Cardiac Surgery and Coronary Artery Revascularization

Study Notes

Heart disease is the leading cause of death worldwide.
Cardiac surgery may be used as a treatment when heart disease symptoms increase in severity and frequency or the disease process worsens.

The heart has four chambers: the left and right atria, and the left and right ventricles.
Four valves regulate blood flow through the heart: tricuspid valve, pulmonary valve, mitral valve, and aortic valve.
Coronary arteries supply the heart muscle with blood.

Coronary artery bypass grafting (CABG) is a surgical procedure in which a blood vessel from another part of the body is grafted to the occluded coronary artery.
CABG allows blood to flow beyond the occlusion.

Respiratory status: chest movement, breath sounds, ventilator settings, respiratory rate, ventilatory pressure, arterial oxygen saturation, and pleural chest tube drainage.
Peripheral vascular status: peripheral pulses, skin color, nailbeds, mucosa, lips, and ear lobes, skin temperature, edema, and condition of dressings and invasive lines.
Renal function: urinary output, urine specific gravity, and osmolality.
Fluid and electrolyte status: intake, output from all drainage tubes, and cardiac output parameters.
Pain: nature, type, location, duration, and response to analgesics.

The patient is continuously assessed for indications of impending complications.
The nurse and surgeon collaborate to identify early signs and symptoms of complications and institute measures to reverse their progression.

Decreased cardiac output: a threat to the patient who has had cardiac surgery, symptoms include restlessness, headache, confusion, dyspnea, hypotension, and cyanosis.
Decreased cardiac output can lead to hypoxia.

Decreased cardiac output related to blood loss, compromised myocardial function, and dysrhythmias.
Impaired gas exchange related to trauma of extensive chest surgery.
Risk for deficient fluid volume (and electrolyte imbalance) related to alteration in circulating blood volume.
Disturbed sensory perception (visual or auditory) related to excessive environmental stimuli, insufficient sleep, psychological stress, altered sensory integration, and electrolyte imbalances.
Acute pain related to surgical trauma and pleural irritation caused by chest tubes.
Ineffective tissue perfusion (renal, cerebral, cardiopulmonary, gastrointestinal, peripheral) related to decreased cardiac output, hemolysis, vasopressor drug therapy, venous stasis, embolization, underlying atherosclerotic disease, effects of vasopressors, or coagulation problems.
Ineffective thermoregulation related to infection or postpericardiotomy syndrome.
Deficient knowledge about self-care activities.

Arrangements are made for a home care nurse to provide care when appropriate.
The education plan is continued by the home care nurse.
Vital signs and incisions are monitored, the patient is assessed for signs and symptoms of complications, and support for the patient and family is provided.

Lowering blood pressure and cholesterol levels can help reduce the risk of developing coronary heart disease.

Aneurysms can occur anywhere, but the most common occur in the aorta, brain, leg behind the knee, intestine, and spleen.
Symptoms may develop suddenly and include pain, clammy skin, dizziness, nausea and vomiting, rapid heart rate, shock, and low blood pressure.