CABG Care Plan

[Kenneth Oja, PhD, RN]

You'll want to consider the general risks related to any type of surgery/procedure as well as the risks specific to the cardiac system. The biggest priority for a CABG patient who is a fresh post-op sent to a telemetry unit from CCU is anything related to airway and breathing (think ABCs!) 

• Risk for Ineffective Airway Clearance 
• Risk for Ineffective Breathing Pattern 
• Risk for Impaired Gas Exchange 

So, your top priorities for the post-op CABG patient include assessment and monitoring of airway and respiratory status and intervening as necessary per the Nursing Scope and Standards of Practice. Possible nursing interventions for these diagnoses might include: 

• Positioning the patient upright as tolerated 
• Encouraging coughing and deep breathing 
• Encouraging and assisting with ambulation as tolerated 
• Monitoring oxygen saturation and coordinating with respiratory therapy 
• Administering prescribed oxygen and other medications as necessary 

In addition to the above, you also need to closely assess and monitor the cardiac system, since the patient is post-CABG. Some of the nursing diagnoses to keep in mind include: 

• Risk for Decreased Cardiac Output 
• Risk for Decreased Cardiac Tissue Perfusion 
• Risk for Excess Fluid Volume 

Based on the diagnoses specific to the CABG procedure, additional nursing interventions to those listed above might include: 

• Monitoring the patient's heart rate/rhythm, blood pressure, and respiratory rate 
• Assessing extremities for color, temperature, cap refill, edema 

There are multiple nursing priorities when caring for a CABG patient who is fresh post-op. The key is using your nursing knowledge to determine which priority is the "biggest,” or most important, at any given moment. Priorities will change, sometimes minute to minute. It is our responsibility as nurses to anticipate that change, and re-prioritize as needed, to provide the best possible outcomes for patients.   

[RNKPCE]

I work on a tele floor and this is exactly the kind of patient we get. First priority is Pulmonary Toliet( kind of old term) but turning coughing, deep breathing, using triflow or incentive spirometer. Next or maybe along with first is pain control, so they can deep breathe, and then get them up and move them. Our surgeon wants them up in chair tid for meals and walked qid by 2nd post op day. up chair and at least one walk on 1st post op day. You also have to watch fluid retention. Most patients are above their pre-op weight following surgery due to fluid overload. So watch urinary output, lasix or extra lasix maybe needed. Goal is usually to pre-op weight by discharge. Another thing is to monitor for arrhythmmias, very common to go into Atrial fib post-op after surgery. I would say about 30-40% do have some AF. Overall goal is also teaching to pt and significant other.

[PSA, RN]

After CABG these are some Nursing Diagnosis:

Decreased cardiac output r/t dysrhythmia, depressed cardiac function, increased systemic vascular resistance.

Deficient fluid volume r/t intraoperative fluid loss, use of diuretics in surgery.

Fear r/t outcome of surgical procedure.

One Intervention that comes to mind is:

Monitor for symptoms of heart failure and decreased cardiac output, including diminished quality of peripheral pulses, cool skin, and extremities, increased respiratory rate, presence of aroxysmal nocturnal dyspnea or orthopnea, increased heart rate, neck vein distention, decreased level of consciousness, and presence of edema.

Hope this helps. Good luck.

[Alice nurse]

acute pain

[TorsadesDePointesRN]

Check the cath site (for oozing or hematoma) and also check the pedal pulse on the cathed side. (compare L and R pulses to compare quality)

[Nrs. LaLa-Land]

Wow! That is great!! thank-you soooo much!!

That is exactly what I was looking for!