Perioperative Care For CABG Patients
Perioperative Care For CABG Patients
Students Name :
A coronary artery bypass graft (CABG) is a surgical procedure used to treat coronary
heart disease. It diverts blood around narrowed or clogged parts of the major arteries to improve
Like all organs in the body, the heart needs a constant supply of blood.This is supplied by
2 large blood vessels called the left and right coronary arteries. Over time, these arteries can
become narrowed and hardened by the build-up of fatty deposits called plaques. This process is
known as atherosclerosis. People with atherosclerosis of the coronary arteries are said to
have coronary heart disease. Your chances of developing coronary heart disease increase with
you smoke
Coronary heart disease can cause angina, which is chest pain that occurs when the supply
of oxygen-rich blood to the heart becomes restricted. While many cases of angina can be treated
with medication, severe angina may require a coronary artery bypass graft to improve the blood
supply to the heart. Another risk associated with coronary heart disease is the possibility of one
of the plaques in the coronary artery rupturing (splitting), creating a blood clot. If the blood clot
blocks the blood supply to the heart, it can trigger a heart attack. A coronary artery bypass graft
The procedure
A coronary artery bypass graft involves taking a blood vessel from another part of the
body (usually the chest, leg or arm) and attaching it to the coronary artery above and below the
This new blood vessel is known as a graft. The number of grafts needed will depend on
how severe your coronary heart disease is and how many of the coronary blood vessels are
narrowed. A coronary artery bypass graft is carried out under general anaesthetic, which means
you'll be unconscious during the operation. It usually takes between 3 and 6 hours.
Risks of surgery
complications. These are usually relatively minor and treatable, such as an irregular heartbeat or
a wound infection, but there's also a risk of serious complications, such as a stroke or heart
attack.
The preoperative nursing management for patients usually begins before hospitalization.
Patients with nonacute heart disease may be admitted to hospital the day before or at the same
day of their surgery, and then nurses will begin with the preoperative assessment first with
includes:
1. Medical history, personal ID, any allergies that exists and an IV line.
2. Physical examination:
JVP
3. Chest Xray examination especially the latest PA film ,an ECG ,Transthoracic
malnutrition
5. Laboratory analysis :
2. Type and crossmatch four or more units of blood as ordered. Blood is made
3. Consent form for operation. (Including documentation of the major risks and
4. Nose, throat swaps and, sputum and then given Bactroban to use at home and
Aspirin and Clopidogrel- it should be stopped 7-10 days before surgery, if not, should be
stopped on the day of admission of the patient - unless there is unstable angina.
Anticoagulants - These are tailed off over a few days prior to operation.
Beta Blockers, Calcium Antagonists, Long Acting Nitrates - Patients with coronary artery
interfere with these drugs in any way but to continue them until the day before operation.
preoperatively.
Digoxin, Diuretics and potassium supplements- Continued until the day before operation.
Information when conducting preoperative teaching with a patient scheduled for CABG
surgery may include sights and sounds that will be experienced, invasive lines that will be
inserted, anticipated sensations from preoperative medications, and anticipated length of the
operation. During the preoperative teaching session, the nurse should also provide information
Reassurance that pain will be managed during the postoperative period is important to
communicate to the patient and significant other. Teaching about incision splinting and
postoperatively, resulting in a temporary inability to speak. Assure the patient that a competent
caregiver will be in close proximity during the immediate postoperative recovery period and will
be able to anticipate and provide for needs. The patient should be assured that the endotracheal
Pulmonary care is an important part of the postoperative care of the patient after CABG
surgery. Preoperative practice with the equipment (such as an incentive spirometer) that will be
used postoperatively is helpful. Teaching in the preoperative period assists the patient to
comprehend the necessity of coughing effectively in spite of incisional pain to achieve positive
The significant other may be anxious and this may intensify as his/her loved one is taken
to surgery. Separation is inevitable, but communication with the significant other during the
intraoperative period is helpful to minimize anxiety. There are often questions about the length
of the operation, the condition of the patient, and when the anticipated reunion will be possible.
Nursing interventions important for significant others include teaching them about the
expected patient appearance. The patient may appear pale, cool, and edematous. The nurse
should also discuss equipment that will be connected to the patient. This equipment will include
the ventilator, chest tubes, nasogastric tube, invasive lines, and urinary catheter.
Intraoperative phase
Coronary bypass surgery generally takes between three and six hours and requires
general anesthesia. The number of bypasses you need depends on where in your heart and how
For general anesthesia, a breathing tube is inserted through your mouth. This tube
attaches to a ventilator, which breathes for you during and immediately after the surgery.
Most coronary bypass surgeries are done through a long incision in the chest while a
heart-lung machine keeps blood and oxygen flowing through your body. This is called on-pump
spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily
stopped with medication and a heart-lung machine takes over to circulate blood to the body.
The surgeon takes a section of healthy blood vessel, often from inside the chest wall or
from the lower leg, and attaches the ends above and below the blocked artery so that blood flow
beating heart using special equipment to stabilize the area of the heart the surgeon is
working on. This type of surgery is challenging because the heart is still moving. It's not an
incisions in the chest, often with the use of robotics and video imaging that help the
surgeon operate in a small area. Variations of minimally invasive surgery might be called
After completing the graft, the surgeon will restore your heartbeat, disconnect you from
the heart-lung machine and use wire to close your chest bone. The wire will remain in your body
the heart-lung machine and use wire to close your chest bone. The wire will remain in your body
Coronary bypass surgery, and any heart surgery for that matter, is performed by a team
rather than just the surgeon. It’s the same as when you take an airplane flight; the pilot depends
on many people behind the scenes to get the plane off the ground.
1) The scrub nurse or scrub tech, who organizes and transfers the instruments to the surgeon.
This individual is "scrubbed in", meaning that he or she has thoroughly washed the hands and
arms before putting on a sterile gown and gloves. The scrub nurse is part of the clean “sterile
field” and is allowed to touch the patient, instruments, and instrument table.
2) The circulating nurse, who remains outside of the sterile field. As a “circulator”, he or she
transfers sterile instruments and supplies to the instrument table, performs the documentation of
3) The surgical assistant. This can be another physician, or a non-physician such as a physician
assistant (P.A.), nurse, nurse practitioner, or a surgical assistant (S.A.). The assistant is
“scrubbed in” as part of the sterile field and assists the surgeon with the conduct of the
operation.
4) The perfusionist. This highly trained individual has undergone years of instruction to operate
the heart lung machine. He or she also operates the cell saver, a machine that processes any
blood loss so that the patient's own blood can be given back to them.
5) The anesthesiologist (a physician), possibly assisted by an anesthetist (a nurse or physician
assistant). They insert monitoring lines, administer the general anesthesia to the patient, and act
Additionally, the operating room team depends on other people, such as preoperative nurses,
technical specialists, workers in the instrument room where the instruments are sterilized,
collaborates to try to get the best possible outcomes from the surgery. Among these professionals
are operating room nurses and technicians who support the cardiac surgeon as he or she performs
the procedure. Operating room nurses and technicians also monitor the patient’s condition and
There will special monitoring and equipment in the Operating Room andthe Cardiac
Endotracheal (ET) Tube: A tube that helps you breathes during and immediately after
surgery. Once you can breathe on your own, the tube will be removed.
Central Intravenous Line: Also called a central line, this larger IV tube is placed in a
large blood vessel and is used for giving medications, IV fluids, or blood.
Intravenous Lines: Small tubes inserted into your blood vessels to give fluids and
medications.
Arterial Catheters: Used to monitor blood pressure and draw blood samples.
Foley Catheter: Thin tube inserted into your bladder to drain and monitor urine amounts
during and after your surgery. This tube will be removed as soon as possible to prevent
infection.
Chest Tubes: Drain excess fluid from around your heart and lungs.
External Pacing Wires: Small, fine, temporary pacemaker wires, placed in surgery, in
case your heartbeat needs to be regulated in the days after surgery. They are removed
Nasogastric Tube: Thin tube inserted into your nose down into your stomach to prevent
Chest Electrodes: Similar to the "sticky" buttons of an EKG, these attach to the skin on
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
The resident should be present in the ICU when the patient arrives from the operating
room to receive a sign-over from the anesthesiologist and the cardiac surgical team. During
this period, the ICU nurses will be transferring the patient to the ICU monitors and checking
all lines and infusions. The nurse will then do the initial set of hemodynamic readings. The
Respiratory Technician will place the patient on a ventilator. Unless the patient is unstable it
is best to stay out of the way of the nurses during this period, and wait until they are finished
History :
Collect the following information from the anesthesiologist, surgeon, and the patient chart.
Ease of separation from CPB ( dysrhythmias, need for inotropes, pacing, etc).
Difficulty coming off pump may imply problems with myocardial preservation or with the
revascularization.
Use of Intra-aortic balloon pump (IABP), ventricular assist devices (VAD), or nitric
oxide (NO).
Significant bleeding
Other significant co morbidity, with emphasis on those conditions that may alter the
post-operative management or course (carotid artery disease, COPD, asthma, diabetes,
renal failure, hepatic failure, etc.)
Pre-operative medications
Allergies
CABG.
pulmonary management.
Desired outcomes include adequate oxygenation and ventilation while the patient is
intubated.
Early extubation is also a desired outcome as long as the patient is hemodynamically and
neurologically stable.
Maintain airway patency. Monitor the patient's pulmonary status closely and report any
Monitor chest tube drainage (generally serosanguineous) and report drainage of over 100
ml/hour.
blood gas analysis, continuous pulse oximetry, pulmonary care (including suctioning
while the patient is intubated and coughing and incentive spirometry after extubation),
Most protocols require a chest x-ray after heart surgery to determine placement of the
Pain control is usually achieved with intravenous narcotics while the patient is intubated.
The nurse must balance the need for pain control without respiratory depression with the
The nurse must assess the patient for readiness for early extubation. Extubation should be
As the patient is being weaned from the ventilator, ventilatory support is gradually
During the weaning process, the nurse should assess the patient for an increase in
respiratory and/or heart rates, use of accessory muscles, fatigue, and color changes
because these findings may indicate the patient is not ready for extubation.
An increase in pulmonary artery pressures can indicate an increase in PCO2 and give the
nurse an early indication prior to arterial blood gas analysis that the patient is not ready
for extubation. Early extubation is desirable but if parameters are not met and/ or the
patient is hemodynamically unstable, there may be detrimental effects of early
extubation.
Movement of the patient from the operating room to the recovery room/ICU can create
A cuff BP is usually taken to provide correlation of the BP obtained from the arterial
line.
Assess the patient's hemodynamic and cardiac status. Atrial fibrillation (AF) is a
Titrate drugs to optimize cardiac function and BP. Notify the surgeon of changes in
monitoring.
Monitor the patient's electrolytes and report abnormal values. Provide replacement
The nurse must continually assess the patient for cardiac dysfunction and hemodynamic
instability.
The receiving nurse must intensively monitor the interrelationship between heart rhythm
and rate, preload, afterload, contractility, and myocardial compliance to achieve this
outcome
Blood pressure must be maintained within ordered parameters to provide tissue perfusion
The nurse must monitor the volume in the system, which is reflected by the right atrial
If the BP is too low, there is either too little volume (preload), a decrease in contractility,
or the SVR is too low (the patient’s blood vessels are dilated). If the BP, CO, and
RAP/PCWP are all low, the patient probably needs volume .Volume is generally
replaced as needed with a colloid such as hetastarch unless the hematocrit is low and
then volume may be replaced with packed red blood cells. If the BP and CO are low but
the PCWP is high, the patient may be experiencing decreased contractility and inotropic
low and the CO is adequate or elevated, the systemic vascular resistance may be low and
the patient may need a constrictive agent such as phenylephrine. Low BP can be
temporarily increased by turning off positive end expiratory pressure (to decrease
intrathoracic pressure and augment preload) and by position changes. The patient should
be put in the supine position with legs elevated to allow the BP to increase until the cause
of the low BP can be determined and corrective measures are taken. Although not
position. The Trendelenburg position can offer symptomatic relief from low BP,
especially in the early postoperative phase, by shifting volume from the legs to the chest
and increasing preload. The positive changes identified with Trendelenburg positioning
becomes too high, especially in the early postoperative period, the surgical anastomoses
may become disrupted, which could cause significant intrathoracic bleeding,
hemodynamic instability, poor tissue perfusion, and necessitate a return to the operating
room. It is important for the nurse to carefully monitor the patient for high BP and
also be used to cause vasodilation and lower the BP .These medications should be started
The patient must be monitored closely as the BP may drop as the patient’s body
temperature increases.
The nurse must rewarm the patient after surgery if hypothermia persists. The negative
postoperatively).
blankets, warm humidified oxygen, convective air mattresses, and other individual
Because of the potential for issues with graft anastomoses and the importance of
maintaining BP within the reference range, a vasodilator may be needed while the
patient is rewarming.
The nurse should carefully monitor the pulmonary artery pressures and the CO as well as
The nurse should regularly perform neurovascular assessments of the lower extremities
Dysrhythmias are common after CABG surgery. Constant assessment of the patient, as
Often, cardiac surgeons place epicardial wires on the atrium and/or the ventricle during
the operation. Temporary pacing can be instituted to override a slow intrinsic rhythm so
Atropine may be given to increase the heart rate in the absence of epicardial pacing
The specific medication utilized will depend on hospital protocols and physician
preference. The critical care nurse should utilize standing orders in the institution as well
should be considered when assessing the patient’s potential for bleeding. Patients who were on
anticoagulants and antiplatelet agents (including glycoprotein IIb/IIIa receptor antagonists such
as abciximab) prior to surgery are at an increased risk of postoperative bleeding. The aorta and
the atrium are cannulated during surgery. The grafts have proximal and distal anastomosis sites.
Other potential sites for bleeding include the internal mammary site, the chest wall, and chest
tube sites. Induced hypothermia, the use of the CPB machine, and the administration of heparin
The nurse should be aware that heparin can be stored in adipose tissue and some patients
adipose composition.
the risk of postoperative bleeding. This drug is a protease inhibitor that inhibits
fibrinolysis. Aprotinin may also have some anti-inflammatory effects and therefore be
The nurse should monitor the patient for signs of bleeding from the chest tubes and the
Sometimes the surgeon orders serial coagulation profiles for a patient at risk for bleeding.
If bleeding is an issue, drugs such as protamine sulfate (to reverse the effects of heparin)
ordered.
Blood products such as fresh frozen plasma and platelets may also be ordered.
When bleeding occurs there is potential for the blood to accumulate in the pericardium,
and therefore, the nurse must be cognizant of the potential for cardiac tamponade. The
decreased BP, narrowed pulse pressure, increased heart rate, jugular venous distention,
elevated central venous pressure, and muffled heart sounds . So the nurse should assess
this signs
There is a potential for renal dysfunction in the postoperative cardiac surgery patient.
One reference suggests that the incidence is approximately 8%.1 Renal insufficiency may be
related to advanced age, hypertension, diabetes, decreased function of the left ventricle, and
length of time on the CPB. One indicator of effective CO is adequate renal perfusion as
The nurse must monitor the urinary output at least hourly during the early postoperative
period.
The urine should be assessed for color and characteristics as well as amount.
Diuresis is likely in the postoperative period when renal function is adequate, as the
The patient’s potassium level should be monitored at least every 4 to 6 hours for the first
The patient should be astutely monitored for cardiac dysrhythmias if the serum
Other laboratory values that should be monitored at least daily are the blood urea
or after surgery. Manipulation of the aorta has been implicated in embolic events. Other risk
factors for stroke may include age, previous stroke, carotid bruits, and hypertension. The
period. When the patient is admitted to the intensive care unit, he/ she will likely be
Pupils should be assessed initially, however, normal size and reactivity may not
Neurologic status cannot be completely assessed until the patient is fully awake and
extubated. At that time, the patient should be assessed for orientation to person,
Perform peripheral and neurovascular assessments hourly for the first 8 hours. Then,
if the patient is stable, perform these checks every 2 hours for the next 8 hours and
Neurologic assessments must continue because the risk of stroke does not end with
the operation.
Patients presenting post-operatively with new confusion and agitation/delirium/post
pancreatitis, acute cholecystitis, bowel ischemia, diverticulitis, and liver dysfunction. Some risk
factors for gastrointestinal dysfunction include age over 70, a history of gastrointestinal disease,
a history of alcohol misuse, cigarette smoking, heart valve surgery, emergent operation,
prolonged CPB, postoperative hemorrhage, use of vasopressors, and low postoperative CO.If the
gastroepiploic artery is used as a conduit for bypass, this may also increase the risk of
gastrointestinal dysfunction. Anesthetic agents, analgesics, and hypoperfusion of the gut during
The nurse should monitor the patient for bowel sounds, abdominal distention, and nausea
and vomiting.
The intubated patient will have a nasogastric tube to low intermittent suction or Salem
Placement and patency should be assessed as well as amount, color, and characteristics of
the drainage.
Prior to extubation, if bowel sounds are present, the nasogastric tube will be discontinued
and the nurse should continue to assess the patient for potential gastrointestinal
disturbances.
The nurse should administer antiemetic agents as ordered if the patient is nauseated.
The comfort of the patient as well as the sterility of the sternal dressing must be
maintained.
Some surgeons order a histamine blocker to minimize acid secretion until normal dietary
patterns are resumed. When the nasogastric tube is removed, the patient will be started on
a clear liquid diet and this can be advanced as tolerated by the patient.
Dependent upon surgical approach, the patient may have a median sternotomy incision,
leg incision(s), and/or a radial incision. Manipulation of the chest cavity, use of retractors during
surgery, and electrocautery may all contribute to postoperative pain. In addition, positioning on
the operating room table and length of time of the surgery may also be factors in pain
experienced postoperatively.
Poorly controlled pain can stimulate the sympathetic nervous system and lead to
cardiovascular consequences. The heart rate and BP can increase and the blood vessels can
constrict, causing an increase in the cardiac workload and myocardial oxygen demand. Effective
pain control is essential for patient comfort, hemodynamic stability, and prevention of pulmonary
complications.
Nurses must individualize pain assessment and control for each patient as responses vary
among individuals.
control pain and minimize the amount of narcotic needed. Ketorolac is a nonsteroidal
The nurse must monitor renal status of patients taking ketorolac, and the drug may be
Pulmonary care is more effective for the patient when pain is effectively managed.
Teaching the patient to splint the incision when coughing and moving improves pain
control.
The nurse should evaluate the effectiveness of pain management interventions regularly.
Significant others are often concerned about the postoperative pain experienced by the
patient.
Explanations about interventions utilized and outcomes achieved can decrease anxiety.
Another source of pain for the patient after CABG is the removal of the chest tubes. This
chest tube drainage meet ordered parameters as long as there is no air leak noted in the
water seal chamber. Pain medication should be administered prior to removal of chest
Manage the patient's pain. Morphine, the drug of choice, may be given by patient-
Assessment for, and prevention of, infection is part of the nurse’s role in the
postoperative period.
The patient should be assessed for local and systemic signs of infection.
institution protocols.
Control of blood glucose level may help with prevention of infection. It is desirable to
control blood glucose levels of greater than 150 mg/dL with a continuous intravenous
Some surgeons order corticosteroids postoperatively. When used, these drugs are
intended to minimize the potential risks of inflammation after heart surgery. Patients
should be monitored for suppression of the immune system, as this can be an adverse
Patients need to be taught how to slowly discontinue the medication after discharge per
elevation in serum glucose levels. A sliding scale insulin order may be needed to
maintain blood glucose levels within normal limits while the patient is in the hospital.
Gradually rewarm the patient with warmed blankets, but avoid temperature-regulating
blankets or devices. Warming him too rapidly can cause vasodilation and a rapid drop in
The nurse must intensively care for the patient in the early postoperative period. This
intensive monitoring and postoperative discomfort can interfere with the patient’s need for
sleep. There is a potential for sleep disturbance as the patient is recovering from CABG.
Lack of sleep may negatively affect postoperative outcomes. Organization of needed care
and provision of time for uninterrupted sleep cycles is important for effective outcomes.
Some of the postoperative confusion experienced by patients may be minimized and positive
outcomes maximized when time for sleep is provided. Hospital routines and too many visits
by well-meaning significant others may add to the sleep deprivation problem. Significant
It is the role of the intensive care nurse to balance the need for visitation with the
need for rest and sleep. It can be frightening for significant others to visit the patient
during the early postoperative period because of the monitoring equipment and
appearance of their loved one. Explanations regarding the equipment and physical
touching the patient postoperatively and receive reassurance from the professional
Post-CABG Rehabilitation after CABG has a number of benefits. The patients start in a
phase III program as soon as healing is completed. Because of the lower level of invasiveness
with new techniques, such as minimally invasive CABG, off- pump CABG, robotic surgery, and
other techniques, a larger number of patients with severe pre-existing cardiac disease can now
tolerate surgery. Unlike the past, patients with low EFs and CHF are also considered candidates
for revascularization. There is a role for a symptomlimited cardiac stress test if continued
ischemia is considered a risk. Testing can be safely performed at 3–4 weeks after surgery. The
exercise test should determine maximal functional capacity, maximal HR, exercise blood
program to help modify risk factors and supervised and unsupervised home programs can help
with the management of risk of recurrent heart disease. Cardiac rehabilitation after CABG has
two stages: the immediate postoperative period and the later maintenance stage. The in-hospital
period usually only lasts 5–7 days. This phase has three parts: (1) intensive mobilization starting
postoperative day 1, (2) progressive ambulation and daily exercises, and (3) discharge planning
Early mobilization should only be delayed for an unstable postoperative course or severe
CHF. Early mobilization has several benefits, including decreasing effects of immobility and
preventing cardiac deconditioning. Days 2–5 include progressive ambulation and daily exercise.
Initial ambulation aims for assistance with distances of 150–200 feet, followed by independent
ambulation by the third day. In the last few days prior to discharge, the patient is given a
program of self-monitored exercise that allows for a gradual return to previous levels of activity.
procedure. Inpatient rehabilitation may be needed for high-risk patients or those who have had
to risk into either low-, moderate-, or high-intensity programs. A low-intensity program is in the
area of 2–4 METs, with a target HR of 65–75% of maximum HR. A moderate-intensity program
is from 3 to 6.5 METs, with target HR 70–80% of maximum HR. Ahigh-intensity program is
from 5 to 8.5 METs with a target HR of 75–85% of maximum HR. In the presence of β-
blockade, the target HR is 20 bpm above the resting HR or at a target HR determined through an
ETT aiming at a target MET level. Assignment of level of exercise is determined by the
objective criteria and patient observation in the postoperative period. A level of exercise that
equals a rating of perceived exertion (RPE) of 13 on the Borg scale is a level of training where
the patient can be safely prescribed in the outpatient setting. The inpatient program for high-risk
patients has to be tailored to the specific needs of the patient in cooperation with the patient’s
cardiologist.
Physiotherapy
Suctioning not attended until patient 4hrs post op to prevent unnecessary coughing
Patients who are haemodynamically stable and have no bleeding can be considered for
Once extubated deep breathing and coughing is encouraged 2nd hourly to re-expand
Always encourage patient to splint sternum with towel when coughing and moving to
Day 2 commenced on low saturated fat no added salt diet and maintain fluid restriction
1. According to the American Heart Association, the best bet is to choose a variety
of:
Fruits
Vegetables
Whole grains
Breads
2. Limit their consumption of saturated fat, sugar, and salt, and avoid:
Processed meats
Junk food
Fast food
3. Tell the patient It’s not unusual to experience problems like nausea, lack of
POST op Medication
Administer aspirin within 6 hours after CABG in doses of 81 to 325 mg daily. Continue
After off-pump CABG, administer dual antiplatelet therapy (DAPT) for 1 year with
combined aspirin (81-162 mg daily) and clopidogrel (75 mg daily) to reduce graft
occlusion.
After CABG, clopidogrel 75 mg daily is a reasonable alternative for patients who cannot
take aspirin.
administer combination antiplatelet therapy with aspirin and either prasugrel or ticagrelor
After on-pump CABG, combination therapy with aspirin and clopidogrel for 1 year may
be considered in patients without recent ACS, but the benefits are not well established.
Warfarin should not be routinely prescribed after CABG for graft patency unless patients
have other indications for long-term antithrombotic therapy (such as atrial fibrillation [AF],
Administer moderate-intensity statin therapy for those patients who are intolerant of
high-intensity statin therapy and for those at greater risk for drug-drug interactions Pre- or
Administer beta-blockers as soon as possible around the time of CABG, in the absence of
patients with recent MI, left ventricular (LV) dysfunction, diabetes mellitus, and chronic
kidney disease. Carefully consider the patient's renal function in determining the timing of
Routine ACE inhibitor therapy is not recommended early after CABG among patients
disease, because it may lead to more harm than benefit and an unpredictable BP response.
Cardiac rehabilitation is recommended for all patients after CABG, with the referral
References :
Martin, C. G., & Turkelson, S. L. (2006). Nursing care of the patient undergoing
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surgery. Nursing2019, 34(7), 48-49.
Philadelphia: Saunders.
Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft
e652–e735.
6(3), 109-113.
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