Case Study 13 Coronary Artery Disease and Coronary Artery Bypass Surgery

Case Study 13 Coronary Artery Disease and Coronary Artery Bypass Surgery Difficulty: Advanced Setting: Hospital Index Words: coronary artery disease (CAD), heart failure (HF), coronary artery bypass graft (CABG), cardiac catheterization, hemodynamic monitoring, laboratory values, medications, assessment Giddens Concepts: Clinical Judgment, Coping, Gas Exchange, Patient Education, Perfusion HESI Concepts: Assessment, Clinical Decision Making—Clinical Judgment, Gas Exchange, Patient Education, Perfusion, Stress & Coping Scenario Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an anterior wall myocardial infarction (MI). In addition, he has chronic anemia, hypertension, chronic renal insufficiency, and a recently diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to retire from his job as a railroad engineer about 6 months ago. This morning, he is being admitted to your telemetry unit for a same day cardiac catheterization. As you take his health history, you note that his wife died a year ago (at about the same time that he had his MI) and he does not have any children. He is a current cigarette smoker with a 50–pack-year smoking history. His vital signs (VS) are 158/94, 88, 20, and 97.2 ° F (36.2 ° C). As you talk with him, you realize that he has only a minimal understanding of the catheterization procedure. 1. Before he leaves for the catheterization laboratory, you briefly teach him the important things he needs to know before having the procedure. List five priority topics you will address. • The importance of smoking cessation • Extensive measures are taken to reduce the need for RBC transfusion, but there is a possibility of having to get a blood transfusion if bleeding occurs • Fasting 6 to 8 hours prior to procedure • Avoid strenuous activity until your provider gives the OK to resume normal activities • Must lie flat after procedure is done • You will be awake during procedure but they will give you something to take the edge of