[Nrs. LaLa-Land]

I am in my last semester and I am currently doing clinicals on a Tele floor. We have to write a graded careplan for a post-MI or post-CABG pt. I have had two CABG pt. but both of them were just getting ready to go home.

My instructor said to write the careplan as if the patient was fresh out of surgery.

My question is ....What is the biggest priority for a CABG pt. who is a fresh post-op sent to the Tele unit from CCU?
Thanks in advance!

[batmik]

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 procdure.

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.

[Nrs. LaLa-Land]

Wow! That is great!! thank-you soooo much!!
That is exactly what I was looking for!