Page 164 - Critical Care Nursing Demystified
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Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 149
Interpreting Test Results Pre- and Postoperatively
CBC and electrolyte studies are done for baselines.
Nasal swabs for methicillin-resistant Staphylococcus aureus (MRSA) are completed
to prevent contamination of the surgical field with a preexisting infection.
Baseline coagulation studies are done to prevent hemorrhage.
Renal and hepatic function tests are done to see if there are other preexisting
conditions that might prevent the patient from tolerating the surgical procedure.
Pulmonary function tests are done as the elderly and patients with COPD
are at greater risk for respiratory complications and need to be identified
early.
Chest x-rays are completed to rule out a preexisting tumor, fluid accumula-
tion, or infection.
Echocardiography is completed to determine ejection fraction, functioning
of heart valves, and heart wall motion.
Nursing Diagnoses for CABG Expected Outcomes
Impaired gas exchange due to The patient will have SaO and baseline Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
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malpositioned endotracheal tube, ABGs
increased capillary permeability, The CVP and PAP will be baseline
increased fluids, pulmonary
hypertension
Decreased cardiac output due to The patient will have normal VS
stunned myocardium from sur- The patient will have normal PAP, PCWP,
gery and/or cardiac dysrhythmias CO/CI
The patient will be in normal sinus rhythm
The patient will have a normal CVP, flat
neck vein, and clear heart sounds
Fluid volume deficit due to bleed- The patient will have a normal H&H, coag-
ing from the incisional areas, ulation profiles, chest tube drainage
chest tube sites
Interventions (Early)
Assess vital signs to determine if patient is stable and not going into cardio-
genic shock and/or fluid volume deficit.
Assess airway and SaO as the patient will be intubated and on the ventilator
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(see ventilator care; Chapter 2).
