CORONARY ARTERY BYPASS GRAFT

1. CORONARY ARTERY BYPASS GRAFT SUBMITTED BY Miss . A. Auxilia IInd Year M.sc Nursing Arvinth College of Nursing

2. LESSON PLAN ON CORONARY ARTERY BYPASS GRAFT TOPIC : CORONARY ARTERY BYPASS GRAFT GROUP : CLIENTS WITH POSTED FOR CABG PLACE : SUDHA HOSPITAL,ERODE. MEHOD OF TEACHINH : LECTURE CUM DISCUSSION TEACHING AIDS : POWER POINT PRESENTATION TIME : 1 HOUR

3. INTRODUCTION INTRODUCTION Coronary artery bypass surgery, also coronary artery bypass graft(CABG, pronounced “ cabbage “ surgery, and heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease This surgery usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass ; techniques are available to perform CABG on beating heart so called “off-pump surgery

4. MEANING OF CABG MEANING OF CABG Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart is to treat people who have severe coronary heart disease (CHD).

5. REVIEW OF HEART STRUCTURE REVIEW OF HEART STRUCTURE The heart weight is around 280 to 340 grams The heart is situated at the center of the chest and points slightly towards left. Our Heart is about the size of a fist divided into four chambers namely two ventricles and two atria

6. REVIEW OF CORONARY ARTERIES REVIEW OF CORONARY ARTERIES Coronary arteries supply blood to the heart muscle The 2 main coronary arteries are the left main and right coronary arteries.

7. CAUSES

8. RISK FACTOR RISK FACTOR AGE SEX FAMILY HISTORY SMOKING HIGH BLOOD PRESSURE HIGH BLOOD CHOLESTEROL LEVELS DIABETES OVERWEIGHT OR OBESITY PHYSICAL INACTIVITY HIGH STRESS

9. TYPES OF CABG ON PUMP CABG Surgery performed on open chest, heart is stopped, heart-lung bypass machine is used for circulation of blood to rest of the body allowing surgeon to perform on still heart

10. TYPES OF CABG OFF-PUMP CABG Similar to Traditional CABG, only heart is not stopped and Heart lung bypass machine is not used.

11. TYPES OF CABG MINIMAL INVASIVE DIRECT CABG Not performed on an open chest, instead cuts are made between the ribs on chest. Mainly done to bypass blood vessels at the front of the heart.

12. PURPOSES 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. • Lower the risk of a heart attack.

13. INDICATIONS FOR CABG INDICATIONS FOR CABG • Patients with blockages in coronary arteries. • Patients with angina. • Patients who cannot PTCA (Percutaneous transluminal coronary angiography) and do not respond well to drug therapy.

14. CONTRA INDICATION CONTRA INDICATION • Absence of an open artery 1’ mm or more in diameter beyond the obstructing lesion. • Absence of viable myocardium in the area supplied by the stenosed artery. • Co-existing severe non cardiac condition with poor prognosis. • pregnant

15. COMPLICATION IMMEDIATE COMPLICATION IMMEDIATE COMPLICATION LONG TERM COMPLICATION LONG TERM COMPLICATION Myocardial dysfunction Cardiac tamponade Graft ischaemia Arrhythmia Irregular heartbeat Death Reduced kidney function Brain-related problems Coagulopathy Hyperglycemia Mediastinitis and other infection

16. PROCEDURE PROCEDURE Intra operative Sedation Intubation Insert folly's catheter and central line Opening Cannulation “ on pump or off- pump “.cardioplegia Applied the pass Evaluation Applied chest tube. Close by suturing the wound

17. PROCEDURE

18. POST OPERATIVE RECOVERY

19. POST OPERATIVE RECOVERY DAY OF SURGERY 1.moved to the Cardiovascular Unit (CVU) 2. Heart rhythm monitored with sticky patches (electrodes) 3.On ventilator 4. intravenous tubes on neck 5. Ryle's tube, Urinary catheter ,chest tubes present on ‘0’ pod

20. POST OPERATIVE RECOVERY POST-OP DAY ONE blood test, Electrocardiogram (ECG) and chest X-ray will take oxygen therapy Chest tube some iv line may be removed Start to drinking fluids Breathing and coughing exercise Breathing is stable moved to patient care centre

21. POST OPERATIVE RECOVERY POST-OP DAY 2 Blood test and weight check Continue pain medication Start to eat Continue breathing and coughing exercise Start to walk in the hall

22. POST OPERATIVE RECOVERY POST-OP DAY-3 Weight check Tell your nurse stomach is upset or nauseated Start to wash in the bathroom Continue breathing and coughing exercise Continue to walk in the hall 3 times a day.

23. POST OPERATIVE RECOVERY POST-OP DAY 4 UNTIL DISCHARGE 1. blood test, ECG and chest x-ray will take 2. Temporary pacing wire will discontinued 3. Use the hands for self care activities 4. Protect your breast bone with ( chest binder) 5.If bowel is not clear use laxative

24. Common experiences after heart surgery Post-operative confusion (Delirium) Clicking of the sternum (breast bone) Numbness and tingling Swelling (edema) of the legs and ankles Fatigue (feeling tired) Memory and concentration Upset stomach

25. FOLLOW UP CARE MEDICATIONS Antiplatelet therapy Beta blockers Nitrates ACE inhibitor Lipid lowering therapy Other medications

26. FOLLOW UP CARE WOUND CARE Avoid heavy lifting and extremes of shoulder movement If the patient develops any of the following signs or symptoms of wound infection, a healthcare provider should be contacted immediately. Reddened skin, bleeding or pus-like drainage from the incision

27. FOLLOW UP CARE CARDIAC REHABILITATION Most people who have undergone bypass surgery benefit from participating in a structured, comprehensive cardiac rehabilitation program

28. FOLLOW UP CARE EXERCISE • Breathing and Leg Exercises Before and After Surgery • Do each exercise once every hour • Incentive Spirometry – Repeat 5 times every hour while awake • Breath and Cough – Repeat 2 times • Leg Circulation – Repeat 10 times

29. FOLLOW UP CARE FOLLOW A HEART HEALTHY DIET  LOW SALT LOW CHOLESTROL LOW FAT HIGH FIBER

30. FOLLOW UP CARE STOP SMOKING Cigarette smoking significantly increases the risk of coronary heart disease and heart attack, and stopping smoking can rapidly reduce these risks

31. FOLLOW UP CARE MANAGE DIABETES The diet, exercising, monitoring blood glucose levels regularly, and taking oral hypoglycemic medications complications. Tight control can be achieved by losing weight, managing (for people with type 2 diabetes) or insulin (for people with type 1 and sometimes type 2

32. FOLLOW UP CARE PSYCHOSOCIAL TREATMENT Feelings of depression, anxiety, and denial are common after bypass surgery, occurring in up to 40 percent of people antidepressant medication, can be helpful. reduce stress 

33. FOLLOW UP CARE SAFE SEX An important issue for many patients who have had bypass surgery is when sexual activity can be safely resumed

34. FOLLOW UP CARE PERIODICAL HOSPITAL VISIT Follow-up care is of great importance since people who have had bypass surgery have a significantly increased risk of more cardiac events, including recurrent chest pain, heart attack, heart failure, and an increased risk of dying

35. The art of healing comes from nature , not from physician must start from nature, with an open mind Paracelsus This is a sample text. Insert your desired text here. Again, this is a dummy text, enter your own text here. This is a sample text. Insert your desired text here. Again, this is a dummy text, enter your own text here. This is a sample text. Insert your desired text here.

36. Thank you