Would Like Input - CABG

[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!

[prep8611]

2 weeks still intubated..... Sounds like a high mortality rate for me, im sorry.

[dah doh, BSN, RN]

PFTs are not routinely ordered as pre-op for CABG. Your patient sounds like they were high risk pre-op. Do you know why exactly the patient can't get extubated? Are they fluid overloaded? Do they get tachypneic on CPAP? Do the ABGs stink? Are they not waking up? There are many possibilities.

[Biffbradford]

^^^ +1

It happens. Nothing all that unusual, not to worry. The patient may even get a trach to keep 'em comfortable, but it's usually temporary. They get corked down the road and then head off to long term acute care, or rehab. until they can go home.

[NickiJules]

She had been extubated and reintubated several times. Her ABGs were off but i dont believe they were horrible. She was awake and responding. Her CXR showed worsening opacities. Last I checked, the nurses were trying to wean her off the vent. I've never worked with vents so what I read in the doctors notes regarding settings and things was foreign to me.

Thank you very much for the responses!

[Laurie52]

If you are no longer caring for this patient, reading her medical record is a HIPAA violation.

[NickiJules]

Didn't think of that as HIPAA violation but that's true.

[psu_213, BSN, RN]

Didn't think of that as HIPAA violation but that's true.

Unfortunately, nurses have a habit of looking up information on patients they had recently (a patient who went from the ER to an ICU, a patient whom you "preopped," a patient who died unexpectedly 2 days after you cared for them, etc.). It is usually done with good intentions, but it is indeed a violation.

As for the original situation, this pt sounded like had multiple co-morbidities, and that is contributing to their difficult recover. I doubt that preop PFTs would have made in difference in this postop period.

[NewbieNeedsHelp]

I was always told it would be okay to look them up if it was "forward" in their care on the same admission you had them for... So you can't look if you didn't have them that same admission... But if they got transferred to icu or simple a different nurse had them it was okay? I don't know because frankly, I never had enough time to look up pts I wasn't actively caring for haha, too busy..but I was curious..

[dah doh, BSN, RN]

It sounds like your patient is heading toward a trach. Hopefully the trach will be temporary and used for safer vent weaning. It happens and can't always be predicted.

But I will advise you to stop reading that patient's chart as you are not actively caring for the patient at this time. Our facility has even made it a HIPPA violation to even look up the location of a patient for a family member; we have to refer the family member to the lobby information desk now! Crazy huh?

[Guest343211]

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.

[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.