Would Like Input - CABG - page 2

by NickiJules

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Can't stop thinking about my pre-op CABG... Any input would be greatly appreciated! My patient was admitted for recurrent CHF exacerbation, mostly having SOB that would come and go. So she was admitted, had positive cardiac... Read More


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    Wow, people and places are so reactionary.

    You used to be able to learn a lot re: your patients for the sake of learning. But you know, there are idiots that can't just take the information academically and learn from it. They have to blab about it.

    Now, I am going to see how residents advance their learning experiences in light of reactionary HIPAAism. I mean people do need to learn. But it's usually some idiots that make things a problem for others.

    Personally I don't see the problem if you are learning from the cases but your mouth is shut. I can see someone making an issue for a nurse out of this, even if the person says nada, but is just trying to learn from the particular case.

    I hate reactionary BS.
    NickiJules, Esme12, and Bubbles like this.
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    Your patient from the start was at high risk for not coming off the vent without PFT's. I am sure the doctor was aware of that fact and explained the risks and benefits to the patient before surgery( at least we hope so). Pt will probably end up failing weaning and may end up with a trach, but probably otherwise would be dead.

    Don't worry, the docs disn't need PFT's to know this.
    NickiJules likes this.
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    Quote from MomRN0913
    Your patient from the start was at high risk for not coming off the vent without PFT's. I am sure the doctor was aware of that fact and explained the risks and benefits to the patient before surgery( at least we hope so). Pt will probably end up failing weaning and may end up with a trach, but probably otherwise would be dead.

    Don't worry, the docs disn't need PFT's to know this.
    No doubt pulmonary is on the case now. I have seen patient's get extubated way off of typical schedule, but it all depends on what is going on with them.
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    actually, it's the anesthesiologist that pretty much decides if pt is candidate for surgery.
    i am wondering where this pt is with her lung ca, as she very well may be candidate for hospice...
    and certainly not major surgery.

    it's too bad, as it 'sounds' like yet, another futile and invasive intervention for this person.
    may she soon find comfort and peace.

    leslie
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    Quote from leslie :-D
    actually, it's the anesthesiologist that pretty much decides if pt is candidate for surgery.
    i am wondering where this pt is with her lung ca, as she very well may be candidate for hospice...
    and certainly not major surgery.

    it's too bad, as it 'sounds' like yet, another futile and invasive intervention for this person.
    may she soon find comfort and peace.

    leslie
    When my grandfather was in the hospital, they tried to unsuccessfully endoscopic ally peg him and couldn't. They anted to do it surgically under general anesthesia . My dad was his health care proxy . My grandfather lived quite a full active life and would not want to spend his life on a vent with a peg. My dad asked me to help make the decision. He put me on the phone with the nestesiologist and I asked " wi his CHF and pleural effusions, will he come off the vent? He said, most likely not. So, to get trached to get pegged was not a quality of life for an 86 yo like my grandfather. I told my dad not to do it, and to make him DNR. The next morning he passed in his sleep, peacefully.
    GrnTea, Esme12, and leslie :-D like this.
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    Quote from MomRN0913
    When my grandfather was in the hospital, they tried to unsuccessfully endoscopic ally peg him and couldn't. They anted to do it surgically under general anesthesia . My dad was his health care proxy . My grandfather lived quite a full active life and would not want to spend his life on a vent with a peg. My dad asked me to help make the decision. He put me on the phone with the nestesiologist and I asked " wi his CHF and pleural effusions, will he come off the vent? He said, most likely not. So, to get trached to get pegged was not a quality of life for an 86 yo like my grandfather. I told my dad not to do it, and to make him DNR. The next morning he passed in his sleep, peacefully.
    God bless you, momrn.
    very wise and compassionate decision on your part.

    leslie
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    Quote from NickiJules
    Can't stop thinking about my pre-op CABG... Any input would be greatly appreciated!

    My patient was admitted for recurrent CHF exacerbation, mostly having SOB that would come and go. So she was admitted, had positive cardiac cath, and scheduled for open heart the next a.m.

    Last I knew, she was still intubated, over 2 weeks post op.

    Her Hx included lung ca and R lower lobectomy. Im the one who completed her pre op orders. CXR showed possible small pleural effusion. For some reason, it did not occur to me until later that day that PFTs were not ordered for her.

    I don't know if they routinely check PFTs pre op at this facility but does anyone know if this could have made a difference in decision to operate? I cant remember the extent of occlusion per her cath. Also, what are the chances of recovery for someone intubated this long?

    Thanks!
    There is a learning exclusion to HIPAA. How else do people learn.

    Now..your patient. Recurrent CHF...there are many thing that determine CABG and post op outcome.

    My questions/thoughts would include...what what the ECHO...what was the ejection fraction? How may prior MI's had this patient had? What co-morbidities were present? She is behind the 8ball due to the lobectomy and lung CA....the surgeon's I had worked with would do PFT's and baseline abg's pre-op for guidance post op.

    Her mortality depends if she experienced any complications during the surgery like another MI, a stroke, damage to the phrenic nerve.....that will affect her mortality.

    Just because someone is still intubated 2 weeks op isn't necessarily a sign that they will not leave the hospital it is significant that she has suffered complications that will prolong and complicate her stay.
    NickiJules likes this.
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    Quote from Esme12

    There is a learning exclusion to HIPAA. How else do people learn.

    Now..your patient. Recurrent CHF...there are many thing that determine CABG and post op outcome.

    My questions/thoughts would include...what what the ECHO...what was the ejection fraction? How may prior MI's had this patient had? What co-morbidities were present? She is behind the 8ball due to the lobectomy and lung CA....the surgeon's I had worked with would do PFT's and baseline abg's pre-op for guidance post op.

    Her mortality depends if she experienced any complications during the surgery like another MI, a stroke, damage to the phrenic nerve.....that will affect her mortality.

    Just because someone is still intubated 2 weeks op isn't necessarily a sign that they will not leave the hospital it is significant that she has suffered complications that will prolong and complicate her stay.
    The only learning exclusion I can think of is when aggregate used . I don't know of ant health care organization that lets health care workers look at charts of patients you are no longer carrying for. If I'm wrong could you please direct me to what that exclusion is called? Tganks
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    Thanks everyone for the helpful responses! I'm happy to learn she has hope for recovery-unfortunately, it will be a difficult one, if she does improve. If/when she returns to our floor, I will get to see her but will not be checking her chart anymore, certainly!

    Regarding HIPAA, I don't see the harm in checking the chart (for purposes of learning or just simply out of concern) but if it's a violation, I'm sure it is for a good reason.

    Anyway, thanks again everyone for your input.
  10. 0
    Quote from Esme12
    There is a learning exclusion to HIPAA. How else do people learn.
    Unfortunately nurses look at their patients charts "just to see what happened to them" and not necessarily as a learning experience.


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