Post Op Care for Cabg Pts
NURSING: The Postoperative Phase
Postoperative care of the cardiac surgery patient is challenging in that changes can occur rapidly. The preoperative condition of the patient as well as intraoperative events should be considered in postoperative care. It is essential for the nurse to anticipate the possible complications so that appropriate interventions are initiated in a timely manner in order to ensure a positive outcome for the patient.
There is a flurry of activity as the patient enters the recovery room/ICU and the admitting nurse connects the patient and the invasive lines to the monitoring equipment while another staff member connects drainage devices appropriately and draws admission blood work. The operating room nurse and the anesthesiologist report the patient's condition to the receiving nurse.
Postoperative Pulmonary Management
Pulmonary dysfunction and hypoxemia may occur in 30% to 60% of patients after CABG.10 Patient history and intraoperative factors must be considered in the postoperative pulmonary management. A history of smoking, obstructive pulmonary disease, steroid use, gastroesophageal reflux disease, heart failure, and poor nutrition may increase postoperative pulmonary complications.11
Although there are some variations to this protocol, most patients will be intubated and mechanically ventilated upon arrival in the recovery room. Desired outcomes include adequate oxygenation and ventilation while the patient is intubated. Early extubation isalso a desired outcome as long as the patient is hemodynamically and neurologically stable. There is potential for an increase in postoperative complications when patients are intubated longer than 24 hours. The length of hospital stay may also increase with longer intubation times.12 The current trend is to extubate patients within the first 12 hours after surgery. On occasion, patients may be extubated in the operating room. Routine postoperative care to promote oxygenation and
Postoperative care of the cardiac surgery patient is challenging in that changes can occur rapidly. The preoperative condition of the patient as well as intraoperative events should be considered in postoperative care. It is essential for the nurse to anticipate the possible complications so that appropriate interventions are initiated in a timely manner in order to ensure a positive outcome for the patient.
There is a flurry of activity as the patient enters the recovery room/ICU and the admitting nurse connects the patient and the invasive lines to the monitoring equipment while another staff member connects drainage devices appropriately and draws admission blood work. The operating room nurse and the anesthesiologist report the patient's condition to the receiving nurse.
Postoperative Pulmonary Management
Pulmonary dysfunction and hypoxemia may occur in 30% to 60% of patients after CABG.10 Patient history and intraoperative factors must be considered in the postoperative pulmonary management. A history of smoking, obstructive pulmonary disease, steroid use, gastroesophageal reflux disease, heart failure, and poor nutrition may increase postoperative pulmonary complications.11
Although there are some variations to this protocol, most patients will be intubated and mechanically ventilated upon arrival in the recovery room. Desired outcomes include adequate oxygenation and ventilation while the patient is intubated. Early extubation isalso a desired outcome as long as the patient is hemodynamically and neurologically stable. There is potential for an increase in postoperative complications when patients are intubated longer than 24 hours. The length of hospital stay may also increase with longer intubation times.12 The current trend is to extubate patients within the first 12 hours after surgery. On occasion, patients may be extubated in the operating room. Routine postoperative care to promote oxygenation and