CABG (Coronary

artery Bypass
Grafting)

ATUL LAWRENCE
M.Sc Nsg. 2ND YEAR

Definition of CABG
Coronary artery bypass graft surgery is

a surgical procedure in which one or

more blocked coronary arteries are
bypassed by a blood vessel graft to
restore normal blood flow to the heart.
These grafts usually come from the
patient's own arteries and veins located
in the leg, arm, or chest.

PURPOSES
Restore blood flow to the heart
Relieves chest pain and ischemia
Improves the patient's quality of

life
Enable the patient to resume a
normal lifestyle and to lower the
risk of a heart attack

Indications
Patients with blockages in at

least three major coronary

arteries
Patients with angina
Patients who cannot tolerate
PTCA and do not respond well
to drug therapy.

Contraindications
Acute Cerebral

vascular
Accident

Bleeding disorders

Types of CABG
ON-PUMP
CABG surgeon to open require
the chest bone (sternum),stop
the patient's heart, and place
the patient on a This lung
machine.-heart machine takes
over the function of the
patient's heartdelivering
oxygenated blood through out
the body and brainwhile the
bypass is performed.

OFF PUMP
CABG pump method eliminates the
off need for the surgeon to stop
the heart and to place the . The
patient on bypass surgeon
operates directly on the beating
heart, reducing the risk for perioperative bleeding and stroke
associated with the on-pump
procedure

NURSING MANAGEMENT
Preoperative Nursing
Management.
Intra operative Nursing
Management.

Postoperative Nursing
Management.

PREOPERATIVE NURSING MANAGEMENT

PREOPERATIVE
History
ASSESSMENT

Physical examination
Radiographic examination
Electrocardiogram
Laboratory analysis
Typing and cross-matching of blood.
Assessing patients functional level
Psychosocial assessment.
Family support system

PHYSICAL EXAMINATION
General appearance and behavior
Vital signs
Nutritional and fluid status, weight

& Height
Inspection and palpation of heart
AUSCULTATION OF HEART
JVP (JUGULAR VEIN PRESSURE)
PERIPHERAL PULSES.
PERIPHERAL EDEMA.

PSYCHOSOCIAL ASSESSMENT
Meaning of surgery to

patient
Coping mechanisms being
used.
Anticipated changes in
lifestyle
Support system in effect
Fear regarding present &
future
Knowledge & understanding
of surgical procedure

NURSING DIAGNOSIS
Fear related to surgical procedure, its uncertain

outcome, and the threat of well-being.

Goal: To reduce fear.

Encourage the patient to

talk about the fear of dying.

Patient should be reassured
and misconceptions
should be corrected.

NURSING DIAGNOSIS
Knowledge deficit regarding the surgical procedure

and the postoperative course.

Goal: To provide the knowledge regarding surgery
Patient and family teaching about
Hospitalization
Surgery
Length of surgery
Expected pain and discomfort
Critical care phase
Recovery phase

PATIENT TEACHING
Physical preparation

before surgery
Medications before
surgery
Information regarding
equipments, tubes that
will be present
postoperatively
Teaching the
postoperative exercises.
Outcome of the surgery

NURSING DIAGNOSIS
Potential for complications related to the stress of

impending surgery (Angina, Severe anxiety, Cardiac

arrest)
Goal: To monitor and manage the complications
Assess for complications
Angina: oxygen therapy and

nitroglycerine therapy.
Severe anxiety: emotional support
Cardiac arrest: cardiac life support

INTRAOPERATIVE NURSING
MANAGEMENT

Assisting in surgical procedure

Continuous monitoring
Monitoring for complications:
dysrhythmias, hemorrhage, MI,
CVA, embolization etc.

THE PROCEDURE

POST OPERATIVE NURSING

MANAGEMENT

ASSESSMENT:
Neurological status
Cardiac status
Respiratory status
Peripheral vascular status
Renal function
Fluid & electrolyte status

POST-OP ASSESSMENT Contd

Pain
Assessment of equipments and tubing's
Psychological and emotional status as

patient regains consciousness

Assessing for complications.

NURSING DIAGNOSIS
Decreased cardiac output related to blood loss and

compromised myocardial function

Goal: To restore cardiac output
Monitor cardiovascular status
Assess arterial pressure every 15 min. until
stable
Ascultate for heart sounds and rhythms
Assess all peripheral pulses
Hemodynamic monitoring
ECG monitoring

NURSING DIAGNOSIS
Risk for impaired gas exchange related to trauma of

extensive chest surgery

Maintain proper ventilation
Monitor ABG, tidal volumes,
peek inspiratory pressures
chest physiotherapy as prescribed
Promote deep breathing coughing and
turning, use of incentive spirometer.
Teach incisional splinting with a cough
pillow to decrease discomfort
Suction tracheobronchial secretions.

NURSING DIAGNOSIS
Risk for alteration in fluid volume and electrolyte

balance related to alteration in blood volume

Goal: To maintain fluid and electrolyte balance
Maintain intake and output chart
Assess the following parameters: BP,
CVP, weight, electrolyte levels,
hematocrit, JVP, tissue turgor, breath
sounds, urinary output etc.
Measure post operative chest drainage
Be alert to serum electrolyte levels

NURSING DIAGNOSIS
Pain related to operative trauma

and pleural irritation caused by

chest tubes
Goal: To relieve pain
Record nature, type, location and duration
Providing comfortable position
Assist patient to differentiate between
surgical &angina pain
Administer prescribed pain medication
Encourage relaxation techniques

NURSING DIAGNOSIS
Risk for alteration in renal perfusion related to

decreased cardiac output, hemolysis, or vasopressor

therapy
Goal: To maintain adequate renal perfusion

Measure urine output strictly

Monitor renal function tests
Report to physician if urine

output less
Administer medications as
prescribed

NURSING DIAGNOSIS
Risk for hypothermia/hyperthermia related to

cardiopulmonary bypass surgery, infections etc.

Warm the patient gradually with warm
air or warm blankets or heat lamps
Assess for elevated body temperature
Assess for infection.
Meticulous care to be taken to prevent
contamination at the sites of catheter
and tube insertion
Care of the graft donor site.

NURSING DIAGNOSIS
Knowledge Deficit related to the
Recovery,
Treatment and follow up
Develop teaching plan for :
Diet
Activity progression
Exercise
Deep breathing, coughing
exercises
Medication regimen
Follow up