protocol for post CABG patients

[LASD95]

It's been a while since I've done clinical nursing in cardiac area and I know standards are always changing. What is the current standard for monitoring of post CABG patients after the immediate post-op recovery? When moved to the unit and beyond how often are EKG and weights done? I&O? When I worked the floor (over a decade ago) I remember EKGs daily x 3 as well as with any chest pain unassociated with incision pain and with any rhythm changes, and daily weights and I&O until discharge. Is the standard the same? If not, what has changed? Any other monitoring indicators that have changed significantly?

[delphine22]

Daily weights, i&o and chest tube drainage q shift (more often if condition warrants). I don't recall a lot of ekgs unless they are in post op afib, being digitalized, etc. Walk 4x a day, lots of bowel regimens. Daily drsg changes. Strict sternal precautions always of course.

[psu_213, BSN, RN]

Are your talking about step down? The PP pretty much hit all the points. Also, I would add frequent ambulation to the list. When I worked step-down, one of our surgeon's requirements for discharge was that the pt was able to get up and take a shower on their own.

As for EKGs, in step-down they were not done routinely on post op CABGs--only if the situation warranted (chest pain, rhythm change, meds that had dysrhythmias as a side effect, etc.).

[MissM.RN, BSN, RN]

I hope I don't sound silly, but what is included for sternal precautions? thank you

[delphine22]

I hope I don't sound silly, but what is included for sternal precautions? thank you

Not silly at all, I had to ask too, the first time I had postop pts. (And someone please jump in and correct me if I miss/misstate something!)

Each pt will have a pillow (or in our case it's a flattened teddy bear.) That pillow becomes their best friend. Not only will they use it to brace their incision when they cough, but it's for almost all movement. They basically are not allowed to push or pull, or lift anything heavier than 5 lbs, for at least a month. So getting a pt out of bed becomes, at first, a two person assist. You have to swing their legs over the bed, guide them to a sitting position using their shoulders and their back (they are hugging their pillow this whole time). Then each of you hooks an arm under their arms, but this is more for guidance, they really have to use their legs to stand. Splint also while lowering to a seated position.

You basically can't use your pectoral muscles to help you move, which means you can't use your arms to steady yourself or pull yourself up. Especially for pts who had great mobility before surgery, it takes a LOT of reminders.