RSPT 2266-2267



RSPT 2266-2267 Patient Sticker

CABG CASE STUDY

Student Date

A. Describe a Coronary Artery By-Pass Graft (CABG) procedure. (Use back of page if necessary.)

B. Demographic Data

|Age: | |Ht: | |Wt: | |Sex: | |

| | | | | | | | |

|Occupation: | |Admission date: | |

| | | | |

|Other: | |

C. Health History

1. What symptoms prompted this patient to seek medical attention?

2. History of present illness:

3. Past medical history:

4. Family history:

D. Diagnostic Imaging

|Date/Procedure |Interpretation |

| | |

E. ECG

|Date/Time |Interpretation |

| | |

F. Pulmonary Function Studies

|Date/Test |Normal |Patient Result |Interpretation |

| |Values | | |

| | | | |

G. Patient Assessment (post-op)

1. Breathing pattern:

2. Sensorium: Glascow Coma Scale

| |Eyes Opening (E) |Verbal Response (V) |Motor Response (M) |

|1 |None |None |None |

|2 |To pain |Incomprehensible sounds |Decerebrate posturing |

|3 |To voice |Utters inappropriate words |Decorticate posturing |

|4 |Spontaneous |Confused, disorientated |Withdraws to pain |

|5 | |Normal |Localizes to pain |

|6 | | |Normal |

Total Glascow Coma Score (GCS) = E + V + M

| |Immediate |Hourly Post-op |

| |Post-op | |

|GCS | | | | | | |

3. Chest examination:

a. Auscultation:

[pic]

|1 Clear |

|2 Diminished |

|3 Absent |

|4 Wheezes |

|5 Rhonchi |

|6 Rales |

|7 Pleural rub |

b. Size and shape of chest:

c. Excursion:

d. ETT size, route, depth:

4. Physical observations:

|Respiratory | |Peripheral |Cough |Sputum |Sputum |Sputum | |

|Distress |Cyanosis |Edema |Quality |Amount |Consistency |Color |Clubbing |

|None |None |None |Clear |None |Thin |Clear |None |

|Mild |Nail beds |+1 |Tight |Small |Thick |White |Mild |

|Mod. |Fingers |+2 |Loose |Mod. |Viscid |Yellow |Mod. |

|Severe |Lips |+3 |Croupy |Large |Frothy |Green |Severe |

| |Tongue | |Harsh | | |Brown | |

| |Toes | | | | |Pink | |

| |Severe | | | | |Bloody | |

5. Vital Signs:

| |Normal |Hourly Post-op |

| |Value | |

|Date/Time | | |

|Date/Time | | |

|Date/Time | | | | |

|pH | | | | |

|PaCO2 | | | | |

|HCO3- | | | | |

|PaO2 | | | | |

|SaO2 | | | | |

|FiO2 | | | | |

|Vent Settings | | | | |

|Interpretation | | | | |

J. Laboratory Studies

| |Normal | |Post-op |

| |Value |Admission | |

|Date/Time | | | | | | |

|Hb | | | | | | |

|Hct | | | | | | |

|Na | | | | | | |

|K | | | | | | |

|Cl | | | | | | |

|Ca | | | | | | |

|WBC | | | | | | |

|Total protein | | | | | | |

|Albumin | | | | | | |

|Glucose | | | | | | |

|BUN | | | | | | |

|Creatinine | | | | | | |

|Bilirubin | | | | | | |

|Treponin | | | | | | |

|Creatine Phosphokinase | | | | | | |

|(CPK, CK) | | | | | | |

K. Other

| |Normal |Admission |Post-op |

| |Values | | |

|Date/Time | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

L. Pharmacology

1. List all drugs the patient has received. Describe the action, dosage and frequency of each drug. Also identify possible cardiopulmonary side-effects of each drug.

|Drug |Dosage/ Route |Freq |Action |Cardiopulmonary Side-Effects |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

M. Assessment

1. From your analysis of the subjective/objective information obtained, list all of the data that supports the need for CABG surgery in this patient. Be specific and complete.

N. Post-Op Evaluation

1. Complete the following diagram of this patient’s grafts:

[pic]

2. Describe other procedures that, in some patients, may be an alternative to a CABG operation.

3. What is the purpose for deliberate hypothermia during the operative CABG procedure?

4. How does hypothermia affect the oxyhemoglobin dissociation curve? Include in your discussion, the effects on hemoglobin affinity for oxygen, PaO2 and tissue oxygenation.

5. How is your patient being warmed in ICU?

6. Does your patient have a chest tube? Describe its purpose and location.

7. How soon will this patient most likely be weaned from mechanical ventilator support?

8. What weaning parameters must be met before the ventilator is discontinued? Be specific (parameters and normal values).

9. List potential complications that may arise from the CAB operation and the mechanical ventilation. What respiratory care would be required to prevent/treat each potential complication? Include goals for each respiratory care procedure described.

10. When will this patient be ambulated?

11. Describe the modifications this patient will need to make in his lifestyle (diet, exercise, stress levels, etc.) to remain healthy.

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