UNIT 2 and 3 CHAPTER 35 Coronary Artery Bypass Graft (CABG

Question 1

Complication of CABG

Answer 1

• Cardiac – dysrhythmias, cardiac tamponade, decreased output, and
  hypotension * Hematologic – bleeding and clotting * Renal – renal failure * Pulmonary – atelectasis * Neurologic – stroke, encephalopathy * Wound infection – mupirocin can be used as a nasal ointment can reduce the
  risk of mediastinitis, dehiscence risk can be reduced by reducing strain on
  incision site.

Question 2

cardiac tamponade S/S

Answer 2

Assess for, document, and report manifestations of cardiac tamponadeimmediately, including:
* Sudden cessation of previously heavy mediastinal drainage
* Beck triad:
* Jugular venous distention but clear lung sounds * Distant, muffled heart sounds
* Hypotension
* Pulsus paradoxus (BP more than 10 mm Hg higher on expiration than on inspiration)
* An equalizing of PAOP and right atrial pressure
* Cardiovascular collapse

Question 3

What vessel is used for CABG

Answer 3

Potential for DVT/PE - mobility may be limited during 1 st 24 hours, may be on
ventilator and will have chest tube. Saphenous vein is most often used as
bypass graft, will further diminish venous return in affected extremity.

Question 4

Preop patient teaching

Answer 4

If the procedure is elective, demonstrate and have the patient return a demonstration of how to splint the chest incision, cough, deep breathe, and perform arm and leg exercises. Stress that:

• The patient should report any pain to the nursing staff.
• Most of the pain will be in the site where the vessel was harvested.
  (With the use of endovascular vessel harvesting [EVH] and one or two small incisions, the pain and edema are less than for previously performed procedures.)
• Analgesics will be given to decrease pain.
• Coughing and deep breathing are essential to prevent pulmonary
  complications.
• Early ambulation is important to decrease the risk for venous
  thrombosis and possible embolism.

Question 5

PREOP Nursing intervention CABG

Answer 5

• If possible, treat any underlying infections prior to surgical procedure.
• Have patient shower or bathe with soap or antiseptic agent the night before surgery. Chlorhexidine gluconate for skin preparation is recommended (Seifert, 2017).
• If hair removal is necessary, clip hair immediately prior to the procedure.
• Preoperative antibiotics or antimicrobials are used prior to skin incision.
• Use an alcohol-based antiseptic agent to prepare skin prior to incision.
• Antimicrobial agents should not be applied to incision sites.
• Maintain perioperative glucose levels <200 mg/dL even in those patients without a history of diabetes mellitus.