Introduction
Coronary Artery Bypass Graft (CABG) is a type of surgery performed to increase the efficiency of the flow of blood to the muscles of the heart. It is used to decrease the risks of death caused by coronary artery disease. Blood vessels are removed from other areas of the victim’s body and used to replace the damaged arteries.
These arteries of the heart are referred to as the coronary arteries. This is mainly done to create new routes in areas where the arteries had narrowed or blocked up (Smeltzer, Bare, Hinkle, & Cheever, 2008). This allows enough blood to flow through it and supply blood rich in nutrients and oxygen to the muscles of the heart, which is referred to as the myocardium.
Overview of the disease
The CABG surgery is necessary when a patient is suffering from coronary artery disease (Glenn, 1972). This is mostly done on a heart that is not pumping blood. This calls for the use of a cardiopulmonary bypass. However, there are techniques that can be employed to perform the same surgery on a beating heart. When this is done, it is referred to as an ‘off-pump’ surgery (Shroyer et al., 2009).
This disease occurs when the arteries harden and build up within the walls of the coronary arteries. This hardening is what is referred to as atherosclerotic plaque. The plaque is mostly made of cholesterol. Some habits or diseases may accelerate the amount of accumulation in the arteries (plaque). For example, habits such as smoking may accelerate the effect. Diseases and conditions such as high blood pressure, diabetes and elevated cholesterol may work in a way as to accelerate the accumulation effect.
Age is a determining factor when it comes to this disease. Men of ages 45 and above and women of ages 55 and above are at higher risk. This disease causes certain changes in the normal functioning of the human body (pathophysiology) but treatment is available. Patient education is also necessary when it comes to those suffering from coronary artery disease (CAD).
Pathophysiology
Since the arteries become narrow, there is a limited amount of blood that flows into the heart. This causes ischemia, which is the starvation of the cell from lack of oxygen. The cells that suffer in this case are the myocardial cells. They may eventually die when they lack oxygen for a substantial amount of time.
When this occurs, this is referred to as myocardial infarction. This is commonly referred to as a heart attack. This leads to the damaging of the heart muscle. Consequently, it leads to the death of the heart muscle. Myocardial scarring occurs and this may cause the heart muscle not to grow again (Glenn, 1972).
In cases where the arteries have constricted to a high degree, this leads to the induction of ventricular arrhythmia. This may cause ventricular fibrillation, which is deadly (may lead to death). The sudden blockage of a blood vessel (coronary artery) leads to myocardial infarction. This usually occurs when a plaque ruptures. This causes the activation of the process of clotting and this causes the blood vessel to close suddenly. The reason why the plaque raptures have not been understood clearly despite the many theories that have been developed.
The plaque that forms within the artery appears like a large pimple. This causes a partial obstruction of the vessel. This plaque is mostly made out of deposits. These deposits may consist of calcium, inflamed cells, and fats. In cases where calcium phosphate is deposited within the muscles of blood vessels, this may cause two things to happen.
First, it causes the stiffening of the arteries. Secondly, it causes the early stages of coronary arteriosclerosis. This is evident in the calcification that occurs in patients suffering from chronic kidney disease. Despite the patients suffering from chronic kidney disease, 50 percent of all deaths are due to CAD.
Treatment of Coronary artery disease
There are medicines that are available to treat angina. This reduces the demand for oxygen by the heart muscle. This is necessary to compensate for the reduced blood supply caused when the coronary arteries constrict. There are three main classes of drugs used to treat coronary artery disease. They include calcium blockers, beta-blockers, and nitrates. An example of nitrate is Nitroglycerin. Propranolol and atenolol are examples of beta-blockers. Nifedipine and nicardipine are examples of medicines in the category of calcium blockers.
Aspirins may also be used in the treatment of angina. Intravenous blood thinner heparin is also useful in this treatment. Since clotting of the blood may be deadly when it comes to coronary artery disease, a medication that prevents the clumping of platelets is necessary. Aspirin plays an important role. In order to prevent blood clots from occurring on the surfaces of the plaques, heparin is used. This prevents the narrowing of the arteries to critical stages.
However, patients with CAD may continue to have angina even when all these forms of medication have been administered. Patients may also show signs of significant ischemia. In such situations, coronary arteriography is used. The data collected gives the doctors enough information to decide whether the patient requires percutaneous transluminal angioplasty (angioplasty). This is whereby a balloon-like structure is inserted to inflate the artery and remove the blockage.
If all forms of medical therapy fail (including angioplasty), CABG surgery is performed. This is especially important when a patient has multiple narrowing in several branches of the artery. This surgery has been determined to improve long-term survival in patients. This is especially when it comes to those who had significant narrowing of the main coronary artery. This also significantly helps those whose heart muscles had decreased in pumping functions.
Nursing interventions
The nurse should constantly monitor the heart rate and the patient’s blood rate when it comes to angina episodes. Nitroglycerin should be kept close to allow for immediate use when the need arises. During nursing care, the nurse should record the duration of pain. It is also necessary to record the amount of medication necessary to relieve the pain and the symptoms that accompany the medication should be put down. If the patient is scheduled for surgery, it is important for the nurse to explain the procedures to the patient (Hannan, 2008).
Patient educational handout
Medication
The doctor may recommend cardiac rehabilitation through medication. This may apply for both angina and after CABG has been performed. When surgical treatments are combined with medication, the recovery of the patient may be faster (Hannan, 2008). It is important for the patient to understand the importance of the medication and ensure that he or she has finished the dose.
Activity
The patient should be encouraged to make lifestyle changes in order to help prevent or treat CAD. This includes the following of a heart healthy eating plan. This helps prevent or reduce high blood cholesterol high blood pressure. One should also be encouraged to increase the physical activity in order to maintain a healthy weight (Tung et al., 2010).
However, it is important to confirm with the doctor what kind of activity and how much of it is healthy for your condition. One should also quit smoking if one is a smoker. Avoiding secondhand smoke is also vital because the effect is the same. Learning to cope with stress is also vital for such patients.
Post op teaching
Every individual who has undergone a coronary artery bypass graft surgery recovers at a different rate. This may take between 6 to 8 weeks. During this time, it is important for the patient to maintain contact with the doctor. The instructions that would be provided would include general postoperative instructions. Others include information of how to get the family involved and information about sex after surgery.
Discharge teaching
As the patient is discharged, he or she is made to understand that the recovery is still a long way to go. This would mean that the patient keeps in touch with the doctor and continue with the medication provided. The patient will also be advice to maintain a healthy lifestyle.
Conclusion
Coronary artery bypass graft is a procedure that is done on patients suffering from CAD. It involves taking portions of arteries from other parts of the body to the coronary artery. This helps to replace the areas of the coronary artery that had blocked. This improves the flow of blood to the heart muscle. Several types of medication exist but surgery (CABG) is necessary for chronic conditions. After surgery, the patient is provided with vital information (education) that helps the person lead a healthier life in order to eliminate risks of coronary artery disease.
References
Hannan, E. (2008). Drug-eluting stents vs. coronary artery bypass grafting in multivessel coronary disease. N. Engl. J. Med., 358(4), 331-341.
Shroyer, A., Grover, L., Hattler, M., Collins, D., McDonald, O., Kozora, E., …Novitzky, D. (2009). On-pump versus off-pump coronary artery bypass surgery. N. Engl. J. Med., 361, 1827-1837.
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2008). Brunner & Suddarth’s Textbook of medical surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.
Tung, H., Chen, Y., Wei, J., Liu, C., Chang, C., & Wang, T. (2010). Leisure physical activity and quality of life after coronary artery bypass graft surgery for patients with metabolic syndrome in Taiwan. The Journal of acute and critical care, 39(5), 410-420.