Coronary Bypass Surgery

Coronary artery bypass grafting is a surgery undertaken to improve the flow of blood to the heart. Surgeons use CABG for the treatment of individuals who have serious coronary heart diseases. Coronary heart disease refers to a disease in which a waxy substance identical to plaque forms inside the coronary arteries. These arteries are usually involved in the provision of blood rich in oxygen to the heart. As time passes, the plaques can harden. The hardened plaque causes narrowing of the coronary artery thus reducing the flow of the blood rich in oxygen to the heart. The hardening may lead to chest pain or angina discomfort. If the plaque ruptures, a blood clot may form blocking the artery that may later on lead to heart attack.

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Assessment

The coronary bypass surgery is carried out to treat a blockage or one or more coronary arteries narrowing to allow for maximum blood supply to the heart muscle. The symptoms the patient showed were: pain in the chest; fatigue; palpitations; abnormal rhythms of the heart; and breath shortness. Symptoms may not occur in the early coronary artery disease, but the disease may progress until the blockage comes out to cause the symptoms and problems. The continuous decrease in the blood supply to the muscle of the heart increasing coronary artery obstruction may lead to heart attack or myocardial infarction. Reviewing the medical history of the patient was vital and coronary artery disease suspicion comes out when one has suggestive symptoms, strong history of the family of coronary heart disease and multiple risk factors. Risk factors to be observed during the assessment include high blood cholesterol, male sex, high blood pressure, and diabetes mellitus and cigarette smoking.

After undergoing the surgery, the patient may experience some difficulties with the drugs given after the surgery or from the wound itself. The patient was taken to the Intensive Care Unit to be monitored closely. The patient will be connected to the electrocardiogram detecting, blood pressure, rate of breathing, and level of oxygen. The surgical incision may be sore for several days after the surgery. The multidisciplinary team was involved in the assessment. The dietician examined the nutritional status of the patient. In this situation of the disease, the patient was reported to be consuming food high in cholesterol that leads to increased high blood pressure. The physical therapist examined the patient body condition that shows to constitute a lot of fat layers underlying the body thus a sign of obesity and lack of exercise. The nurse will confirm the blood pressure and rate of breathing of the patient.

Nursing Diagnosis

Coronary artery disease presence was confirmed using noninvasive stress test or by application of cardiac catheterization. A stress test was carried out on a treadmill through monitoring by electrocardiogram. A cardiac catheterization study involved an invasive test with a small tube catheter being passed through the artery in the arm or groin to the heart and contrast medium introduced into the coronary arteries, which x-rays pictures taken to show the presence of an obstruction. The combination of echocardiography imaging with exercise stress testing is a correct technique to detect the coronary artery disease. The existence of a significant blockage has the heart muscle that is supplied by the artery not contracting like the other muscle. When diagnosing the patient, high blood cholesterol signified the risk for high blood pressure. The patient was therefore in a position to suffer from coronary artery disease. The rate at which he patient also smoke was another factor considered which also place him at the risk of contracting the disease.

Planning

Improvement and change in the lifestyle of the patient are the factors that can minimize the chances of the patient contracting coronary artery disease. One of the goals of this care plan is to improve the nutritional status of the patient. What the patient eats determines whether he will come back to the hospital for treatment of the same condition. The patient should be involved in the monitoring of his lifestyle by watching what goes into his digestive system. After the surgery, the patient was advised to eat more protein, fruits and vegetables to improve his rate of healing and to strengthen his immune system. The patient was also required to minimize the consumption of foods that are high in cholesterol which usually lead to increased blood pressure. It is also important to improve the wellbeing of the patient was advised to carry out some forms of physical exercise on a weekly basis. It only through exercise that the patient may get rid of the excess calories in the body and also strengthen his immune system.

Intervention/Implementation

One of the interventions is providing medicines to the patient especially after the surgery to treat angina and minimize the heart muscle demand for oxygen to provide compensation for the reduced supply of the blood. The three major drug classes used are beta blockers, nitrates, and calcium blockers. Nitroglycerin is a nitrate example. Examples of beta blockers are atenolol, propanolol. Calcium blockers examples include felodipine and amlodipine (Braunwald et al. 2000). Another intervention is to supervise the patients diet to ensure consumption of food low in cholesterol. Cholesterol is the one believed to increase the blood pressure of an individual thus putting him at a risk of contracting coronary artery disease. It was, therefore, vital to educate the patient on foods to avoid and foods to increase in consumption. It was, therefore, vital in the provision of information concerning certain foods to the patient giving him supporting reason he should consume such foods or avoid certain foods. Monitoring the patients level of physical exercise is also another significance intervention. The patient is supposed to be guided on the exercises to do and motivated to do such exercises by telling him the benefits.

Evaluation

Carrying out a follow up to see the progress of the patient is a very vital step in the achievement of the goals that were set at the beginning of the care plan. Monitoring the changes the patient undergoes after a given period is important as it will show whether the objective has been achieved or not. The patient should be assessed to find out how he is fairing after the surgery. The patient is advised to come back for a check up after some weeks or advised to come back immediately in case of any concerns about their health. This is important in maintaining a good rapport with the patient and selling of a good image of the health facility involved. The patient may not be able to do the outdoor physical exercise due to maybe social status. This is put into consideration and indoor exercises like gymnastic are preferred.

Conclusion

In carrying out the care plan, various ethical and legal practices were put into consideration. The status of the patient was put confidential and was only accessible to the medical personnel. Keeping of the patient record confidential is by the law unless the patient permits the relatives and family members accessibility to the medical records. During monitoring of the patient's nutritional status, it was important not to reveal what the patient eats and to what extent. All these were between the nurse and the patient himself. This, therefore, shows adherence to the ethical considerations. Cultural and religious boundaries were considered ion advising the patient on what to do or what to eat with the patient given permission to avoid what is nit culturally y accepted his society and given the options for what to go for.

References

Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., &

Smith, S. C. (2000). ACC/AHA Guidelines for the Management of Patients With Unstable Angina and NonST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation, 102(10), 1193-1209.