Nursing care plan cardiac surgery

POSTOPERATIVE CARE— CORONARY ARTERY BYPASS GRAFT (CABG),
MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB), CARDIOMYOPLASTY, VALVE REPLACEMENT

I. Purpose: to maximize cardiac output by improving blood
flow and myocardial muscle function

II. Types
a. Reparative: closure of atrial or ventricular septal defect or
repair of stenotic mitral valve; reparative surgeries more
likely to produce cure or prolonged improvement
b. Reconstructive: coronary artery bypass grafting (CABG),
restructure of incompetent valve leaflets
c. Substitutional: valve replacement, cardiac transplant

III. Procedures
a. Procedures requiring use of cardiopulmonary bypass (CPB)
i. CABG has an average patency rate of 20 years and
decreased overall mortality from coronary heart disease,
relief from angina, improved functional status, and may
improve quality of life due to decreased need for pharmacological
therapy and a reduction in frequency of
interventional procedures (Kark, 2008).
ii. Open heart valve repair or replacement using natural
(biological) or artificial (mechanical) valves are the most
common minimally invasive heart surgery procedures
(Cleveland Clinic, 2007).
iii. Port-access coronary artery bypass (PACAB) is a minimally
invasive option in certain conditions, such as single
bypass from left mammary artery to left anterior
descending coronary artery.
b. Procedures not requiring use of CPB (heart-lung) machine
i. Off-pump coronary artery bypass (OPCAB) or beating
heart bypass surgery may be an option for client
with single-vessel disease, such as the left anterior
descending artery or right coronary artery.
ii. Minimally invasive direct coronary bypass (MIDCAB)
iii. Robotic-assisted coronary artery bypass (RACAB),
also called closed-chest heart surgery
iv. Totally endoscopic coronary artery bypass (TECAB)
using a port access, which may be video and robotic
assisted—primarily carried out in large heart centers
where specialized equipment and training are available

v. Percutaneous mitral, aortic, and pulmonic valvotomy
for stenosis; transapical aortic valve implant
vi. Transmyocardial laser revascularization (TMR) uses
lasers to create channels in heart muscle to improve
direct blood flow.
vii. Endoscopic pulmonary vein isolation for the treatment
of atrial fibrillation, thoracic endografting for the
treatment of aortic aneurysmal disease

IV. Statistics
a. 46,900 CAB procedures and 106,000 valve replacements
were performed in the United States in 2005 (American
Heart Association [AHA], 2007).
b. Cost: The mean charge per CABG procedure in 2001 was
$60,853 (AHA, 2004).

Care Setting

Client is cared for at inpatient acute hospital on a surgical or
post-intensive care unit (ICU) step-down unit.
Related Concerns
Angina
Heart failure: chronic
Dysrhythmias
Myocardial infarction
Pneumothorax/hemothorax
Psychosocial aspects of care
Surgical intervention
Transplantation considerations—postoperative and lifelong

Nursing Priorities

1. Support hemodynamic stability and ventilatory function.
2. Promote relief of pain and discomfort.
3. Promote healing.
4. Provide information about postoperative expectations and
treatment regimen.

Discharge Goals

1. Activity tolerance adequate to meet self-care needs.
2. Pain alleviated or managed.
3. Complications prevented or minimized.
4. Incisions healing.
5. Postdischarge medications, exercise, diet, and therapy
understood.
6. Plan in place to meet needs after discharge.

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