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CRITICAL PATHWAYS FOR  CARDIAC SURGERY IPD CLEARANCE Should not be more than 24 hrs   EXAMINATION : Vital Signs Height Wei...
<ul><li>CBC, Electrolyte, LFT, RFT, Coagulogram, </li></ul><ul><li>Trop I in recent MI </li></ul><ul><li>ECG, CXR PA view ...
<ul><li>Anesthesia </li></ul><ul><li>Social service </li></ul><ul><li>Patient care coordinator  </li></ul><ul><li>Physioth...
ACTIVITY <ul><li>Out of bed as tolerated except in left main disease. </li></ul>
MEDICATION <ul><li>Antihypertensive and anti-anginals and anti-arrhythmic to continue. </li></ul><ul><li>Premedication and...
INFORMED CONSENT/SPECIAL CONSENT Surgery, Anesthesia, HIV, Blood transfusion, high risk consent (euro score form in CABG p...
DIET <ul><li>Low fat and cholesterol. </li></ul><ul><li>Low sodium diet </li></ul>
EDUCATION <ul><li>Adequate understanding on what to expect, preliminary plan and potential risks. </li></ul>
 
INTRA OP
 
 
 
Care of CABG Patient… (Zero day) <ul><li>Cleaning of the unit </li></ul><ul><li>Post OP bed </li></ul><ul><ul><li>Disinfec...
Care of CABG Patient…(Zero Day) <ul><li>Patient received </li></ul><ul><li>Setting of the patient </li></ul><ul><li>All li...
CRITICAL PATHWAYS FOR  CARDIAC SURGERY <ul><li>TRANSFER TO STEP DOWN </li></ul><ul><li>VITAL SIGNS </li></ul><ul><li>BASIC...
INVESTIGATIONS <ul><li>CXR, ECG,CBC, LFT, RFT, COAGULOGRAM. </li></ul>
ACTIVITY <ul><li>Dangle legs after extubation, out of bed to chair, </li></ul><ul><li>Ambulate in room with assistance. </...
MEDICATION <ul><li>Adequate analgesia </li></ul><ul><li>Nebulizer to keep SaO 2 >92% </li></ul><ul><li>Chest PT QID. </li>...
DIET <ul><li>Clear fluids. </li></ul>
EDUCATION <ul><li>Dorsiflexion and leg elevation. Address Patient & family concerns. </li></ul>
CRITICAL PATHWAYS FOR  CARDIAC SURGERY POST OPRATIVE DAY TWO TO FOUR TRANSFER TO WARD VITAL SINGS WT., FLUID BALANCE. BREA...
INVESTIGATIONS <ul><li>K + </li></ul><ul><li>INR in VALVE CASES </li></ul><ul><li>RBS x 8 HRLY IN DIABETES. </li></ul>
ACTIVITY <ul><li>Physiotherapy and dietetics review. </li></ul><ul><li>Consultants Round and all instruction should be not...
MEDICATION <ul><li>Adequate analgesia </li></ul><ul><li>SaO 2 >95% on room air </li></ul><ul><li>Chest PT x QID </li></ul>...
EDUCATION <ul><li>Diet instruction by dietician. </li></ul><ul><li>Address patient/family concerns. </li></ul><ul><li>Prel...
<ul><li>VITAL SIGNS. </li></ul><ul><li>I/O </li></ul><ul><li>BREATH SOUNDS x TID. </li></ul><ul><li>BASELINE WT ACHIEVED. ...
PRE-DISCHARGE INVESTIGATION <ul><li>PACING WIRE REMOVAL. </li></ul><ul><li>CXR & ECG  </li></ul><ul><li>Endocrinology cons...
ACTIVITY <ul><li>Ambulate x QID. </li></ul><ul><li>Stairs ½ to 1 flight under the guidance of Physiotherapists. </li></ul>
MEDICATIONS <ul><li>Adequate pain control. </li></ul><ul><li>Laxative SOS </li></ul><ul><li>Dressing & crepe bandage. </li...
EDUCATION <ul><li>Patient education, medication, diet, activity, physiotherapy and follow-up. </li></ul>
<ul><li>THANKS </li></ul>
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Critical Pathways For Cardiac Surgery

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Critical Pathways For Cardiac Surgery

  1. 1. CRITICAL PATHWAYS FOR CARDIAC SURGERY IPD CLEARANCE Should not be more than 24 hrs EXAMINATION : Vital Signs Height Weight History & Physical Examination PREOPERATIVE DAY
  2. 2. <ul><li>CBC, Electrolyte, LFT, RFT, Coagulogram, </li></ul><ul><li>Trop I in recent MI </li></ul><ul><li>ECG, CXR PA view (Lateral view and CT chest in re-do cases). </li></ul><ul><li>Echocardiography for LV function , carotid /radial Doppler in CABG and Annulus size in valve cases. </li></ul><ul><li>Cross match and confirm availability of blood. </li></ul><ul><li>Blood Clearance not old more than 3 days </li></ul>INVESTIGATION
  3. 3. <ul><li>Anesthesia </li></ul><ul><li>Social service </li></ul><ul><li>Patient care coordinator </li></ul><ul><li>Physiotherapy </li></ul><ul><li>Dietetics </li></ul><ul><li>Any other as required </li></ul>CONSULTATIONS
  4. 4. ACTIVITY <ul><li>Out of bed as tolerated except in left main disease. </li></ul>
  5. 5. MEDICATION <ul><li>Antihypertensive and anti-anginals and anti-arrhythmic to continue. </li></ul><ul><li>Premedication and NPO after midnight or as per PAC. </li></ul>
  6. 6. INFORMED CONSENT/SPECIAL CONSENT Surgery, Anesthesia, HIV, Blood transfusion, high risk consent (euro score form in CABG patient) <ul><li>PREPARATION OF PARTS </li></ul><ul><li>Use clipper only </li></ul><ul><li>Betadine Bath ,Betadine paint </li></ul>
  7. 7. DIET <ul><li>Low fat and cholesterol. </li></ul><ul><li>Low sodium diet </li></ul>
  8. 8. EDUCATION <ul><li>Adequate understanding on what to expect, preliminary plan and potential risks. </li></ul>
  9. 10. INTRA OP
  10. 14. Care of CABG Patient… (Zero day) <ul><li>Cleaning of the unit </li></ul><ul><li>Post OP bed </li></ul><ul><ul><li>Disinfections of the bed by bacillocid 2% </li></ul></ul><ul><ul><li>Linen pack with sterile four sheets </li></ul></ul><ul><ul><li>washed blanket-1 </li></ul></ul><ul><li>Medication Trolley </li></ul><ul><ul><li>Drugs-inotropes, vasodilator, vasoconstrictor, sedative, fluid </li></ul></ul><ul><ul><li>Consumable-Gloves, PM line, Handrub,O 2 mask, Nebulizer kit, Nasal prone </li></ul></ul><ul><li>Monitor set-up </li></ul><ul><ul><li>Module & Cables </li></ul></ul><ul><ul><li>ECG,SPO 2 , Pressure (ABP,PAP), Respiration, Temperature, Cardiac Output </li></ul></ul><ul><li>Ventilator Set-Up </li></ul><ul><ul><li>PRVC mode </li></ul></ul><ul><li>Suction & Oxygen </li></ul><ul><ul><li>Suction tubes & bottles </li></ul></ul>
  11. 15. Care of CABG Patient…(Zero Day) <ul><li>Patient received </li></ul><ul><li>Setting of the patient </li></ul><ul><li>All lines </li></ul><ul><li>Transducers </li></ul><ul><li>3 ways, Suction Oxygen </li></ul><ul><li>X-Ray Chest </li></ul><ul><li>Check position of the Ryles tube & E.T Tube </li></ul><ul><li>IABP catheter check </li></ul><ul><li>Check all lines </li></ul><ul><li>Stat ABG </li></ul><ul><li>Start Fluid & Antibiotics </li></ul><ul><li>Check Drainage & output every hourly </li></ul><ul><li>E.T Suction </li></ul><ul><li>Sedation if pt. awake </li></ul><ul><li>Weaning of Ventilator </li></ul>
  12. 16. CRITICAL PATHWAYS FOR CARDIAC SURGERY <ul><li>TRANSFER TO STEP DOWN </li></ul><ul><li>VITAL SIGNS </li></ul><ul><li>BASIC CARE (mouth care, back care) </li></ul><ul><li>WT,FLUID BALANCE </li></ul><ul><li>ECG,CXR, CARDIAC OUTPUT </li></ul><ul><li>O 2 SATURATION x 4 HRLY while weaning O 2 ,SaO 2 >92% on O 2 . </li></ul><ul><li>AUSCULTATE breath sounds x 6HRLY </li></ul><ul><li>Resting HR>60 & <120/min without pacemaker </li></ul><ul><li>U/O >0.5ml/kg/hr. </li></ul><ul><li>Effective cough & airway clearance. </li></ul><ul><li>Afebrile </li></ul><ul><li>Bowel sounds present </li></ul><ul><li>Moving all extremities </li></ul><ul><li>Chest tube output. </li></ul>POSTOPRATIVE DAY - 1
  13. 17. INVESTIGATIONS <ul><li>CXR, ECG,CBC, LFT, RFT, COAGULOGRAM. </li></ul>
  14. 18. ACTIVITY <ul><li>Dangle legs after extubation, out of bed to chair, </li></ul><ul><li>Ambulate in room with assistance. </li></ul><ul><li>Limit sitting with legs down </li></ul><ul><li>Dorsiflexion x 1 hrly while awake. </li></ul>
  15. 19. MEDICATION <ul><li>Adequate analgesia </li></ul><ul><li>Nebulizer to keep SaO 2 >92% </li></ul><ul><li>Chest PT QID. </li></ul><ul><li>Coughing/deep breathing x 2hrly when awake. </li></ul><ul><li>Remove ICD according to drainage. </li></ul>
  16. 20. DIET <ul><li>Clear fluids. </li></ul>
  17. 21. EDUCATION <ul><li>Dorsiflexion and leg elevation. Address Patient & family concerns. </li></ul>
  18. 22. CRITICAL PATHWAYS FOR CARDIAC SURGERY POST OPRATIVE DAY TWO TO FOUR TRANSFER TO WARD VITAL SINGS WT., FLUID BALANCE. BREATH SOUNDS X 6HRLY HR>60 & <100/min without pacemaker Effective cough and airway clearance. Alert & Oriented.
  19. 23. INVESTIGATIONS <ul><li>K + </li></ul><ul><li>INR in VALVE CASES </li></ul><ul><li>RBS x 8 HRLY IN DIABETES. </li></ul>
  20. 24. ACTIVITY <ul><li>Physiotherapy and dietetics review. </li></ul><ul><li>Consultants Round and all instruction should be noted and implemented,never overlook or change the instruction of the senior consultant without their permission . </li></ul><ul><li>Ambulate gradually to one flight of steps by day 4. </li></ul>
  21. 25. MEDICATION <ul><li>Adequate analgesia </li></ul><ul><li>SaO 2 >95% on room air </li></ul><ul><li>Chest PT x QID </li></ul><ul><li>Coughing/deep breathing x 2 hrly </li></ul><ul><li>Dressing after 48 hours and SOS </li></ul><ul><li>Crepe bandage </li></ul><ul><li>Discontinue Foley's and make patient void. </li></ul><ul><li>Electrolyte replacement, Beta blockers, diuretics & ACE inhibitors advised every morning. </li></ul><ul><li>Amiodarone to be given to all patients with EF<40% </li></ul>
  22. 26. EDUCATION <ul><li>Diet instruction by dietician. </li></ul><ul><li>Address patient/family concerns. </li></ul><ul><li>Preliminary plans for discharge. </li></ul>
  23. 27. <ul><li>VITAL SIGNS. </li></ul><ul><li>I/O </li></ul><ul><li>BREATH SOUNDS x TID. </li></ul><ul><li>BASELINE WT ACHIEVED. </li></ul><ul><li>HR >60 & <120/min </li></ul><ul><li>BP>90 & <160 systolic </li></ul><ul><li>Resting O 2 >90/on room air. </li></ul><ul><li>Effective cough & airway clearance. </li></ul><ul><li>Afebrile </li></ul><ul><li>Lungs clear. </li></ul><ul><li>Alert & Oriented. </li></ul>CRITICAL PATHWAYS FOR CARDIAC SURGERY POST OPRATIVE DAY FIVE
  24. 28. PRE-DISCHARGE INVESTIGATION <ul><li>PACING WIRE REMOVAL. </li></ul><ul><li>CXR & ECG </li></ul><ul><li>Endocrinology consult in diabetic patients </li></ul>
  25. 29. ACTIVITY <ul><li>Ambulate x QID. </li></ul><ul><li>Stairs ½ to 1 flight under the guidance of Physiotherapists. </li></ul>
  26. 30. MEDICATIONS <ul><li>Adequate pain control. </li></ul><ul><li>Laxative SOS </li></ul><ul><li>Dressing & crepe bandage. </li></ul><ul><li>Oral antibiotics. </li></ul><ul><li>Adjust electrolyte replacement Beta blockers and diuretics. </li></ul><ul><li>Prepare and check discharge summary. </li></ul>
  27. 31. EDUCATION <ul><li>Patient education, medication, diet, activity, physiotherapy and follow-up. </li></ul>
  28. 32. <ul><li>THANKS </li></ul>

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