Designing nurse training curriculum for coronary artery bypass graft surgery

Coronary Bypass

Nurse Training for Support in Coronary Artery Bypass Graft Surgery (CABG)

The purpose of the account that follows is to propose a course design for nurse training specific to the tasks and responsibilities relating to the treatment of Coronary Artery Bypass Graft Surgery. All preliminary research is intended to serve a set of learning objectives to be instilled in the nursing students and nursing professionals enrolled in the training course. Consideration will be given to the practical and ethical implications of the nursing role.

Subject Matter:

The Coronary Artery Bypass Graft Surgery (CABG) is both a very common and a very serious medical procedure. This is performed only in instances where physicians have deemed it as absolutely necessary as a means to reducing the risk of heart attack or intervening where a heart attack appears imminent. The most common of coronary procedures in the response or preemption to a heart attack, the CABG removes critical blockages in the arterial blood vessels leading to the heart and replaces the damages arteries with unblocked vessels typically grafted from the arm or leg. According to the National Heart Lung and Blood Institute (NHLBI), "CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new passage, and oxygen-rich blood is routed around the blockage to the heart muscle." (NHLBI, 1)

Preliminary Research:

Perioperative Considerations for CABG Surgery:

Incidence

Coronary Artery Bypass Graft surgery is typically a measure taken in the event of angina and is intended to reduce the risk of heart attack or other heart malady in those with some form of coronary disease. (CC, p. 1) Heart disease is among the most common causes of fatality in the United States on an annual basis and is caused by a wide range of factors including obesity, high blood pressure, poor diet and nicotine addiction. As such, CABG is an important tool at the disposal of heart surgeons. Kulick & Shiel report that (2011), "according to the American Heart Association 427,000 coronary artery bypass graft (CABG) surgeries were performed in the United States in 2004, making it one of the most commonly performed major operations."

Causes

The primary cause of CABG is the presence of a blockage in one or more of the arteries that carry blood to the heart. (CC, p. 1) According to Kulick & Shield (2011), "coronary artery disease (CAD) occurs when atherosclerotic plaque (hardening of the arteries) builds up in the wall of the arteries that supply the heart. This plaque is primarily made of cholesterol. Plaque accumulation can be accelerated by smoking, high blood pressure, elevated cholesterol, and diabetes. Patients are also at higher risk for plaque development if they are older (greater than 45 years for men and 55 years for women), or if they have a positive family history for early heart artery disease." (p. 1)

Indications for Surgery

Any number of symptoms of heart disease may be emergent in the subject, including high blood pressure, chest pains, dizziness, fatigue or the actual occurrence of a heart attack. The presence of heart disease is not, in and of itself, an indicator that surgery is necessary. In many cases, prescription medication or lifestyle changes can make a significant difference in the patient's health outlook. (NHLBI, p. 1) However, where a heart attack has occurred or where the presence of medical evidence that such an event is imminent, this resort may be taken.

Physician and Nursing Orders

Physicians and nurses will play a crucial role in ensuring that the patient regains consciousness and orientation slowly, carefully and in a comfortable environment. The bypass procedure is physically traumatic and it is important that the attending nurses and physicians provide an atmosphere where the subject can gather himself without undue stressors. This means that the present nurses and physicians should be available to speak with the patient, to remind him of his surroundings, to report the degree of success experienced during the procedure and to offer some concise instruction of what to expect next. During this time, it is also essential that the patient be closely monitored for any immediate negative bodily responses to the procedure and, further, that those attending are prepared to act in an emergency capacity should the need arise.

Ward Care

Physician and Nursing Orders

During the patient's postoperative stay in the hospital, the nurses and physicians will play a central role in preparing the patient for discharge. Primary responsibilities at this juncture include administering medication, cleaning and dressing incision wounds, providing nutrition, monitoring vital signs and monitoring the patient for progress in accepting the surgery. According to Aroesty (2010), "before leaving the hospital, it is important for the patient and family to participate in and understand the discharge plan. Make sure all questions are answered and obtain written directions for how to take all medications (new and old). After bypass surgery, it is common to start new medications and stop or adjust the doses of previous medications." (p. 1)

Length of Stay

The commonality of the procedure has led to continually shortened lengths of stay following treatment. Patients are routinely discharged, if free from complications, in a matter of 3 to 4 days.

Home Care

Discharge Instructions

Aroesty indicates that discharge instructions should be focused on lifestyle changes. The patient will be required to make certain changes relative to the likely causes of the initial heart disease, whether related to diet, exercise, smoking or exposure to other potentially negative effectors.

Follow-Up Appointments

Aroesty indicates that for many CABG patients, some cardiac rehabilitation is required, which typically denotes several therapy appointments a week during the early post-operative period. Regular monitoring through cardiac physicians is also required.

Terminal Objective:

At the end of the educational period recommended here, the learner should be able to perform all nursing duties in relation to Coronary Artery Bypass Graft surgery. The performance of these duties refers to an understanding of all supporting needs of the patient throughout the perioperative period, including but not limited to the proper administration of medication, maintenance of vital function machinery, maintenance of a clean, safe and sanitary environment, proper hand hygiene, compassionate bedside manner and the capacity to transmit critical knowledge to the patient for long-term self-care upon discharge.

Learning Objectives:

In support of the Terminal Objective, several key learning objectives will drive the content and curriculum for nurses undergoing the present training course. Primary among them, the training course is designed to create a standardized set of behaviors amongst nurses that conform with existing and evolving best practices in the perioperative care of CABG patients. This means that course content and design will be geared toward achieving procedural and professional consistency amongst attending nurses where preoperative, intraoperative and postoperative care are concerned.

An additional learning objective is to ensure that outgoing students are informed in the ethical and personal dimensions of the profession. Coronary surgical procedures are inherently serious in nature as are the heart and circulatory conditions that typically require such procedures. Therefore, it is of critical importance that nurses are trained in the proper bedside manner to approach patients, families and extended support systems with potentially difficult information, including the preparedness to address cases where fatality occurs. These realities of the field must be given proper consideration in the context of the course and should be intended to provide students with a firm grounding in the behavioral implications of nursing coronary bypass patients.

Works Cited:

Aroesty, J.M. (2010). Patient information: Recovery after coronary artery bypass graft surgery (CABG). Up To Date, 19(2).

Cleveland Clinic (CC). (2011). Diseases and Conditions. my.ClevelandClinic.org.

Kulick, D. & Shiel, W.C. (2011). Coronary Artery Bypass Graft Surgery. MedicineNet.com.

National Heart Lung and Blood Institute (NHLBI). (2010). What is Coronary Artery Bypass Grafting. National Institute of Health.

Yusuf, S. et al. (1994). Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. The Lancet, 344(8922), 563-570.