CASE STUDY: CABG
Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-
standing coronary artery disease (CAD) with occasional episodes of heart failure
(HF). One year ago, he had an anterior wall myocardial infarction (MI). In addition,
he has chronic anemia, hypertension, chronic renal insufficiency, and a recently
diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD,
he had to retire from his job as a railroad engineer about 6 months ago. This
morning, he is being admitted to your telemetry unit for a same-day cardiac
catheterization. As you take his health history, you note that his wife died a year
ago (about the same time that he had his MI) and that he does not have any
children. He is a current cigarette smoker with a 50-pack-year smoking history. His
vital signs (VS) are 158/94, 88, 20, and 97.2° F (36.2° C). As you talk with him, you
realize that he has only minimal understanding of the catheterization procedure.
1. Before he leaves for the catheterization laboratory, you briefly teach him
the important things he needs to know before having the procedure. List
five priority topics you will address.
a. He needs to know how the procedure will go. Such as where it will go:
Internal jugular (IJ), Subclavian (SVC), Femoral, Peripheral
b. That he will need to keep whichever limb it goes in straight and still
for prescribed time (usually 4-6 hours).
c. That the catheter will administer blood easier to the heart
d. He needs to know complications that could happen such as:
phlebitis, occlusion, and mechanical complications
e. Teach client how to take care of catheter right after surgery for example:
not submerging it in water. To shower, cover dressing site to avoid water
exposure
2. Look at his past history. What other factors are present that could
contribute to his risk for cardiac ischemia?
a. His high blood pressure
b. Smoking
c. The aneurysm
d. The stress of his wife passing away
e. The stress of retiring from his job due to health issues
f. Being alone could elevate his emotions as well (since he has no children)
CASE STUDY PROGRESS
Several hours later, K.Z. returns from his catheterization. The catheterization report
1
, shows 90% occlusion of the proximal left anterior descending (LAD) coronary artery,
90% occlusion of the
2
Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-
standing coronary artery disease (CAD) with occasional episodes of heart failure
(HF). One year ago, he had an anterior wall myocardial infarction (MI). In addition,
he has chronic anemia, hypertension, chronic renal insufficiency, and a recently
diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD,
he had to retire from his job as a railroad engineer about 6 months ago. This
morning, he is being admitted to your telemetry unit for a same-day cardiac
catheterization. As you take his health history, you note that his wife died a year
ago (about the same time that he had his MI) and that he does not have any
children. He is a current cigarette smoker with a 50-pack-year smoking history. His
vital signs (VS) are 158/94, 88, 20, and 97.2° F (36.2° C). As you talk with him, you
realize that he has only minimal understanding of the catheterization procedure.
1. Before he leaves for the catheterization laboratory, you briefly teach him
the important things he needs to know before having the procedure. List
five priority topics you will address.
a. He needs to know how the procedure will go. Such as where it will go:
Internal jugular (IJ), Subclavian (SVC), Femoral, Peripheral
b. That he will need to keep whichever limb it goes in straight and still
for prescribed time (usually 4-6 hours).
c. That the catheter will administer blood easier to the heart
d. He needs to know complications that could happen such as:
phlebitis, occlusion, and mechanical complications
e. Teach client how to take care of catheter right after surgery for example:
not submerging it in water. To shower, cover dressing site to avoid water
exposure
2. Look at his past history. What other factors are present that could
contribute to his risk for cardiac ischemia?
a. His high blood pressure
b. Smoking
c. The aneurysm
d. The stress of his wife passing away
e. The stress of retiring from his job due to health issues
f. Being alone could elevate his emotions as well (since he has no children)
CASE STUDY PROGRESS
Several hours later, K.Z. returns from his catheterization. The catheterization report
1
, shows 90% occlusion of the proximal left anterior descending (LAD) coronary artery,
90% occlusion of the
2
