CABG

(CORONARY ARTERY
BYPASS GRAFT)
Floranza, Maria Janet Charo
BSN 3

CABG
is a surgical procedure in
which a blood vessel is
grafted to an occluded
coronary artery so that
blood can flow beyond
the occlusion.

Arteries or veins from

elsewhere in the patients
body are grafted (internal
thoracic arteries, radial
arteries and saphenous)

NUMBER

OF BYPASS

singlebypass
doublebypass
triplebypass
quadruplebypass
refertothenumberofcoronaryarteries
bypassedintheprocedure.

Purposes
Restore blood flow to the heart
Relieves chest pain and
ischemia
Improves the patients quality of
life
Enable the patient to resume a
normal lifestyle

IndicationsForCABG
Patients with blockages in
coronary arteries
Patients with angina
Prevention and treatment for
MI, dysrhythmias or heart
failure

 Patients who cannot tolerate

PTCA (Percutaneous
transluminal coronary
angioplasty ) and do not
respond well to drug therapy

 Angina Pectoris - is recurring

acute chest pain or discomfort
resulting from decreased blood
supply to the heart
muscle(myocardial ischemia).
Angina is a common symptom
for coronary heart disease

TYPES OF ANGINA

Stable angina
Unstable Angina
Refractory/intractable
Angina
Variant/Prinzmetal
Angina

RISK FACTORS FOR ANGINA

Advanced age
Coronary artery disease
Hypertension
Increased serum glucose
levels (diabetes)

 Increased serum
lipoprotein levels
Obesity
Smoking
Type A personality

INITIATING FACTORS OF
AN ATTACK
Cold weather
Emotions
Heavy meals
Hypoglycemia
Pain
Smoking

S/s
Chest pain (Severe chest
discomfort (heaviness,
pressure, tightness, choking,
squeezing)
SOB
Pallor

S/S
Cool clammy skin
Nausea & Vomiting
Light-headedness
Anxiety
T waves inversion

Laboratory

ChestPain

Drug

C-reactiveprotein&ECG Nitrates(Nitroglycerin)showsTwaveinversion vasodilators

Amlodipine
CalciumChannel
Blockers

Cholesterol

MetropololBetaBlockers
Lipidprofile<200mg/dl
Rosuvastatin(Antilipid
drugs)

OtherDrugs
(Aspirin)Antiplatelet
Drugs

MonitorforAPTT

(Heparin)Anticoagulant

MonitorforPT

MEDICAL MANAGEMENT
The objectives of the medical
management of angina are:
To decrease the oxygen demand of
the myocardium
To increase the oxygen supply

 these objectives are met

through pharmacologic
therapy and control risk
factor.
Alternately reperfusion
procedures may be used to
restore blood supply to

GREATERSAPHENOUSVEIN(GSV)

NURSING CARE PLAN

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

Evaluation

Patientis
scheduledfor
CABGand
verbalizedfear
forthesurgery.

Fearrelatedto
surgical
procedure,its
uncertain
outcome

After2hoursof
nursing
managementthe
patientwillbe
ableto:
1.Acknowledge
anddiscuss
fears.
2.Verbalize
senseofsafety
relatedtocurrent
situation.
3.Demosntrate
understanding
throughuseof
effectivecoping
behaviors

1.Allowpatient
andfamilyto
expresstheir
fears.
2.Reassuring
thepatient
thatfearof
painisnormal
andexplain
thatsomepain
willbe
experienced
butcertain
measureswill
helptorelieve
thepain.
3.Spendtime
withpatient
eachshiftto
allowtimefor

1.Fearisa
defensive
mechanismin
protecting
oneselfbutif
leftunchecked
canbebecome
disablingtothe
clientslife.
2.Tosoothe
fears.
3.Promotes
atmosphereof
caringand
permits
explanationor
correctionof
misperceptions.

Afternursing
interventionand
management
theclient
experienceda
reductioninfear
andverbalized
senseofsafety
relatedto
current
situation.

Palpitations
Increased
wariness
uncertainty

expressionof
feelings,provide
emotionaloutlet
andpromote
feelingof
acceptance.
4.Educatethe
patientregarding
surgeryand
sensationsthat
areexpected
duringandafter
thesurgery.
5.describeand
explainthe
rationalefor
equipmentand
tubesthatmaybe
present
postoperatively
(e.g.cardiac
monitoring
equipment,
endotrachealtube

4.Toreduce
fearandanxiety

5.Tohave
awareness
aboutthe
contraptions
postoperatively.
6. thispromotes
afeelingin
clientthat
he/shewill
survivesurgery.

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

present
postoperatively
(e.g.cardiac
monitoring
equipment,
endotrachealtube
andventilator,
chesttube,
arterialand
venouslines,
nasogastrictube,
urinarycatheter).
6.Encouragethe
patienttofocus
post-operatively.
7..Administer
sedatives,
tranquilizers,as
indicated.

7.Maybe
desiredtohelp
patientrelax
untilphysically
ableto
reestablish
adequate
coping
strategies.

Evaluation

Problems & Cues Nursing

Diagnosis

Patient
questions/request
sforinformation
verbalizationof
problem,
statement
ofmisconception

Knowledge
deficit
regardingthe
surgical
procedure
andthe
postoperative
course.

Objectives

Interventions

Rationale

Evaluation

After1hourof
healthteaching
thepatientwill
beto
understand
regarding
surgeryand
potential
complications

1.Ascertainlevel
ofknowledge,
including
anticipatory
needs.
2.Detemine
clientsability,
readiness,and
barriersto
learning.
3.Provide
information
relevantonlyon
thesituation.
4.Educatethe
patientandfamily
healthteaching
about
Hospitalization
surgery,lengthof
surgery,expected

1.Toassess
readinessto
learnand
individual
learning
needs.
2.Individual
maynotbe
physically,
emotionally,
ormentally
capableat
thistime.
3.Toprevent
information
overload.
4.Toprovide
knowledge
aboutsurgery
andpost-op
course.

After1hourof
healthteaching
thepatientwas
ableto
understand
regarding
surgeryand
potential
complications.

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

painanddiscomfort 5.Toprovide
Criticalcare
awareness
phase,Recovery
phase
(present

informationat
patient
understanding
level)
5.Orientpatient
tosurrounding.

Evaluation

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

Evaluation

Post-operative
CABG

Decreased
cardiacoutput
relatedto
bloodlossand
compromised
myocardialfunc
tion

Afternursing
management
thepatientwill
beableto
restorecardiac
outputto
maintainorgan
andtissue
perfusion

1.Monitor
cardiovascular
status,hemodynam
isparametersand
cardiacrhythmand
rate.Monitorv/sq.
15mins,until
stable,30minsthen
q1andq4.
2.Auscultatefor
heartsoundsand
rhythm.
3.Assess
peripheral
pulses(pedal,tibial,
radial)
4.ECGmonitoring
5.Assesscardiac
biomarkerresults.
6.Measureurine
outputeveryhalf
hrto1hr.

1.Blood
pressureis
oneofthe
mostimportant
physiologic
parametersto
monitor,vasoco
nstrictionafter
cardiopulmona
rybypass.
2.Ausculataion
provides
evidenceof
pericarditis
(precordial
rub)
dysrhythmias.
3.Presenceor
absenceand
qualityof
pulsesprovide

Thefollowing
parametersare
withinthe
patientsnormal
ranges:
Arterial,pressure
,heart
sounds,pulmona
ryandsystemic
vascular
resistance,cardia
coutput.cardia
biomarkers,urine
output,skinand
mucosalcolor
andskin
temperature.

May exhibit:
Variationsin
BP,heart
rate/rhythm

Pallor/cyanosis
ofskinor
mucous
membranesCoo
l/cold,clammy
skin

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

7.Observebuccal
mucosa,nail
beds,lips,earlobes
andextremities.
8.Assessskin,note
temperatureand
color.
9.Observefor
persistent
bleeding(excessive
chesttubedrainage
ofblood)
10.Observefor
cardiactamponade
(JVD)
11.Observefor
signsofcardiac
failure.Prepareto
administer
diuretics,IVinotropic
agents

Dataabout
cardiacoutput
aswellas
obstructive
lesions.
4.Dysrhythmias
mayoccurwith
coronoary
ischemia,hypoxi
a,bleedingand
acid-baseor
electrolyte
disturbances.ST
-segment
changesmay
indicate
mycordial
ischemia.

Evaluation

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

5.Elevationsmay
indicate
myocardial
infarction.
6.Urineoutput<1
ml/kg/hindicates
decreasedrenal
perfusionand
mayreflect
decreased
cardiacoutput.
7.Duskinessand
cyanosismay
indicate
decreased
cardiacoutput.
8.Coolmoistskin
indicates
vasoconstriction

Evaluation

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

9.Bleedingcan
resulttosurgical
traumato
tissues,anticoagul
antmedications
andclotting
defects.
10.Cardiac
tamponade
resultsfrom
bleedingintothe
pericardialor
accumulationof
fluidinthesac.
11.Cardiacfailure
resultsfrom
decreased
pumpingactionof
theheart;can
causedeficient
perfusiontovital
organs,

Evaluation

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

Evaluation

Postoperative
CABG
May report:
Inabilityto
coughortakea
deepbreath
May exhibit:
Decreased
chest
expansionSplint
ing/muscle
guardingDyspn
ea(normal
responseto
thoracotomy)Ar
easof
diminishedor
absentbreath
Anxiety,change
sinABGsand
pulseoximetry

Impairedgas
exchange
relatedto
traumaof
extensivechest
surgery

Afternursing
management
thepatient
willbeable
tomaintain
adequate
gas
exchange

1.Maintainproper
ventilation
2.Monitorarterial
bloodgases,tidal
volumes,peek
inspiratory
pressuresand
extubation
parameters.
3.Auscultatechest
forbreathsounds.

1.Ventilatory
supportis
usedto
decreasework
oftheheart,to
maintain
effective
ventilation,and
toprovidean
airwayinthe
eventof
complications.
2.ABGsand
ventilator
parameters
indicate
effectiveness
ofventilator
andchanges
thatneedtobe
madeto
improvegas

Afternursing
managementthe
patientwasable
tomaintain
adequategas
exchangeas
evidencedby:
Airway
patent,ABGS
withinnormal
range,breath
soundsclear
bilaterally,
ventilator
synchronous
with
respirations,brea
thesoundsclear
aftersuctioning
andcoughing

4.Suction
tracheobronchial
secretionsas
needed,using
aseptictechnique.
5.Sedatepatient
adequatelyas
prescribedand
monitorRRand
depth.

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

Evaluation

6.Assistinweaning
andendotracheal
tuberemoval.
7.Afterexturbation
promotedeep
breathing,coughing,
andturning.
Encouragetheuse
oftheincentive
spirometerand
compliancewith
breathing
treatments.Instruct
abouttheincisional
splintingwith
coughpillowto
decrease
discomfort.

3.Crackes
indicate
pulmonary
congestion;
decreasedor
absentbreath
soundsmay
indicate
pneumothorax
dislodgement
oftube.
4.Retentionof
secretions
leadsto
hypoxiaand
possible
infection.
5.Sedation
helpsthe
patientto
toleratethe

Abletobe
weaned
successfully
fromventilator.

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

Encouragetheuse
oftheincentive
spirometerand
compliancewith
breathing
treatments.Instruct
abouttheincisional
splintingwith
coughpillowto
decrease
discomfort.

Endotracheal
tubeandto
copewith
mechanical
ventilation.
6.Extubation
decreasesrisk
ofpulmonary
infectionsand
enhancesability
ofpatientto
communicate.
7.Aidsin
keepingairway
patent,
preventing
atelectasis,and
facilitatinglung
expansion.

Evaluation

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

Evaluation

Postoperative
Pain(CABG)

Acutepain
relatedto
operative
trauma
andpleural
irritation
causedby
chesttubes

After1hourof
nursing
management
thepatientwill
beableto
verbalize
relief/absence
ofpain.
demonstrate
relaxedbody
posture,
abilityto
rest/sleep
appropriately.

1.Encourage
patienttoreport
type,location,and
intensityofpain,
ratingonascale
of010.Note
associatedsympto
ms.Askthe
patienthowthis
compares
withpreoperative
chestpain.
2.Observefor
anxiety,irritability,
crying,
restlessness,
sleepdisturbances.
3.Monitorv/s

1.Painis
perceived,
manifested,and
tolerated
individually.It
mustbe
monitoredin
orderforeffective
relief.
2.These
nonverbalcues
mayindicatethe
presence/degree
ofpainbeing
experienced.
3.Heartrate

Afternursing
interventions
thepatientwas
verbalized
relief/absence
ofpain.
demonstrated
relaxedbody
posture,ability
torest/sleep
appropriately.

May report:
Incisional
discomfortPai
n/paresthesia
of shoulders,
arms, hands,
legs
May exhibit:
GuardingFaci
al mask of
pain;
grimacingDist
raction
behaviors;
moaning;
restlessnessC
hanges in
BP/pulse/respi
ratory rate

usuallyincreases
withpain,although
abradycardiac
responsecanoccur
inaseverely
diseasedheart.

Problems &
Cues

Nursing
Diagnosis

Objectives

Interventions

Rationale

4.Teachthepatient
howtoperform
incisionsplinting.
5.Provide

4.useofincisional
splintingdecreases
pain.
5.Maypromote
relaxation/redirect
attentionand
reduceanalgesic
dosage

comfort
measures(e.g.,
backrubs,
position
changes),assist
withself-care
activities,and
encourage
diversional
activitiesas
indicated.
6.Encourage
relaxation
techniques
7.Ambulatethe
patient.
8.Administer
analgesicsas
ordered.

needs/frequency
6.tominimizepain.
7.mobilizationcan
helpcontrolpain.
8.Usuallyprovidesfor
adequatecontrolof
painand
inflammation,and
reducesmuscle
tension,which
improvespatient
comfortandpromotes
healing.

Evaluation

PATIENT HEALTH
EDUCATION
For post operative care;I.Woundcare
Do not wet the wound(first 3 weeks
after surgery).
Keep forearm / leg wounds dry.
If wound get wet, immediately dap with
dry towel.
Use antiseptic soap when bath (after 3
weeks