Coronary Artery Bypass Graft Surgery Term Paper

Pages: 6 (1776 words)  ·  Bibliography Sources: 5  ·  Level: Master's  ·  Topic: Health - Nursing

Coronary Bypass

Nurse Training for Support in Coronary Artery Bypass Graft Surgery (CABG)

The purpose of the account that follows is to propose a course design for nurse training specific to the tasks and responsibilities relating to the treatment of Coronary Artery Bypass Graft Surgery. All preliminary research is intended to serve a set of learning objectives to be instilled in the nursing students and nursing professionals enrolled in the training course. Consideration will be given to the practical and ethical implications of the nursing role.

Subject Matter:

The Coronary Artery Bypass Graft Surgery (CABG) is both a very common and a very serious medical procedure. This is performed only in instances where physicians have deemed it as absolutely necessary as a means to reducing the risk of heart attack or intervening where a heart attack appears imminent. The most common of coronary procedures in the response or preemption to a heart attack, the CABG removes critical blockages in the arterial blood vessels leading to the heart and replaces the damages arteries with unblocked vessels typically grafted from the arm or leg. According to the National Heart Lung and Blood Institute (NHLBI), "CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new passage, and oxygen-rich blood is routed around the blockage to the heart muscle." (NHLBI, 1)

Preliminary Research:

Perioperative Considerations for CABG Surgery:

Incidence

Coronary Artery Bypass Graft surgery is typically a measure taken in the event of angina and is intended to reduce the risk of heart attack or other heart malady in those with some form of coronary disease. (CC, p. 1) Heart disease is among the most common causes of fatality in the United States on an annual basis and is caused by a wide range of factors including obesity, high blood pressure, poor diet and nicotine addiction. As such, CABG is an important tool at the disposal of heart surgeons. Kulick & Shiel report that (2011), "according to the American Heart Association 427,000 coronary artery bypass graft (CABG) surgeries were performed in the United States in 2004, making it one of the most commonly performed major operations."

Causes

The primary cause of CABG is the presence of a blockage in one or more of the arteries that carry blood to the heart. (CC, p. 1) According to Kulick & Shield (2011), "coronary artery disease (CAD) occurs when atherosclerotic plaque (hardening of the arteries) builds up in the wall of the arteries that supply the heart. This plaque is primarily made of cholesterol. Plaque accumulation can be accelerated by smoking, high blood pressure, elevated cholesterol, and diabetes. Patients are also at higher risk for plaque development if they are older (greater than 45 years for men and 55 years for women), or if they have a positive family history for early heart artery disease." (p. 1)

Indications for Surgery

Any number of symptoms of heart disease may be emergent in the subject, including high blood pressure, chest pains, dizziness, fatigue or the actual occurrence of a heart attack. The presence of heart disease is not, in and of itself, an indicator that surgery is necessary. In many cases, prescription medication or lifestyle changes can make a significant difference in the patient's health outlook. (NHLBI, p. 1) However, where a heart attack has occurred or where the presence of medical evidence that such an event is imminent, this resort may be taken.

Nursing Activities

Nursing activities relating to first stages of the process for a bypass surgery will include preparing the subject for initial hospitalization, functioning as a conduit to information regarding the procedure, providing a suitable environment for the patient in emotional preparation for surgery and regarding all appropriate demands in terms of administration of medication, provision of nutrition and accurate reading of all vital signs.

Intraoperative Considerations for CABG Surgery:

Surgical Methods Review

Anatomy and Pathophysiology:

Many times, the symptoms that reveal the presence of a life-threatening heart disease will be instigated by a weakness in the heart's ability to pump blood. It is this deficiency that leads to the dizziness, lightheadedness, nausea and muscle cramping that may be indicators of an imminent health threat. When it is determined that a CABG is the appropriate course of action, the process is designed to restore strength to the heart by removing one or more blockages.

Most frequently, Kulick & Shiel indicate, the bypass artery is the saphenous vein which is found in the leg. An incision is made in the chest and the sternum is broken open so that the surgeon can access the heart. Kulick & Sheil indicate that before the bypass can be performed, the body must be placed on artificial bypass. Accordingly, they report that "plastic tubes are placed in the right atrium to channel venous blood out of the body for passage through a plastic sheeting (membrane oxygenator) in the heart lung machine. The oxygenated blood is then returned to the body." (p. 5)

Subsequently, the bypass vessel is sewed to coronary arteries just above the blockage. Frequently, Kulick & Shiel report, the internal mammary artery is increasingly a preferred artery for grafting. Following the procedure, the sternum is wired shut and the incision is closed.

Risks vs. Benefits:

Any surgical procedure carries certain risks. This is particularly true when this surgery relates to heart function. Though CABG is now seen as a relatively routine surgery from a medical perspective, it is a traumatic event for the heart and body in general that is only performed when significant health risks are already present. Kulick & Shiel report that the procedure itself has a 3-4% fatality rate and that for 5-10% of patients, fatality from heart attack occurs shortly thereafter in spite of the procedure. (Kulick & Shiel, p. 6)

That said, the benefits are considerable where the procedure is deemed necessary. According to NHLBI, 85% of those who have had the surgery report to substantially reduced symptoms, a reduced risk of heart attack "and a decreased chance of dying within 10 years." (p. 1)

Postoperative Considerations:

PACU Care

Physician and Nursing Orders

Physicians and nurses will play a crucial role in ensuring that the patient regains consciousness and orientation slowly, carefully and in a comfortable environment. The bypass procedure is physically traumatic and it is important that the attending nurses and physicians provide an atmosphere where the subject can gather himself without undue stressors. This means that the present nurses and physicians should be available to speak with the patient, to remind him of his surroundings, to report the degree of success experienced during the procedure and to offer some concise instruction of what to expect next. During this time, it is also essential that the patient be closely monitored for any immediate negative bodily responses to the procedure and, further, that those attending are prepared to act in an emergency capacity should the need arise.

Ward Care

Physician and Nursing Orders

During the patient's postoperative stay in the hospital, the nurses and physicians will play a central role in preparing the patient for discharge. Primary responsibilities at this juncture include administering medication, cleaning and dressing incision wounds, providing nutrition, monitoring vital signs and monitoring the patient for progress in accepting the surgery. According to Aroesty (2010), "before leaving the hospital, it is important for the patient and family to participate in and understand the discharge plan. Make sure all questions are answered and obtain written directions for how to take all medications (new and old). After bypass surgery, it is common to start new medications and stop or adjust the doses of previous medications." (p. 1)

Length of Stay

The commonality of the procedure has led to continually shortened lengths of stay following treatment. Patients are routinely discharged, if free from complications, in a matter of 3 to 4 days.

Home Care

Discharge Instructions

Aroesty indicates that discharge instructions should be focused on lifestyle changes. The patient will be required to make certain changes relative to the likely causes of the initial heart disease, whether related to diet, exercise, smoking or exposure to other potentially negative effectors.

Follow-Up Appointments

Aroesty indicates that for many CABG patients, some cardiac rehabilitation is required, which typically denotes several therapy appointments a week during the early post-operative period. Regular monitoring through cardiac physicians is also required.

Terminal Objective:

At the end of the educational period recommended here, the learner should be able to perform all nursing duties in relation to Coronary Artery Bypass Graft surgery. The performance of these duties refers to an understanding of all supporting needs of the patient throughout the perioperative period, including but not limited to the proper administration of medication, maintenance of vital function machinery, maintenance of a clean, safe and sanitary environment, proper hand hygiene, compassionate bedside manner and the capacity to transmit… [END OF PREVIEW]

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