CABG Procedure and Post-Op Care Overview
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Questions and Answers

What is the primary goal of an exercise program for a patient post-myocardial infarction (MI)?

  • Increase muscle mass quickly
  • Reduce blood pressure immediately
  • Establish a long-term exercise program (correct)
  • Focus solely on cardiovascular endurance

    • Which medication class is specifically indicated for preventing thrombus formation in patients after a myocardial infarction?

  • Antiplatelets (correct)
  • Statins
  • Long-acting bronchodilators
  • Corticosteroids

    • Which of the following side effects is associated with short-acting bronchodilators?

  • Rhabdomyolysis
  • Thrombocytopenia
  • Liver damage
  • Tachycardia (correct)

    • What should be assessed before initiating an exercise session for a cardiac patient?

    <p>Medical history, vitals, and functional tests (B)</p> Signup and view all the answers

    What is the correct formula to calculate target heart rate using the Karvonen method?

    <p>Target HR = (max HR - resting HR) x % intensity + resting HR (A)</p> Signup and view all the answers

    What is a primary consequence of hard plaque buildup in coronary arteries?

    <p>Reduced blood flow to the heart (B)</p> Signup and view all the answers

    Which of the following is NOT a sternal precaution following CABG?

    <p>Avoiding deep breathing exercises (C)</p> Signup and view all the answers

    What symptom indicates a potential infection at the incision site after CABG?

    <p>Increased drainage (B)</p> Signup and view all the answers

    When can active exercise typically begin post-CABG?

    <p>24 hours after surgery (B)</p> Signup and view all the answers

    Which of the following is an appropriate postoperative activity for a patient on Day 1 post-CABG?

    <p>Using a rocking technique to stand (B)</p> Signup and view all the answers

    What is one of the requirements for participating in cardiac rehabilitation?

    <p>Stable ECG (A)</p> Signup and view all the answers

    Which of the following practices is recommended to alleviate postoperative discomfort during coughing?

    <p>Use of a pillow for splinted coughing (B)</p> Signup and view all the answers

    What is the typical duration of cardiac rehabilitation after CABG?

    <p>6-12 weeks (C)</p> Signup and view all the answers

    Which of the following should be included in a patient's education regarding self-monitoring during recovery after a myocardial infarction?

    <p>Check vital signs and use Rate of Perceived Exertion (RPE) (C)</p> Signup and view all the answers

    What is a potential side effect of antiplatelet medications prescribed after a myocardial infarction?

    <p>Thrombocytopenia (A)</p> Signup and view all the answers

    During risk stratification for an exercise program, which of the following factors is least likely to be considered?

    <p>Dietary preferences (D)</p> Signup and view all the answers

    Before starting an exercise session, which of the following assessments is NOT typically performed?

    <p>Neurological reflex tests (B)</p> Signup and view all the answers

    Long-acting bronchodilators are typically used for which purpose?

    <p>Daily management of chronic respiratory conditions (D)</p> Signup and view all the answers

    What is the main purpose of using a stent during an angioplasty?

    <p>To keep the artery open after balloon inflation (C)</p> Signup and view all the answers

    Which of the following describes a common characteristic of soft plaque?

    <p>It often causes artery ruptures due to inflammation (C)</p> Signup and view all the answers

    What is one of the critical postoperative considerations for a patient following CABG?

    <p>Maintaining symmetrical and proper upright posture (C)</p> Signup and view all the answers

    What should patients avoid while sitting for long periods after CABG?

    <p>Lying prone (D)</p> Signup and view all the answers

    During cardiac rehabilitation, under which condition can exercise be initiated?

    <p>If the patient has not had chest pain for 8+ hours (C)</p> Signup and view all the answers

    What is recommended for patients to manage discomfort when coughing post-CABG?

    <p>Positioning a pillow for splinted coughing (A)</p> Signup and view all the answers

    Which physical activity is appropriate for a patient on Day 3 post-op CABG?

    <p>Progressing mobilization and climbing 2 flights of stairs (A)</p> Signup and view all the answers

    What is a normal postoperative sensation experienced at the incision site after CABG?

    <p>Mild itching, numbness, or tightness (A)</p> Signup and view all the answers

    Flashcards

    Post-MI Exercise Program Goals

    Establish long-term exercise, ensure safe independent completion, restore function, and progress to 150 minutes per week of moderate-intensity exercise.

    Pre-Exercise Evaluation

    Gathering patient medical history, medications, exercise habits, barriers, and psychosocial information before starting an exercise program.

    Target Heart Rate (Karvonen Formula)

    Calculated as (maximum heart rate - resting heart rate) x intensity percentage + resting heart rate. Used to monitor intensity during exercise.

    Antiplatelet Medications (e.g., Aspirin, Plavix)

    Prevent blood clots by stopping platelet clumping. Used after heart attack, a-fib, to prevent thrombus.

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    Short-Acting Bronchodilators (e.g., Albuterol)

    Rescue inhalers, used to relax lung muscles quickly to treat wheezing/dyspnea during an asthma or COPD attack.

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    CABG Post-Op Precautions

    Post-operative guidelines for patients after Coronary Artery Bypass Graft surgery aiming to prevent complications and promote recovery.

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    Sternal Precautions

    Specific instructions to avoid straining the sternum (breastbone) during recovery from CABG surgery.

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    Post-Op Mobility

    Strategies to achieve safe and gradual movement (ambulation) after CABG surgery, progressing over time.

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    Signs of Infection

    Indicators of a possible infection at the CABG incision site, such as increased drainage, redness, warmth, and fever.

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    Cardiac Rehab

    A supervised program of exercise and education for people with heart conditions, such as CABG patients.

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    Cardiac Rehab Start Criteria

    Conditions that must be met before initiating Cardiac Rehabilitation after a cardiac event, such as CABG.

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    Day 1 Post-Op CABG

    Strategies for patient positioning and activity/movement as part of early mobilization/recovery

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    Post-Op Coughing

    Techniques to manage coughing and prevent complications after CABG, such as atelectasis.

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    CAD

    Narrowing of the arteries supplying the heart due to plaque deposits, reducing blood flow and oxygen to the heart. This can lead to a heart attack if left untreated.

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    Hard Plaque

    A hard, solid build-up in the coronary arteries that restricts blood flow and can cause a heart attack. It's like a blockage in a pipe.

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    Soft Plaque

    A soft, inflamed area in the artery that can rupture, causing a blood clot and leading to a heart attack. It's like a weak spot in a pipe that could burst.

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    Angioplasty with Stent

    A procedure where a balloon and stent are inserted into a narrowed artery, the balloon is inflated to widen the artery, and the stent is left in place to keep it open.

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    Sternal Precautions After CABG

    Guidelines to prevent strain on the sternum, such as avoiding lifting, pushing, pulling, and overhead reaching, to allow the sternum to heal properly.

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    Day 1 Post-CABG: Sitting and Standing

    Encouraging early mobility by sitting the patient upright on the edge of the bed and helping them to stand, improving lung function, blood flow, and strengthening the legs.

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    Deep Breathing Exercises

    Instructing patients to take slow, deep breaths to improve lung expansion and prevent atelectasis, a common complication after CABG surgery.

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    Huff Cough

    Teaching patients a technique to cough effectively, preventing complications like pneumonia and atelectasis after CABG.

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    Antiplatelet Drugs

    Medications that prevent blood clots by stopping platelets from clumping together. Commonly used after a heart attack, atrial fibrillation (a-fib) to prevent thrombus formation.

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    Statins

    Medications that lower cholesterol levels in the blood, reducing the risk of heart disease and stroke.

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    Short-Acting Bronchodilators

    Rescue inhalers used to quickly relax the muscles in the airways, relieving symptoms of wheezing and shortness of breath during an asthma or COPD attack.

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    Long-Acting Bronchodilators

    Medications taken daily to prevent symptoms of asthma or COPD, providing long-lasting relief for 12 to 24 hours.

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    Corticosteroids

    Medications used to suppress inflammation in the airways for short-term management of asthma or COPD.

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    Study Notes

    CABG Procedure and Post-Op Considerations

    • CAD (Coronary Artery Disease): Narrowing of arteries supplying the heart due to plaque deposits. Hard plaque slows/stops blood flow (less O2 to the heart). Soft plaque causes most heart attacks.
    • Angioplasty with Stent: Balloon and stent inserted into diseased artery, balloon inflated to open the artery, then deflated and removed.
    • Sternal Precautions (4-12 weeks): Sternum takes 6-8 weeks to heal. No lifting >5-10 lbs, reaching behind back, pushing/pulling with arms, or overhead reaching is restricted. No driving.
    • Post-Op Considerations:
      • Proper posture is important.
      • Incisions should be kept dry and clean.
      • Avoid lotions and ointments.
      • Slight itching or numbness is normal.
      • Keep legs elevated to reduce swelling.
      • No driving.
    • Signs of Infection: Increased drainage, redness, warmth, malaise, and fever (above 100°F) around incision.
    • Day 1 Post-Op:
      • Sit up and stand.
      • This helps to resolve atelectasis and optimize gas exchange.
      • Maintain LE strength/mobility
      • Drain chest fluid.

    Cardiac Rehabilitation

    • Cardiac Rehab: Supervised, safe exercise progression after cardiac procedures (6-12 weeks, 1-3 sessions/week).
    • Goals: Establish a safe exercise program, restore function, and progress to 150 minutes of moderate-intensity exercise per week.
    • Inpatient Program:
      • Begins as inpatient and progresses to outpatient. -No chest pain for 8+ hours -No resting dyspnea -Stable ECG and blood values (troponin and creatine kinase). -Active exercise 24 hours after CABG, 48 hours after MI

    Exercise Protocol and Monitoring

    • Pt Education: Self-monitoring of vitals, RPE (Rate of Perceived Exertion), and early warning signs of cardiac events. Pre-exercise assessment (e.g., BMI, blood glucose, and risk factors).
    • Karvonen Formula: Target heart rate calculation
    • HR: Heart rate should not exceed resting + 20 after MI or resting + 30 after CABG.
    • DBP: Diastolic blood pressure, should not exceed 110 mmHg
    • Exercise intensity: Varying levels (very light, light, moderate, vigorous), guided by heart rate percentages and RPE scale. Monitor patient for Exercise limitations.
    • Angina: Stop exercise if it occurs and take appropriate measures (e.g., medication).

    Pulmonary Rehab and Medications

    • Pulmonary Rehab: Focus on safe exercise in patients with lung disease to improve breathing strategies and exercise tolerance.
    • Cardiac Medications: Include ACE inhibitors, ARBs (angiotensin receptor blockers), nitrates, beta-blockers, calcium channel blockers, diuretics, anticoagulants, and antiplatelets. Medications are used to control blood pressure, heart rate, and other relevant conditions.
    • Pulmonary Medications: Short-acting bronchodilators as needed.

    Pediatric Considerations

    • Normal vitals for adults and infants.
    • Factors: Respiratory infections, small airways, high metabolic rate common in pediatric patients
    • Considerations: Surfactant maturity, immature cough, mechanical advantage (breathing).

    ICU and Critical Care

    • ICU: Acquired delirium risk (assessment tools)
    • Considerations: Various factors include mechanical ventilation, sepsis, pain, deep sedation, and immobility.
    • ECG Interpretation: Cardiac arrhythmias, including atrial fibrillation, sinus tachycardia, and ventricular tachycardia.
    • Medications: Sedation, pain relief, and other supportive medications.

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    PHTH 736 Exam 2 PDF

    Description

    This quiz covers the CABG (Coronary Artery Bypass Grafting) procedure and important post-operative considerations for patients. It addresses symptoms of coronary artery disease, techniques used such as angioplasty with stenting, and essential care steps during recovery. Test your knowledge on managing post-op care and recognizing signs of infection.

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