Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)

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Outline

CABG
- Addresses Perfusion (Hose) Problem that cannot be fixed with a stent = CABG
  - No water = No garden
  - Reroutes hose around the blockage
  - Perfusion restored
- Bypass surgery of clogged hose
- 3-6 hours
CABG indications
- Non-Emergent/Planned (before MI)
  - Left Coronary Artery “Left Main disease”
- Emergent/Not Planned (after MI)
  - NSTEMI/STEMI = does not respond to interventions
- Both have same plan of care (Emergent more fragile)
Surgery → CVSICU → POD#2
- Step Down (PCCN Care)

Vessels Harvested
- Happens before & during surgery
- Arteries & Large veins
  - Internal Mammary Artery
    - Either side of sternum
  - Radial Artery
    - Inner forearm
  - Saphenous Vein
    - leg/calf
Sternotomy “Crack the Chest”
Bypass Machine
- Heart Stops: High KCL Solution/Ice
- Perfusionist: Mechanical Heart/Lungs
  - 2 Tubes inserted into heart = circulation
  - Pumps blood & adds 02
- Surgeon attaches bypass grafts

Subjective Cues
- #1 Concern = Chest pain
  - PQRST
Objective Cues
- Concern = ↓ Cardiac Output (must have a good perfusion/open hose)
- Vital Trend
  - Q 2- 4 hours in PCU
    - Hypotension/Tachycardia/MAP >65
    - Temp >36.0 and <38.5
    - Temp >36.0 and <38.5
  - Pulses
- Heart/Lung sounds
  - S3/crackles/rales = heart failure
  - Muffled heart sounds = Cardiac tamponade
- Skin
  - Temperature & color
  - Sternotomy & Harvest site dressings
  - Temp Pacer
  - Tubes/Drains
    - Chest tube= > 70cc/hr & slow decrease
    - Foley =<30ml/h for 2 hours (DC?)

Labs
- CBC (H/H)
  - Hemorrhage not obvious – Transfusion
- Electrolytes
  - Replace KCL/MAG/Calcium
- Blood Gasses
  - Poor Gas Exchange symptoms only
ECG/Telemetry
- Q Waves – Signs of scar tissue. Common.
- Bradyarrhythmias
  - Temp Pacer
- Atrial Tachyarrhythmias
  - Afib/Aflutter/SVT
    - AFIB =most common = Rate Control
- Ventricular Tachycardias
  - VT and Vfib (rare) = ACLS algorithm

Lab & ECG Telemetry Interventions
Pharmacological Interventions
- Pain management PRN
  - IV → PO
- Electrolyte replacement IVPB
- Fluid Replacement
  - Albumin for low MAP
- Blood Transfusions
  - Low Blood Count
- Vasoactive Infusions – emergent only → ICU
Non-Pharmacological
- Incentive Spirometry
  - Q1 hour while awake
- Cough & Deep breath
- Incision Care/Tube Care
Adjunct Medical Therapy
- Rehabilitation Services: PT/OT
  - EARLY MOBILITY

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Al-Ghamdi, B. (2017). Arrhythmias Post Coronary Artery Bypass Surgery. In (Ed.), Coronary Artery Bypass Graft Surgery. IntechOpen. https://doi.org/10.5772/intechopen.70423
Chaudhari, J. M., Pani, S., Mhaske, A., & Mulay, A. (2022). Effect of nursing care by using Extended Nursing Care Model on quality of life of patients after coronary artery bypass graft. MGM Journal of Medical Sciences, 9(1), 48.
Farooq, N. U. A., & John, S. (2022). Evaluation of the Parameters Influencing Nurses’ Effectiveness in the Treatment of Patients after Coronary Artery Bypass Graft Surgery in ICU. Pakistan Journal of Medical & Health Sciences, 16(02), 1072-1072.
Shea MJ. Coronary Artery Bypass Grafting (CABG). http://www.merckmanuals.com/professional/cardiovascular-disor ders/cardiovascular-tests-and-procedures/coronary-artery-bypas s-grafting-cabg January 31, 2016. Accessed: April 9, 2017.