SUBMITTED BY Miss A Auxilia II nd Year Msc Nursing Arvinth College of Nursing LESSON PLAN ON CORONARY ARTERY BYPASS GRAFT TOPIC CORONARY ARTERY BYPASS GRAFT ID: 911646
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CORONARY ARTERY BYPASS GRAFT
SUBMITTED BY
Miss . A. AuxiliaIInd Year M.sc NursingArvinth College of Nursing
Slide2LESSON PLAN ON CORONARY ARTERY BYPASS GRAFT
TOPIC : CORONARY ARTERY BYPASS GRAFT
GROUP : CLIENTS WITH POSTED FOR CABG
PLACE : SUDHA HOSPITAL,ERODE.
MEHOD OF TEACHINH :
LECTURE CUM DISCUSSION
TEACHING AIDS : POWER POINT PRESENTATION
TIME : 1 HOUR
Slide3INTRODUCTION
INTRODUCTION
Coronary artery bypass surgery, also coronary artery bypass graft(CABG, pronounced “ cabbage “ surgery, and heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease
This surgery usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass ; techniques are available to perform CABG on beating heart so called “off-pump surgery
Slide4MEANING OF CABG
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart is to treat people who have severe coronary heart disease (CHD).
MEANING OF CABG
Slide5REVIEW OF HEART STRUCTURE
The heart weight is around 280 to 340 grams
The heart is situated at the center of the chest and points slightly towards left.
Our Heart is about the size of a fist divided into four chambers namely two ventricles and two atria
REVIEW OF HEART STRUCTURE
Slide6REVIEW OF CORONARY ARTERIES
Coronary arteries supply blood to the heart muscle
The 2 main coronary arteries are the left main and right coronary arteries.
REVIEW OF CORONARY ARTERIES
Slide7CAUSES
Slide8RISK FACTOR
AGE
SEX
FAMILY HISTORY
SMOKING
HIGH BLOOD PRESSURE
HIGH BLOOD CHOLESTEROL LEVELS
DIABETES
OVERWEIGHT OR OBESITY
PHYSICAL INACTIVITY
HIGH STRESS
RISK FACTOR
Slide9TYPES OF CABG
Surgery performed on open chest, heart is stopped, heart-lung bypass machine is used for circulation of blood to rest of the body allowing surgeon to perform on still heart
ON PUMP CABG
Slide10TYPES OF CABG
OFF-PUMP CABG
Similar to Traditional CABG, only heart is not stopped and Heart lung bypass machine is not used.
Slide11TYPES OF CABG
MINIMAL INVASIVE DIRECT CABG
Not performed on an open chest, instead cuts are made between the ribs on chest. Mainly done to bypass blood vessels at the front of the heart.
Slide12PURPOSES
Restore blood flow to the heart.
Relieves chest pain and ischemia.
Improves the patient’s quality of life.
Enable the patient to resume a normal lifestyle.
Lower the risk of a heart attack.
PURPOSES
Slide13INDICATIONS FOR CABG
Patients with blockages in coronary arteries.
Patients with angina.
Patients who cannot PTCA (Percutaneous transluminal coronary angiography) and do not respond well to drug therapy.
INDICATIONS FOR CABG
Slide14CONTRA INDICATION
Absence of an open artery 1’ mm or more in diameter beyond the obstructing lesion.
Absence of viable myocardium in the area supplied by the stenosed artery.
Co-existing severe non cardiac condition with poor prognosis.
pregnant
CONTRA INDICATION
Slide15COMPLICATION
Myocardial dysfunction
Cardiac tamponade
Graft ischaemia
Arrhythmia
Irregular heartbeat
Death
IMMEDIATE COMPLICATION
LONG TERM COMPLICATION
LONG TERM COMPLICATION
IMMEDIATE COMPLICATION
Reduced kidney function
Brain-related problems
Coagulopathy
Hyperglycemia
Mediastinitis and other infection
Slide16PROCEDURE
PROCEDURE
Intra operative
Sedation
Intubation
Insert folly's catheter and central line
Opening
Cannulation “ on pump or off- pump “.cardioplegia
Applied the pass
Evaluation
Applied chest tube.
Close by suturing the wound
Slide17PROCEDURE
Slide18POST OPERATIVE RECOVERY
Slide19POST OPERATIVE RECOVERY
DAY OF SURGERY
1.moved to the Cardiovascular Unit (CVU)
2. Heart rhythm monitored with sticky patches (electrodes)
3.On ventilator
4. intravenous tubes on neck
5. Ryle's tube, Urinary catheter ,chest tubes present on ‘0’ pod
Slide20POST OPERATIVE RECOVERY
POST-OP DAY ONE
blood test, Electrocardiogram (ECG) and chest X-ray will take
oxygen therapy
Chest tube some iv line may be removed
Start to drinking fluids
Breathing and coughing exercise
Breathing is stable moved to patient care centre
Slide21POST OPERATIVE RECOVERY
POST-OP DAY 2
Blood test and weight check
Continue pain medication
Start to eat
Continue breathing and coughing exercise
Start to walk in the hall
Slide22POST OPERATIVE RECOVERY
POST-OP DAY-3
Weight check
Tell your nurse stomach is upset or nauseated
Start to wash in the bathroom
Continue breathing and coughing exercise
Continue to walk in the hall 3 times a day.
Slide23POST OPERATIVE RECOVERY
POST-OP DAY 4 UNTIL DISCHARGE
1
. blood test, ECG and chest x-ray will take
2. Temporary pacing wire will discontinued
3. Use the hands for self care activities
4. Protect your breast bone with ( chest binder)
5.If bowel is not clear use laxative
Slide24Common experiences after heart surgery
Post-operative confusion (Delirium)
Clicking of the sternum (breast bone)
Numbness and tingling
Swelling (edema) of the legs and ankles
Fatigue (feeling tired)
Memory and concentration
Upset stomach
Slide25FOLLOW UP CARE
Antiplatelet therapy
Beta blockers
Nitrates
ACE inhibitor
Lipid lowering therapy
Other medications
MEDICATIONS
Slide26FOLLOW UP CARE
WOUND CARE
Avoid heavy lifting and extremes of shoulder movement
If the patient develops any of the following signs or symptoms of wound infection, a healthcare provider should be contacted immediately.
Reddened skin, bleeding or pus-like drainage from the incision
Slide27FOLLOW UP CARE
CARDIAC REHABILITATION
Most people who have undergone bypass surgery benefit from participating in a structured, comprehensive cardiac rehabilitation program
Slide28FOLLOW UP CARE
EXERCISE
Breathing and Leg Exercises Before and After Surgery
Do each exercise once every hour
Incentive Spirometry – Repeat 5 times every hour while awake
Breath and Cough – Repeat 2 times
Leg Circulation – Repeat 10 times
Slide29FOLLOW UP CARE
FOLLOW A HEART HEALTHY DIET
LOW SALT
LOW CHOLESTROL
LOW FAT
HIGH FIBER
Slide30FOLLOW UP CARE
STOP SMOKING
Cigarette smoking significantly increases the risk of coronary heart disease and heart attack, and stopping smoking can rapidly reduce these risks
Slide31FOLLOW UP CARE
MANAGE DIABETES
The diet, exercising, monitoring blood glucose levels regularly, and taking oral hypoglycemic medications complications. Tight control can be achieved by losing weight, managing (for people with type 2 diabetes) or insulin (for people with type 1 and sometimes type 2
Slide32FOLLOW UP CARE
PSYCHOSOCIAL TREATMENT
Feelings of depression, anxiety, and denial are common after bypass surgery, occurring in up to 40 percent of people
antidepressant medication, can be helpful.
reduce stress
Slide33FOLLOW UP CARE
An important issue for many patients who have had bypass surgery is when sexual activity can be safely resumed
SAFE SEX
Slide34FOLLOW UP CARE
Follow-up care is of great importance since people who have had bypass surgery have a significantly increased risk of more cardiac events, including recurrent chest pain, heart attack, heart failure, and an increased risk of dying
PERIODICAL HOSPITAL VISIT
Slide35The art of healing comes from nature , not from physician must start from nature, with an open mind
Paracelsus
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Slide36Thank you