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?

Medical history, vitals, and functional tests Signup and view all the answers

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

Target HR = (max HR - resting HR) x % intensity + resting HR Signup and view all the answers

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

Reduced blood flow to the heart Signup and view all the answers

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

Avoiding deep breathing exercises Signup and view all the answers

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

Increased drainage Signup and view all the answers

When can active exercise typically begin post-CABG?

24 hours after surgery Signup and view all the answers

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

Using a rocking technique to stand Signup and view all the answers

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

Stable ECG Signup and view all the answers

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

Use of a pillow for splinted coughing Signup and view all the answers

What is the typical duration of cardiac rehabilitation after CABG?

6-12 weeks 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?

Check vital signs and use Rate of Perceived Exertion (RPE) Signup and view all the answers

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

Thrombocytopenia Signup and view all the answers

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

Dietary preferences Signup and view all the answers

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

Neurological reflex tests Signup and view all the answers

Long-acting bronchodilators are typically used for which purpose?

Daily management of chronic respiratory conditions Signup and view all the answers

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

To keep the artery open after balloon inflation Signup and view all the answers

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

It often causes artery ruptures due to inflammation Signup and view all the answers

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

Maintaining symmetrical and proper upright posture Signup and view all the answers

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

Lying prone Signup and view all the answers

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

If the patient has not had chest pain for 8+ hours Signup and view all the answers

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

Positioning a pillow for splinted coughing Signup and view all the answers

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

Progressing mobilization and climbing 2 flights of stairs Signup and view all the answers

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

Mild itching, numbness, or tightness Signup and view all the answers

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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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.