Cardiac Surgery and Coronary Artery Revascularization

Cardiac Surgery

• 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.

Heart Structure and Function

• 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 Revascularization

• 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.

Patient Assessment

• 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.

Assessing for Complications

• 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.

Complications

• 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.

Nursing Diagnoses

• 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.

Continuing Care

• 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.

Expected Patient Outcomes

• Maintains adequate cardiac output.
• Maintains adequate gas exchange.
• Maintains fluid (and electrolyte) balance.
• Experiences decreased symptoms of sensory-perception disturbances.
• Experiences relief of pain.
• Maintains adequate tissue perfusion.
• Maintains normal body temperature.
• Performs self-care activities.

Prevention of Coronary Heart Disease

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

Aneurysms

• 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.

Treatment and Prevention of Aneurysms

• Surgery may be performed to repair or remove the damaged tissue.
• The type of surgery depends on the patient's overall health and the type of aneurysm.

Nursing Care for Aneurysms

• Assess peripheral perfusion.
• Monitor hemodynamics and vital signs to monitor for deterioration.
• Manage pain.
• Administer antihypertensives.
• Monitor for evidence of rupture.
• Larger aortic aneurysms are at high risk for rupture.