
How often/by when should the nurse anticipate ambulating the patient?
**Turn the patient within 2 hr following extubation
**Assist the patient to a chair within 24 hr
**Ambulate patient 25 to100 ft bt the first post-op day
The nurse should monitor patient BP post-op because hypotension and hypertension could occur from what two things?
hypotension due to graft collapse and hypertension due to graft bleeding.
The nurse should monitor pt LOC q __?__ min until the pt awakens from anesthesia and q__?__ hr after that.
1. 30-60 min
2. 2-4 hr
The nurse should monitor chest tube patency and drainage at least once an hour and a volume exceeding ____ could be a sign of hemorrhage and should be reported.
Post- op to a CAB surgery, it is important that the nurse can differentiate between anginal pain and incisional pain. What is the difference in the pain between the two?
**Anginal pain often radiates and is unaffected by breathing
**incisional pain is localized, sharp, aching, burning, and often worsens with deep breathing
What should the nurse instruct the patient about regarding treatment of angina post-operatively?
**Maintain a fresh supply of sub lingual nitro
**Store the nitro in light-resistant container
** Discontinue activity and rest with the onset of pain
What should the nurse instruct a diabetic patient about post-op to CAB surgery?
The nurse should teach the patient to consume a heart-healthy diet. what is consider a heart-healthy diet?
What should the nurse instruct the patient about resuming normal activity?
*remain home during the first week after the surgery
*Week2-- return to work part time
*Week 3-- lift up lb only
*Avoid lifting heavier than 15 lbs for 6 to 8 wks
The nurse should inform the patient he/she can resume sexual activity when the patient is able to do what?
*walk 1 block or climb 2 flight of stair symptom-free
What are some complications that could occur due to the CAB surgery?
*Decrease CO: cardiac temponade, hypovolemia, left ventricular HF
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