Complex Care

Open Heart Surgery Observation

Gregory Angelo

While in the OR for Open Heart Observation I got to see a Coronary artery bypass

grafting (CABG.) A coronary artery bypass grafting is a type of surgery that improves blood

flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease

(CHD). CHD is a disease in which a waxy substance called plaque (plak) builds up inside the

coronary arteries. CHD is a disease in which a waxy substance called plaque (plak) builds up

inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

The purpose of the cardiopulmonary bypass machine (CPB) is a technique that

temporarily takes over the function of the heart and lungs during surgery, maintaining the

circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often

referred to as a heartlung machine or "the pump". Cardiopulmonary bypass is commonly used

in coronary bypass heart surgery because of the difficulty of operating on the beating heart.

Operations requiring the opening of the chambers of the heart require the use of CPB to support

the circulation during that period. The machine pumps the blood, and, using an oxygenator,

allows red blood cells to pick up oxygen, as well as allowing carbon dioxide levels to decrease.

This mimics the function of the heart and the lungs, respectively.

An ethical concerns regarding open heart surgery is a conflict of interest. A surgeon may

be asked to perform surgery on a terminally ill patient when the outcome is likely to be poor. A
patient may have an advanced directive in place, but the person speaking for the patient may not

have the patient's best interests at heart. Surgeons may face decisions about whether they should

tell the truth to patients who have terminal diseases. They may also have to make choices about

providing life-prolonging care to patients with terminal or irreversible conditions.

Some nursing management priorities for patients who require a CABG preoperative are

the following; Fear and Anxiety and patients medical history. Postoperative; Decreased Cardiac

Output. Risk for impaired respiratory function including ineffective breathing pattern, ineffective

airway clearance, and impaired gas exchange. Altered fluid and electrolyte balance including

fluid volume excess, fluid volume deficit and hypokalemia, hypochloremia, and/or metabolic

alkalosis. Activity Tolerance. Risk for infection including pneumonia and wound infection. Some

potential complications are; myocardial infarction, cardiac dysrhythmias, heart failure, cardiac

tamponade, bleeding, thromboembolism, neurological dysfunction, impaired final function and

pneumothorax. Knowledge deficit, ineffective management of therapeutic regimen or altered

health maintenance.

Overall this was a very interesting and educational experience. Its helpful to be in the

OR first hand as opposed to reading a book or notes when it comes to learning and retaining the

information about the operation. It was an amazing experience that Im grateful I got to witness

and learn more about.