Wannabe Treatment Plan

TREATMENT PLAN

Mr. Wannabe has returned to the ward after Triple Coronary Artery Bypass Graft two days ago. He has spent two nights in the special care unit and is now haemodynamically stable and had been well organized to be transferred to his room. He is alert and orientated with mild to moderate complains of pain. Earlier that day, he had his chest drain removed and an x-ray has been done. He was on slow AF with 75-100 bpm, asymptomatic and the surgeon is well aware. Pacing (pacemaker) wires x 2 are in situ and pacing box is at the bedside. The treatment plan I have outlined is for Mr. Wannabe’s post-operative nursing management while in the ward setting in reference to Gulanick & Myers’ (2013) nursing care plan (pp. 312-324).

Assess the

Blood tests are done daily as per routine. Clopidogrel, Aspirin and Daltaparin are collectively use routinely post-op to prevent blood clot formation. Derangements of clotting factors may result in bleeding and deficient fluid balance.

Keep tabs on blood results such as WBC. An increase reading may elicit post-op infection. Cefazolin 1g IV 8 hourly for 7 doses are routinely prescribed post-op.

Monitor electrolyte levels, especially potassium, magnesium, and calcium. Electrolyte imbalances are common causes of dysrhythmias and guide treatment. My patient was having regular Span K 1 tab TDS and the surgeon would add chlorvescent 2 tabs stat doses whenever required.

Perform a 12-lead electrocardiogram (ECG) as prescribed. We do ECG once a day routinely and a cardiac rhythm strip as needed. Besides providing information on dysrhythmias, the ECG may document post-operative myocardial ischemia that may also affect cardiac output. Amiodarone 200mg tds were given in treating atrial fibrillation. Beta blocker (Metoprolol 47.5 m OD) were given to slow the heart rate and control his blood

Specialized therapy or cardiac monitoring is necessary when initially increasing activity. Some exercises may be provided at home. A structured program of low intensity exercise can improve functional capacity, increase self-confidence to exert self and improve quality of life.

Provide resources and contact support groups. Although a lengthy advice has been given whist in hospital by the surgeons and nurses, the patient may not be ready to comprehend a load of information at once. We discharge our patients with educational materials they can read and digest at home and contact support groups they can join. According to the New Zealand Guidelines Group (2002), all patients following a coronary bypass graft are recommended to have a comprehensive cardiac rehabilitation. It have been shown to prevent further cardiovascular events by empowering patients to choose a healthy lifestyle, to improve quality of life for the patient and their family and to assist in the patient’s return to full and active life by enabling the development of their own