Coronary Artery Bypass Graft (CABG) is a major cardiac surgery performed to improve blood flow to the heart by bypassing blocked coronary arteries. This nursing diagnosis focuses on post-operative care, preventing complications, and promoting optimal recovery.
Causes (Related to)
CABG procedures are typically necessitated by several factors:
- Severe coronary artery disease
- Failed medical management of CAD
- Multiple vessel disease
- Left main coronary artery disease
- Unstable angina
- Previous failed interventions
- Risk factors including:
- Advanced age
- Diabetes
- Hypertension
- Obesity
- Smoking history
- Family history of CAD
Signs and Symptoms (As evidenced by)
Post-CABG patients present with various signs and symptoms requiring careful nursing assessment.
Subjective: (Patient reports)
- Chest pain or discomfort
- Breathing difficulty
- Fatigue
- Anxiety
- Sleep disturbances
- Incisional pain
- Limited mobility
Objective: (Nurse assesses)
- Vital sign changes
- Cardiac rhythm variations
- Decreased cardiac output
- Chest tube drainage
- Wound characteristics
- Peripheral pulse quality
- Neurological status
- Respiratory effort
Expected Outcomes
Successful post-CABG recovery is indicated by:
- Maintained hemodynamic stability
- Adequate pain control
- Normal cardiac rhythm
- Clear lung sounds
- Improved activity tolerance
- Proper wound healing
- No signs of infection
- Patient understanding of the recovery process
Nursing Assessment
Monitor Cardiovascular Status
- Assess vital signs
- Monitor cardiac rhythm
- Check peripheral pulses
- Evaluate chest tube drainage
- Monitor hemodynamic parameters
Assess Respiratory Function
- Evaluate breathing pattern
- Monitor oxygen saturation
- Assess lung sounds
- Document cough effectiveness
- Monitor chest tube function
Evaluate Pain Management
- Assess pain levels
- Monitor pain medication effectiveness
- Document pain characteristics
- Evaluate non-pharmacological interventions
- Check for complications
Monitor Wound Healing
- Assess surgical sites
- Check drainage
- Monitor for infection signs
- Document healing progress
- Evaluate tissue perfusion
Assess Activity Tolerance
- Monitor exercise capacity
- Evaluate fatigue levels
- Check vital signs with activity
- Document the progression of mobility
- Assess independence level
Coronary Artery Bypass Graft Nursing Care Plans
Nursing Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to surgical manipulation of the heart and altered preload/afterload as evidenced by hypotension, decreased peripheral pulses, and fatigue.
Related Factors:
- Post-surgical myocardial dysfunction
- Altered preload/afterload
- Blood loss
- Pain
- Medication effects
Nursing Interventions and Rationales:
- Monitor vital signs and hemodynamics q1h
Rationale: Early detection of cardiovascular compromise - Assess peripheral pulses and tissue perfusion
Rationale: Indicates adequacy of cardiac output - Maintain prescribed cardiac medications
Rationale: Supports optimal cardiac function
Desired Outcomes:
- The patient will maintain stable hemodynamics
- The patient will demonstrate adequate tissue perfusion
- The patient will report improved energy levels
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to surgical procedure and chest tube placement as evidenced by verbal reports of pain and guarding behavior.
Related Factors:
- Surgical trauma
- Chest tube presence
- Movement restrictions
- Muscle tension
- Anxiety
Nursing Interventions and Rationales:
- Administer prescribed pain medications
Rationale: Provides comfort and facilitates recovery - Teach splinting techniques
Rationale: Reduces pain during movement - Position for comfort
Rationale: Minimizes strain on incision
Desired Outcomes:
- The patient will report pain at acceptable levels
- The patient will demonstrate proper splinting technique
- The patient will participate in necessary activities
Nursing Care Plan 3: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to surgical wounds, invasive lines, and decreased mobility as evidenced by the presence of surgical incisions and multiple access sites.
Related Factors:
- Multiple surgical sites
- Invasive devices
- Compromised immune function
- Limited mobility
- Environmental exposure
Nursing Interventions and Rationales:
- Maintain sterile technique
Rationale: Prevents contamination - Monitor wound characteristics
Rationale: Early detection of infection - Teach proper hygiene
Rationale: Reduces infection risk
Desired Outcomes:
- The patient will remain free from infection
- Wounds will heal without complications
- The patient will demonstrate proper wound care
Nursing Care Plan 4: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to altered pulmonary blood flow and chest wall pain as evidenced by decreased oxygen saturation and shallow breathing.
Related Factors:
- Post-operative atelectasis
- Pain with deep breathing
- Altered chest wall mechanics
- Medication effects
- Anxiety
Nursing Interventions and Rationales:
- Perform respiratory assessment q2h
Rationale: Monitors ventilation effectiveness - Encourage deep breathing exercises
Rationale: Prevents atelectasis - Maintain proper positioning
Rationale: Optimizes lung expansion
Desired Outcomes:
- The patient will maintain oxygen saturation >95%
- The patient will demonstrate an effective breathing pattern
- The patient will perform respiratory exercises independently
Nursing Care Plan 5: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to surgical recovery and decreased cardiac reserve as evidenced by fatigue and increased workload of breathing with activity.
Related Factors:
- Surgical recovery
- Pain with movement
- Decreased cardiac function
- Bed rest effects
- Emotional state
Nursing Interventions and Rationales:
- Implement a progressive mobility plan
Rationale: Prevents deconditioning - Monitor response to activity
Rationale: Ensures safe progression - Teach energy conservation
Rationale: Optimizes activity tolerance
Desired Outcomes:
- The patient will demonstrate improved activity tolerance.
- The patient will participate in prescribed exercises
- The patient will maintain stable vital signs with activity
References
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