Question

Joey Jones a 70-year-old male client is scheduled tomorrow morning for a port SS coronary artery bypass time three graphs the procedure is also called a totally endoscopic coronary bypass the client has a history of osteoporosis so the surgeon felt the minimally invasive procedure would be the best because of breastbone would not have to be entered the client has no history of smoking cigarettes the surgeon has reviewed the cardio angiogram results in a trans feel echocardiogram and stated he feels confident that the client lesions can be successfully bypassed using the p a c a b approach the client wife needs preoperative education from the LPN question one.
what preoperative instruction should the LPN provide the client family question two what nursing management will The client need post-paratively

Answer 1

Coronary artery bypass grafting is a open heart surgery for coronary heart disease. It helps to remove the severe blockage of large cornoray arteries and improves the blood flow to the heart..

1) Preoperative instructions

Good preoperative instructions assists with recovery, increaseas patient contentment, and decreases post operative complications.

• Instruct regarding anticipated length of operation
• Advice regarding the preoperative medications
• Teach about incision splinting and availability of effective pain medications.
• Inform that endotracheal tube is in place postoperatively. So do not panic. The ET tube makes discomfort and inability to speak.
• Post operative pulmonary care is important. So teach regarding the use of spirometry and its importance.
• Pre operative teaching might include information related to the potential for mobilization to a chair during the first evening.
• Educate regarding the equipments connected to the patient post operatively. That includes ventilator, chest tubes, NG tube, foleys catheter, invasive lines.

2) Postoperative nursing management

The nurses should anicipate the post operative complications and aware of timely management of these complications. It is a challenging phase.

Management of pulmonary complications

• Provide early mobilization to improve the post operative pulmonary outcomes.
• Monitor the vital signs. Continuous cardiac monitoring is essential.
• Assists for the use of spirometry.
• Helps to control the pain and shivering. The nurse must balance the pain control without respiratory depression.

Hemodynamic

• Assess for the readiness of early extubation. Physical assessment of effective ventilation, laboratory analysis of arterial blood gases and specific ventilatory parameters must be completed prior to extubation
• Frequent physical assessment.
• Monitor blood pressure. The BP must be maintained within ordered paramaters to provide good tissue perfusion.
• Bleeding
• Rewarm the patient after surgery if hypothermia persists.
• Monitor the patient for signs of bleeding from the chest tubes and the surgical sites as well as clinical signs of hypovolemia related to blood loss.

Neurologic management

• Perform neurologic assessment. It must be continue because the risk of stroke doesnot end.

Renal management

• Maintain Intake output chart
• Daily monitor blood urea nitrogen and serum creatinine.

Gastrointestinal management

• After removing nasogastric tube start feeding with clear liquid and this can be advanced as tolerated by the patient
• Assess the bowel sounds

Pain management

• Positioning the patient
• Assess the level of pain and give the pain medications such as narcotics. Because the pain will increase the heart rate and blood pressure. It will increases the cardiovascular complications.

A skilled, knowledgable, empathetic sincere nursing care for the patient after cardiac surgery is an asset for the achievement of positive outcome for the patient.