View
220
Download
0
Category
Preview:
Citation preview
8/14/2019 My Case Pres
1/19
8/14/2019 My Case Pres
2/19
8/14/2019 My Case Pres
3/19
8/14/2019 My Case Pres
4/19
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.
8/14/2019 My Case Pres
5/19
8/14/2019 My Case Pres
6/19
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
8/14/2019 My Case Pres
7/19
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.
8/14/2019 My Case Pres
8/19
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.
8/14/2019 My Case Pres
9/19
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
8/14/2019 My Case Pres
10/19
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.
8/14/2019 My Case Pres
11/19
Post Operative
Complications
The heart can beischemic, and notfully contracting.
Dysrhytmias maydevelop fromelectrolyteimbalance, surgery
near the conductingsystem, and ischemia.
8/14/2019 My Case Pres
12/19
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.
8/14/2019 My Case Pres
13/19
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.
8/14/2019 My Case Pres
14/19
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.
8/14/2019 My Case Pres
15/19
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.
8/14/2019 My Case Pres
16/19
8/14/2019 My Case Pres
17/19
8/14/2019 My Case Pres
18/19
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.
8/14/2019 My Case Pres
19/19
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.
Recommended