Plan of Care
CABG or coronary artery bypass graft surgery is advised in case of patients suffering from CAD (coronary artery disease). The aim of the operation is alleviating symptoms, prolonging life and improving QOL (quality of life). Every year, over 300,000 CAD- diagnosed individuals go through CABG surgeries in the US; the preliminary hospital charge for each patient is roughly 30,000 dollars. With continued improvement in surgical methods and peri- surgical care, patients who, at one time, couldn’t undergo surgery can now do so. The increased complexity of CABG cases makes it ever more critical to ensure sound collaboration between surgeons, anesthesiologists, perfusionists, nurses and other peri- surgical healthcare workers (Lamarche, Taddeo & Pepler, 1998).

CABG- related post- surgical care is a tricky business, owing to the fact that swift changes may take place in patient condition. Post- surgical care needs to take into account individual patients’ pre- surgical condition, in addition to intra- surgical events. Nursing personnel in charge of the CABG patient must predict likely complications, in order for implementing timely and proper interventions for ensuring positive patient outcomes. A range of activities are associated with patient transfer from the operation theatre to the intensive care unit or recovery room, with admitting nurses connecting patients and invasive lines with monitoring devices and another provider connecting drainage devices properly and drawing admission blood. Anesthesiologists and operation theatre nurses report patient conditions to receiving nurses (Caron & Sandra, 2006).

Numerous factors associated with heart surgery enhance likelihood of post- surgical pulmonary complications, including surgery length, ensuing increase in required anesthetics’ quantity, prolonged supine- position duration, and quantity of intra- surgical fluids administered. Atelectasis may be linked to inflammatory reaction stimulation, cardiopulmonary bypass, and surfactant inhibition (Henke & Eigsti, 2003). Both inflammatory mediators and atelectasis hamper efficient gas exchange and CO2 and O2 dissemination across alveolar capillary membranes. Lengthy pump time results in fluid shifts, thereby increasing quantity of pulmonary tissue fluid and pulmonary complication likelihood. Further, pain resulting from sternotomy may hamper breathing patterns. A few patients experience shivering (potentially a response to anesthetics or caused by the patient body making up for induced hypothermia) following CABG, which can cause lactic acidosis or increased CO2 concentrations. Moreover, shivering can enhance patients’ O2 consumption; this calls for careful monitoring and subsequent adjustment of O2 levels among patients. This is typically managed through administrating neuromuscular blockers and sedatives whilst mechanically ventilating patients (Caron & Sandra, 2006).

Case

This case...…fluid/blood loss, or secretion accumulation. Respiratory suppression may result owing to heavy opioid analgesic consumption or prolonged exposure to anesthesia. Timely abnormal ventilation identification and treatment can avert complications.

Auscultate breathing sounds. Determine sites of absent or reduced breathing sounds and adventitious sounds’ presence (e.g., rhonchi or crackles).

Breathing sounds commonly get diminished within lung bases for some duration following operation, the cause being typically occurring atelectasis. Such absence of active breathing sounds within prior ventilation zones can indicate a lung segment collapse, particularly in case of recent removal of chest tubes. Rhonchi or crackles can signify accumulation of fluid on account of pulmonary edema, interstitial edema, infection, or secretion accumulation-related partial airway blockage.

Making note of the nature of sputum produced, and cough.

Recurrent coughing can be caused by throat irritation due to pulmonary congestion or mere surgical ET (endotracheal tube) placement-related cough. Purulent sputum indicates pulmonary infection onset.

Elevation of the head of the patient’s bed, whether in a semi- Fowler or upright position. Aid in initial ambulation and increase in time periods spent out of bed.

Improves lung expansion and respiratory function. Successfully prevents and resolves the issue of pulmonary congestion.

(Doenges, Moorhouse & Murr, 2012).