Nursing Care Plan Cardiac Surgery : Posoperative care-coronary artery bypass graft, MIDCAB, Cardiomyoplasty, Valve Replacement

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Inpatient acute hospital on a surgical or post-ICU step-down unit.


  1. Angina
  2. Heart failure: chronic
  3. Dysrhythmias
  4. Myocardial infarction
  5. Hemothorax/pneumothorax
  6. Psychosocial aspects of care
  7. Surgical intervention
  8. Patient Assessment Database
  9. The preoperative data presented here depend on the specific disease process and underlying cardiac condition/reserve.


May report: 

  1. History of exercise intolerance
  2. Generalized weakness, fatigue
  3. Inability to perform expected/usual life activities
  4. Insomnia/sleep disturbance

May exhibit: 

  1. Abnormal heart rate, BP changes with activity
  2. Exertional discomfort or dyspnea
  3. ECG changes/dysrhythmias


May report: 
History of recent/acute MI, three (or more) vessel coronary artery disease, valvular heart disease, hypertension

May exhibit: 
  1. Variations in BP, heart rate/rhythm
  2. Abnormal heart sounds: S3/S4, murmurs
  3. Pallor/cyanosis of skin or mucous membranes
  4. Cool/cold, clammy skin
  5. Edema, JVD
  6. Diminished peripheral pulses
  7. Abnormal breath sounds: crackles
  8. Restlessness/other changes in mentation or sensorium (severe cardiac decompensation)


May report: 
  1. Feeling frightened/apprehensive, helpless
  2. Distress over current events (anger/fear)
  3. Fear of death/eventual outcome of surgery, possible complications
  4. Fear about changes in lifestyle/role functioning

May exhibit: 
  1. Apprehension, restlessness
  2. Facial/general tension; withdrawal/lack of eye contact
  3. Focus on self; hostility, anger; crying
  4. Changes in heart rate, BP, breathing patterns


May report: 
  1. Change in weight
  2. Loss of appetite
  3. Abdominal pain, nausea/vomiting
  4. Change in urine frequency/amount

May exhibit: 
  1. Weight gain/loss
  2. Dry skin, poor skin turgor
  3. Postural hypotension
  4. Diminished/absent bowel sounds
  5. Edema (generalized, dependent, pitting)


May report: 
Fainting spells, vertigo

May exhibit: 
Changes in orientation or usual response to stimuli
Restlessness; irritability, exaggerated emotional responses; apathy


May report: 
Chest pain, angina


May report: 
Shortness of breath

May exhibit: 
Productive cough


May report: 
Infectious episode with valvular involvement or myopathy


May report: 
  1. Familial risk factors of diabetes, heart disease, hypertension, strokes
  2. Use of various cardiovascular drugs
  3. Failure to improve
  4. Postoperative Assessment


May report: 
Incisional discomfort
Pain/paresthesia of shoulders, arms, hands, legs

May exhibit: 
  1. Guarding
  2. Facial mask of pain; grimacing
  3. Distraction behaviors; moaning; restlessness
  4. Changes in BP/pulse/respiratory rate


May report: 
Inability to cough or take a deep breath

May exhibit: 
  1. Decreased chest expansion
  2. Splinting/muscle guarding
  3. Dyspnea (normal response to thoracotomy)
  4. Areas of diminished or absent breath sounds (atelectasis)
  5. Anxiety
  6. Changes in ABGs/pulse oximetry


May exhibit: 
Oozing/bleeding from chest or donor site incisions


  1. Discharge plan DRG projected mean length of inpatient stay: 4.7 days, acute care (additional days may be considerations: divided among multiple levels of care)
  2. Short-term assistance with food preparation, shopping, transportation, self-care needs, and homemaker/home maintenance tasks
  3. Refer to section at end of plan for postdischarge considerations.

  1. Hemoglobin (Hb)/hematocrit (Hct): A low Hb reduces oxygen-carrying capacity and indicates need for red blood cell replacement. Elevation of Hct suggests dehydration/need for fluid replacement.
  2. Coagulation studies: Various studies may be done (e.g., platelet count, bleeding and clotting time) to determine therapeutic level of anticoagulant therapy when used.
  3. Electrolytes: Imbalances (hyperkalemia/hypokalemia, hypernatremia/hyponatremia, and hypocalcemia) can affect cardiac function and fluid balance.
  4. ABGs: Verifies oxygenation status, effectiveness of respiratory function, and acid-base balance.
  5. Pulse oximetry: Provides noninvasive measure of oxygenation at tissue level.
  6. BUN/creatinine: Reflects adequacy of renal and liver perfusion/function.
  7. Amylase: Elevation is occasionally seen in high-risk patients, e.g., those with heart failure undergoing valve replacement.
  8. Glucose: Fluctuations may occur because of preoperative nutritional status, presence of diabetes/organ dysfunction, rate of dextrose infusions.
  9. Cardiac enzymes/isoenzymes: Elevated in the presence of acute, recent, or perioperative MI.
  10. Chest x-ray: Reveals heart size and position, pulmonary vasculature, and changes indicative of pulmonary complications (e.g., atelectasis). Verifies condition of valve prosthesis and sternal wires, position of pacing leads, intravascular/cardiac lines.
  11. ECG: Identifies changes in electrical, mechanical function such as might occur in immediate postoperative phase, acute/perioperative MI, valve dysfunction, and/or pericarditis.
  12. Cardiac echocardiogram/catheterization: Measures chamber pressures and pressure gradients across valves, identifies occlusions of arteries, impaired coronary perfusion, and possible wall motion abnormalities.
  13. Transesophageal echocardiography: Useful in diagnosing cardiac valve and chamber abnormalities, such as regurgitation, shunting, or stenosis in patients in whom transthoracic approach is not feasible.
  14. Nuclear studies (e.g., thallium-201, DPY-thallium/Persantine): Heart scans demonstrate coronary artery disease, heart chamber dimensions, and presurgical/postsurgical functional capabilities.


  1. Support hemodynamic stability/ventilatory function.
  2. Promote relief of pain/discomfort.
  3. Promote healing.
  4. Provide information about postoperative expectations and treatment regimen.


  1. Activity tolerance adequate to meet self-care needs.
  2. Pain alleviated/managed.
  3. Complications prevented/minimized.
  4. Incisions healing.
  5. Postdischarge medications, exercise, diet, therapy understood.
  6. Plan in place to meet needs after discharge.

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