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8/14/2019 My Case Pres

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It is also known as Bypass surgery, Coronary arterybypass surgery or Heart bypass surgery

Coronary artery bypass grafting (CABG) is a type ofsurgery that improves blood flow to the heart. It's used forpeople who have severe coronary heart disease (CHD), also

called coronary artery disease.It is surgery that involves the bypass of the blockage in

one or more of the coronary arteries using saphenous veins,mammary artery, or radical artery as conduits or replacementvessels.

It is the surgical restoration of blood flow to the vesselsserving the heart. It is a commonly used approach for thosewith obstructions of the heart vessels.


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Anatomy involveThe chest is opened by median

sternotomy for the access and

pericardium is incised. Saphenous

veins are being harvested.

The great saphenous vein is the

conduit of choice for vascular

surgeons when available, for doing

peripheral arterial bypassoperations because it has superior

long-term patency compared to

synthetic grafts or biosynthetic

grafts


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Coronary Artery

The aorta (the main blood supplier to the body) branches off into two

main coronary blood vessels (also called arteries). These coronary arteries

branch off into smaller arteries, which supply oxygen-rich blood to the entire

heart muscle.

The right coronary artery supplies blood mainly to the right side ofthe heart. The right side of the heart is smaller because it pumps blood only

to the lungs.

The left coronary artery, which branches into the left anterior

descending artery and the circumflex artery, supplies blood to the left side of

the heart. The left side of the heart is larger and more muscular because it

pumps blood to the rest of the body.


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Functions of organs or body involveSaphenous vein was used as a conduit it is performed by two

teams: one harvest the greater saphenous vein and the other

opens the chest and prepares for CPB. An adequate vein is

removed to obtain sufficient graft material.


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Etiology of disease

Accumulation of lipids, complex carbohydrates, blood products,

fibrous tissue, and calcium deposits that results in thenarrowing of coronary artery.

Signs& symptoms

It is performed with arteriosclerotic coronary artery disease.

Usually clients with continues angina and abnormal ECG or

stress test are candidates for CABG.

Symptoms of coronary artery disease may include, but are

not limited to, the following:

chest pain fatigue

palpitations

shortness of breath


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Intra Operative Complications

Cardiovascular complications

include dysrhythmias,

decreased cardiac output, and

persistent hypotension. Whenhearts metabolic demands are

reduced during surgery, heart

needs nutrient blood and

oxygen supply.


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Post Operative

Complications

The heart can beischemic, and notfully contracting.

Dysrhytmias maydevelop fromelectrolyteimbalance, surgery

near the conductingsystem, and ischemia.


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Skin preparation

The skin preparation usually involves iodophor scrub and

solution. The chest to groin to and including ankles should be

free from hair.Draping

The cardiovascular drape is used exposing the entire body

except feet, genitalia and pubic areas.

Position

Supine Position place patients legs on a rounded pillow or

cushion and in frog leg position.


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Anesthesia

General Endotracheal anesthesia is used and

premedicated with morphine and scopolamine. Inhalation with an

airway tube placed in the windpipe.

Endotracheal anesthesia is a form of anesthesia in which

inhaled gases are delivered directly into the trachea with the use

of an endotracheal tube. As long as gases are supplied through

the tube, the patient will remain deeply unconscious andinsensate to pain. This technique is widely used for the purpose

of keeping patients unconscious in surgery in a technique known

as general anesthesia. It can be practiced by an anesthesiologist

or nurse anesthetist.


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Incision site

The skin incision should continue proximally wothout

creating flaps. The desired legth of vein is freed, it should

be ligated at distal end after being clamped.

The dissection of the chest may be done with forceps,

cautery and metzenbaum scissors. It is grafted in the usual

distal having been pass over or through pericardium.


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In coronary artery disease, the blood vessels that nourish the heart

muscle become narrowed or completely blocked, causing the amount ofblood flow through them to decrease. The purpose of coronary artery

bypass graft surgery is to improve the blood supply to an area of the

heart that has been deprived of adequate circulation. Veins from other

parts of the body are grafted onto the diseased coronary artery above

and below the blockage. This graft restores blood circulation to thedamaged area. Coronary artery bypass surgery is actually two surgeries

performed at the same time. One incision is made in the leg to remove

a vein. This vein is used as a graft, or conduit, to create a new coronary

artery. Another incision is made in the chest to allow the surgeon to

reach the heart. The length and number of incisions depend on how

many bypasses are needed. One end of the vein graft is sewn in the side

of the aorta, the large artery of the heart. The other end of the graft is

sewn below the area of the blocked coronary artery. This vein actually

detours, or bypasses, the blood around the obstruction to restore

good blood flow to the area. The graft is usually taken from the

saphenous vein in the leg, an internal mammary vein or a radial artery.


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Nursing Diagnosis Scientific Analysis Goals andObjectives

Nursing Intervention Rationale

Acute pain related topostoperativenerve trauma

Unpleasant sensory andemotional experiencearising from actual or

potential tissue damageor described in terms ofsuch damage; sudden orslow onset of anyintensity from mild tosevere with ananticipated orpredictable end.( NANDA page 492)

Goal: after 1 hour ofnursing intervention, theclient will exhibit

comfort as evidenced byverbalization ofdecreased pain

Objectives:The client will havenormal vital signs.

The client will reporttype, location, andintensity of pain, ratingon a scale of 010.

The client will identify aposition of comfort usingadjuncts as necessary.

Monitor vital signs.

Encourage patient to reporttype, location, andintensity of pain, rating ona scale of 010. Noteassociated symptoms. Askthe patient how thiscompares with preoperativechest pain.

Identify/promote positionof comfort, using adjunctsas necessary.

Heart rate usually increases with pain,although a bradycardiac response canoccur in a severely diseased heart. BP maybe elevated slightly with incisionaldiscomfort but may be decreased orunstable if chest pain is severe and/or

myocardial damage is occurring.

Pain is perceived, manifested, andtolerated individually. Many CABG patientsdo not experience severe discomfort inchest incision and may complain moreoften of donor site incision discomfort.Severe pain in either area should beinvestigated further for possiblecomplications.

These nonverbal cues may indicate thepresence/degree of pain beingexperienced.


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Nursing Diagnosis Scientific Analysis Goals andObjectives

NursingIntervention

Rationale

Acute pain related topostoperativenerve trauma

The client will verbalizecomfort through thenonpharmacologicmeasures.

The client will verbalizecomfort through the useof diversional activities.

Provide comfortmeasures (e.g., backrubs, position changes),assist with self-careactivitiesIdentify/encourage useof behaviors such asguided imagery,distractions,visualizations, deep

breathing.

May promote relaxation/redirect attentionand reduce analgesic dosage needs/frequency.

Relaxation techniques aid in management ofstress, promote sense of well-being, mayreduce analgesic needs, and promote healing.

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