Page 1680 - Saunders Comprehensive Review For NCLEX-RN

3. The opening on the surface of the heart heals;
however, the main channels remain and perfuse the
myocardium.
F. Coronary artery bypass grafting (Fig. 52-4)

1. Description

a. The occluded coronary arteries are
bypassed with the client’s own venous
or arterial blood vessels.
b. The saphenous vein, internal mammary
artery, or other arteries may be used to
bypass lesions in the coronary arteries.
c. Coronary artery bypass grafting is
performed when the client does not
respond to medical management of
coronary artery disease or when
vessels are severely occluded.
d. A minimally invasive direct coronary
artery bypass (MIDCAB) may be an
option for some clients who have a
lesion in the LAD artery; a sternal
incision is not required (usually a 2-
inch [5-cm] left thoracotomy incision is
done), and cardiopulmonary bypass is
not required in this procedure.
2. Preoperative interventions
a. Familiarize the client and family with
the cardiac surgical critical care unit.
b. Inform the client to expect a sternal
incision, possible arm or leg incision(s),
1 or 2 chest tubes, a Foley catheter, and
several IV fluid catheters.
c. Inform the client that an endotracheal
tube will be in place for a short period
of time and that she or he will be
unable to speak.
d. Advise the client that she or he will be
on mechanical ventilation and to
breathe with the ventilator and not
fight it.
e. Instruct the client that postoperative
pain is expected and that pain
medication will be available.
f. Instruct the client in how to splint the
chest incision, cough and deep breathe,
use the incentive spirometer, and
perform arm and leg exercises.
g. Encourage the client and family to

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