Decreased cardiac output r/t CABG - Graded care plan HELP!!

  1. 0
    Hi, I am writing my graded care plan and need some help. I know that risk for decreased cardiac output is the most important nursing diagnosis for me to use. I am just trying to understand why CABG can lead to decrease cardiac output.

    A little hx of my pt:
    74 y.o. male pt with hx of CAD, HTN, hyperlipidemia, and R carotid stenosis was brought to the hospital after c/o increased SOB. CABG was performed since 3 vessel were found to be occluded.

    On my clinical day he was post-op day 5. BP averaging at 130/80, HR varying between 95-105. sinus tacky. RR 18. O2 95% RA. c/o SOB. Crackles on lower lobes (CXR was done and showed pleural effusion).

    So I was thinking in writting: decreased cardiac output r/t depressed cardiac function and increase systemic vascular resistance 2nd to CABG.

    Does that makes sense? Why cardiac function and systemic vascular resistance is changed after CABG?

    Thanks a lot :-)
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  3. 17 Comments so far...

  4. 0
    In working on a cardiac floor I would say pt is as risk for decreased cardiac output if they develop a dysrhythmia after surgery which is very common. Happens to about 30% of patients after CABG...Is that maybe what you are looking for ? Or am i even hitting close lol
  5. 0
    More than likely your patient needed a CABG due to an occluded vessel or vessels...which leads to ischemia of heart muscle. If the pt had an MI, there is damage to the myocardium. This affects the ways the heart pumps. If the heart is not pumping effectively=decreased contactility...the there is decreased Cardiac output. Heart failure can occur because the heart cannot effectivly pump the blood causing it to back up into lungs and periphery. MI can cause left ventricular failure. What is your patients EF?
  6. 0
    I do not have his EF. We did not have computer access that day and that information was not on the paper charting. I dont think he had a MI also, although he was probably closed to one.
  7. 0
    Also did you mean after the CABG procedure as to what could affect cardiac output or before the CABG intervention? if before CABG intervention, i agree with the previous poster.
  8. 0
    After the CABG. When I had my pt he had that done 5 days prior. In class my professor said that post cabg pt is always at risk for decreased cardiac output, i just trying to understand why.
  9. 0
    Then i would definitely say with my patients they are at risk for decreased cardiac output because this heart surgery has irritated the heart significantly and it is trying to heal at the same time from the surgeons stitching the graft and what not. When the heart is healing some of our patients with go into dysrhythmias such as afib, vfib, aflutter, svt, VT, A MULTITUDE of cardiac dysrhythmias. of course if your heart is not in normal sinus rhythm, these rhythms will impair cardiac output because it's not the normal electrical pathway of the heart to follow, so it wont pump as effectively as it should providing the necessary cardiac output. This is when we either start a cardiac drip (for afib) or of course if they are coding we will do more intense interventions

    From experience, that is the way that I am looking at it. OF course their EF will never be great because of possible heart injury before the cabg. but as far as why a patient is at risk for decreased cardiac output after cabg, that would be my answer.
    hope that helps.
  10. 0
    and also after surgery we have a lot of patients who third space their fluid rather than pulling it in their vessels... these patients will often have a lot of swelling or in your patients case it sounded like he had some fluid build up in his lungs.. which most of them the docs will put on lasix
  11. 0
    Manipulation of the heart puts at risk for arrhythmias especially AFib. Depeding on the extent of damage done to the heart as well. Even ischemia from a blocked artery in the absence of a MI can do damage to heart..t wave inversion and (ST elevation mi) too. This patient seems to have some HF and reported SOB. Oxygenation may be a higher priority?
  12. 0
    I can totally see now. Thank you so much for your help. You guys are great!!!


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