3. Pre-operative therapy and medications

4. Nurses pre-operative role: Assessment, Diagnostic studies, Medications, Education

5. Operation: Coronary Artery Bypass Grafting

CABG: The nurses role and the surgical procedure

The nurse plays a major role in the success of a cardiac surgery patient. They evaluate the patient pre-operatively, post-operatively, during surgery, and in cardiac rehab afterwards. This paper discusses the different diagnosis and treatments for patients undergoing (CABG) Coronary Artery Bypass Grafting.

Underlying causes that make a need for CABG surgery

The major cause of CAD (coronary artery disease) is atherosclerosis. This is a pathologic process that causes thickening of artery walls. The thickening usually starts in individuals after age 20. These fibrous plaques or lesions usually produce localized narrowing in the proximal portions of the major coronary arteries. The blood supply to the myocardium can be impeded by several mechanisms: the lesion creates a fixed obstruction so that blood flow through the artery cannot increase

in response to demands, the vessel lumen becomes completely occluded, or portions of clot or plaque embolize. The growth of obstructive lesions in the coronary arteries cause other blood vessels to provide alternative routes for blood flow to the myocardium. If the blood vessel becomes completely occluded, myocardial infarction is likely to occur. There are three major risk factors in CAD: hypertension, hypercholesterolemia, and cigarette smoking. Elimination or control of these factors offers hope of preventing disease and slowing its progression. Higher cholesterol levels, usually above 240 mg/dL increases risk for CAD. The risk factors for CAD that cannot be modified include: heredity, older age, and male sex. The individuals who are 30% over ideal body weight and who smoke are 10 times are likely to have cardiovascular events in their lives that non-obese smokers. The diagnosis of CAD is usually never seen until a MI or angina occurs. This preventive therapy is so important for individuals in the risk groups and it is usually determined by exercise stress testing, cardiac catherization, and sometimes radionuclide imaging techniques. A stress test is a noninvasive screening method. The procedure exercises the patient in a controlled setting while monitoring EKG, blood pressure, and heart rate. Cardiac catherization is the definitive diagnostic study for CAD. They use angiography, which a dye is injected into the right and left coronary arteries. The coronary anatomy is outlined and areas of narrowing are identified. A contrast injection of the left ventricle is performed to demonstrate the contractile status of the left ventricle and to obtain an estimation of the left ventricular ejection fraction. These are useful in diagnostic evaluation of selected patients with CAD.

The aspect of patient teaching is an important part of pre-operative therapy. Patient teaching is known to have many positive effects, including increased knowledge retention, decreases length of hospitalization, and improved cooperation with the medical regimen. Pre-operative education is one type of patient teaching in which the patient is instructed about planned operative procedure and the projected post-operative course. The role of teacher is a main role for a nurse. Making sure the patient understands the procedure, consequences and benefits. This allows the patient to remain under less stress and have a larger knowledge base.

The surgery starts with a median sternotomy incision. After the skin is cut, the sternum is cut longitudinally with special saw to open it up. Then the pericardium is opened up and tacked on the retractors for the sternum. This is done very carefully to avoid damaging the phrenic nerve which lies medial and posterior to the incision. When these steps are done, the right atrium and ascending aorta re cannulated and cardiopulmonary bypass is initiated. The body's core temperature is cooled to approximately 28.0 C. The cardioplegic solution is administered into the coronary circulation to produce cardiac arrest and provide myocardial protection. Once these steps are in place a probe is passed into the artery being bypassed onto. This checks the size and patency of the artery. The vein is then sewn to the coronary artery and the distal end attached on the descending aorta. The person managing the heart-lung machine repeats the doses of the cardioplegic solution every 15-20 minutes. The amount of grafting depends on the amount of grafting depends on the amount of blockage to the arteries. The heart can be bypassed many times to help increase blood flow. After the graft is complete the probe is inserted again to measure the blood flow. When this is complete the myocardium is warmed sufficiently to resume spontaneous electrical rhythm. This weans the patient form the cardiopulmonary bypass. The cannulas are removed and hemostasis is achieved. The sternum is reapproximated and fastened with heavy suture material or wire and the s

Some common words found in the essay are:
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Approximate Word count = 3107
Approximate Pages = 12 (250 words per page double spaced)