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CARDIAC SURGERY: POSTOPERATIVE CARE—CORONARY ARTERY BYPASS GRAFT (CABG), MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB), CARDIOMYOPLASTY, VALVE REPLACEMENT The goal of treatment for heart disease is to maximize cardiac output. Surgically this may be done by improving myocardial muscle function and blood flow through procedures such as the traditional CABG (or via less invasive procedures such as MIDCAB, percutaneous transmyocardial revascularization [PTMR], and/or port access requiring four small incisions under the left breast), wrapping the latissimus dorsi muscle around the heart, and/or repair or replacement of defective valves. Of the three types of cardiac surgery—(1) reparative (e.g., closure of atrial or ventricular septal defect, repair of mitral stenosis), (2) reconstructive (e.g., CABG, reconstruction of an incompetent valve), and (3) substitutional (e.g., valve replacement, cardiac transplant)—reparative surgeries are more likely to produce cure or prolonged improvement. CARE SETTING Inpatient acute hospital on a surgical or post-ICU step-down unit. RELATED CONCERNS Angina Heart failure: chronic Dysrhythmias Myocardial infarction Hemothorax/pneumothorax Psychosocial aspects of care Surgical intervention Patient Assessment Database The preoperative data presented here depend on the specific disease process and underlying cardiac condition/reserve. ACTIVITY/REST May report: History of exercise intolerance Generalized weakness, fatigue Inability to perform expected/usual life activities Insomnia/sleep disturbance May exhibit: Abnormal heart rate, BP changes with activity Exertional discomfort or dyspnea ECG changes/dysrhythmias CIRCULATION May report: History of recent/acute MI, three (or more) vessel coronary artery disease, valvular heart disease, hypertension May exhibit: Variations in BP, heart rate/rhythm Abnormal heart sounds: S 3 /S 4 , murmurs Pallor/cyanosis of skin or mucous membranes Cool/cold, clammy skin Edema, JVD Diminished peripheral pulses Abnormal breath sounds: crackles Restlessness/other changes in mentation or sensorium (severe cardiac decompensation) EGO INTEGRITY May report: Feeling frightened/apprehensive, helpless Distress over current events (anger/fear)
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Fear of death/eventual outcome of surgery, possible complications Fear about changes in lifestyle/role functioning May exhibit: Apprehension, restlessness Facial/general tension; withdrawal/lack of eye contact Focus on self; hostility, anger; crying Changes in heart rate, BP, breathing patterns FOOD/FLUID May report: Change in weight Loss of appetite Abdominal pain, nausea/vomiting Change in urine frequency/amount May exhibit: Weight gain/loss Dry skin, poor skin turgor Postural hypotension Diminished/absent bowel sounds Edema (generalized, dependent, pitting) NEUROSENSORY May report: Fainting spells, vertigo May exhibit: Changes in orientation or usual response to stimuli Restlessness; irritability, exaggerated emotional responses; apathy PAIN/DISCOMFORT
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