Page 2472 - Saunders Comprehensive Review For NCLEX-RN

the client does not respond to medical management of
coronary artery disease or when vessels are severely
occluded.
4. 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.
5. 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
discuss anxieties and fears related to
surgery.
h. Note that prescribed medications may
be discontinued preoperatively
(usually, diuretics 2 to 3 days before
surgery, digoxin 12 hours before
surgery, and aspirin and
anticoagulants 1 week before surgery).
i. Administer medications as prescribed,
which may include potassium
chloride, antihypertensives,
antidysrhythmics, and antibiotics.

6. Cardiac surgical unit postoperative

interventions
a. Mechanical ventilation is maintained

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