Professional Documents
Culture Documents
I. PREOPERATIVE PATHWAY
Medications o Beta-blocker
o Statins
o ASA
o Clopidogrel
Diet/ o As Prescribed
Nutrition
Activity o Activity as tolerated /as ordered pre- operatively
C . HOSPITAL ADMISSION
Location Admission
Consults o Surgery Pre-Op Conference
Tests o Additional/ Repeat Diagnostics as required
Assessment o Mediastinitis Risk
o Mortality Risk
o CVS risk
o Suitability for Bypass/ Maximal Medical Management
o Number of Bypassable Vessels
o Pre-Op IABP
o Concomitant Valve Surgery/CEA
o Urgency of Surgery
Education
Discharge o Discharge Plans if Inoperable
Planning
Diet/ o NPO
Nutrition
Activity o Ambulatory bedrest
Education o Surgical consent signed and witnessed
o Reinforce pre-operative teaching
o Initiate Patient Plan
o Family Operative updates prn by surgeon/ attending
cardiologist
PATIENT/HOME CARE PROVIDER VERBALIZE
UNDERSTANDING OF POST PROCEDURE CARE PLAN
Discharge o ICU and Respiratory Therapist notified of pending patient
Planning transfer from OR
ADDITIONAL DISCHARGE PLANNING NEEDS IDENTIFIED
Diet/ o NPO
Nutrition o Oral/gastric tube to low suction
A. EXTUBATION
Level of EXTUBATION
Care
Location ICU Ward
Consults Remove from VSI list
B. POSTOPERATIVE DAY 1
Consults
Tests o Chest X-ray , ECG in a.m. X 1
o Diabetics: Blood glucose check 30 min before meals and
H.S.
o Warfarin patients: Prothrombin Time q. a.m.
Medications o Enteric coated ASA 325mg P.O. q. day for patients not
receiving Coumadin
o Mefenamic Acid q 6 hrs P.O. q. 6 hrs PRN (with food)
o Colace 250mg P.O. BID
o MOM 30cc P.O. PRN constipation
o Restoril 15mg P.O. PRN sleep -may
o repeat X 1
o Beta Blocker:
o Kdur:
o Lasix
C. POSTOPERATIVE DAY2
Medications
Diet/Nutrition
Activity
Education
Discharge o
Planning
HEMODYNAMICALLY STABLE
NO DYSRRYTHMIAS
AFEBRILE
+ BOWEL MOVEMENT
ADEQUATE COMFORT LEVEL WITH ORAL ANALGESIA
ADEQUATE ANTICOAGULATION FOR VALVE PATIENTS
WOUND CLEAN, DRY , INTACT
Medications o Enteric coated ASA 325mg P.O. q. day for patients not
receiving Warfarin
o Analgesics P.O. q. 4hr PRN pain (with food)
o Colace 250mg P.O. BID
o MOM 30cc P.O. prn constipation
o Restoril 15mg P.O. PRN sleep
o Beta Blocker:
o K dur:
o Lasix:
o NO MEDICATION ADJUSTMENTS REQUIRED
o TAKING MEDICATIONS
o APPROPRIATE FOR OUTPATIENT SETTING
Treatments o Suture/staple
removal if required
Angiotensin-
converting enzyme
inhibitor in patients
with congestive heart
failure, left
ventricular
dysfunction (ejection
fraction below 40%),
hypertension, or
diabetes mellitus