Dumb Question over here!!!

Editorial Team / Admin · Oct 17, 2006

Hi Holly, and NEVER stop asking questions!!!

I'll attempt to answer your questions. Mind you (this is my disclaimer), I'm mainly a Cath Lab nurse, haven't worked CCU/ICU for many years (but have cared for many ICU pts in the Cath Lab).

First, there are some excellent resource suggestions at the top of this forum, and at the top of the CCU Nursing forum as well, in the form of a "sticky." Check them out, they were placed by Very Knowledgeable And Helpful Nurses! One of my favorite sites is icufaqs.org, for info for nurses. And as you learn, you'll be able to teach as well. As for helping pts understand things, see what resources your unit has available for pt teaching, and ask other nurses what they use for teaching.

CABG = Coronary Artery Bypass Graft (surgery)

Both terms describe the same thing, to me: a blockage/stenosis/diseased area of the coronary artery is bypassed with an alternate way for blood to get past the diseased part, to the rest of the heart that vessel supplies.

Imagine you're driving on your usual road home, when you're alerted there's a huge traffic accident ahead, stopping ALL flow of traffic. You happen to know of a side road nearby, so you turn off onto that, which takes you past the traffic problem, and then you turn back onto your usual road, past the problem area.

Same principle with the bypass.

There are two types of bypasses.

SVGs (saphenous venous grafts, or sometimes surgeons refer to them as RSVGs, reverse saphenous venous grafts) are veins harvested from the legs.* One end is attached to the aorta, and the other end is attached just past the problem area of the coronary artery. Blood then flows from the aorta past the diseased area, to the rest of the artery, supplying that area of the heart. (*sometimes the bypassses are veins harvested from the arms, when the patient has had one or two previous CABGs and the leg veins have already been used)

Arterial grafts are either LIMAs (left internal mammary artery) or RIMAs (right internal mammary artery). LIMAs are used more frequently, mostly to bypass LAD (left anterior descending) disease. The LIMA takes off from the left subclavian artery (in the left upper chest, just near the clavicle), and with its branches descends down to supply blood to the chest. The surgeon disconnects the distal end from the chest wall and attaches it just past the coronary artery's diseased area. Voila, the heart muscle past the diseased area is supplied with blood.

Epicardial pacing leads, as far as I know, are applied for every open-chest heart surgery, just in case emergency pacing is needed.

Well, those were the short answers and I hope they helped. Glad you're asking questions and reading, to help your pts and their families understand what's going on. Medicine and medical terms and physiology, cause-and-effect in the body, are hard enough to understand in the best of circumstances, and our pts are often hearing life-changing news that's overwhelming and difficult to grasp . . . never mind the emotions that creep in, too! Hang in there! --- Diana :)

Holly27 · Oct 17, 2006

Thanks! That helped me out.

:nurse:

metalmom · Oct 17, 2006

Hi All!

I'm sorry if I'm butting into a forum but I don't know where else to post. I just finished day #3 as a new grad (May 2006) on A DOU/Tele unit. I'm so unsure of myelf. Does everybody go through this. I had more confidence as a student. Now I feel overwhelmed to the max, afraid I look stupid and completely out of my own mind and body. Am I going to make it? This is my dream and now all I can think about is how I wish I was the guy handing out visitors tags at the front entrance. Please. Any words of encouragement?

Editorial Team / Admin · Oct 21, 2006

bless you, metalmom, if you surf around here (especially in the New Grad forums), you'll find a HUGE boat overloaded with nurses going through the same trial-by-fire and experiencing the same painful learning curve as you. You deserve GREAT KUDOS for just making it through Nursing School, graduating and getting your license!!

Nursing IS different than school! Please take lots of good, deep breaths, do something good for yourself after work, and don't beat yourself for not knowing as much as the seasoned nurses. Be good to your patients, look your medications up to be sure of them, don't cut corners and BE PATIENT with yourself. Pat yourself on the back for ONE thing learned each day, that you'll do correctly (and more quickly) the next time. Don't listen to the Nurse-Eaters, but ask the Helpful and Caring Ones (the ones you want to emulate) if you have questions. If your Nurse Manager is approachable, you might tell her/him the same as you've posted here. Do you feel you need more orientation? More precepting?? DOU/Tele is tough, lots to learn (and there's lots for ANY new grad to learn!!). You CAN do it. Just not in one day.

Do search through this BB for the section I mentioned before. Ask questions/Vent anytime. Hang in there. -- D :)