RSPT 2266-2267 Practicum
RSPT 2266-2267 Patient Sticker
CABG CASE STUDY
Student ____________________________________________ Date ___________________________
A. Describe a Coronary Artery By-Pass Graft (CABG) procedure. (Use back of page if necessary.)
B. Demographic Data
Age: Ht: Wt: Sex:
Occupation: Admission date:
Other:
C. Health History
1. What symptoms prompted this patient to seek medical attention?
2. History of present illness:
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RSPT 2266-2267
CABG CASE STUDY
3. Past medical history:
4. Family history:
D. Diagnostic Imaging
Date/Procedure Interpretation
E. ECG
Date/Time Interpretation
F. Pulmonary Function Studies
Normal Patient
Date/Test Values Result Interpretation
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RSPT 2266-2267
CABG CASE STUDY
G. Patient Assessment (post-op)
1. Breathing pattern:
2. Sensorium: Glascow Coma Scale
Eyes Opening (E) Verbal Response (V) Motor Response (M)
1 None None None
2 To pain Incomprehensible sounds Decerebrate posturing
3 To voice Utters inappropriate words Decorticate posturing
4 Spontaneous Confused, disorientated Withdraws to pain
5 Normal Localizes to pain
6 Normal
Total Glascow Coma Score (GCS) = E + V + M
Immediate
Post-op Hourly Post-op
GCS
3. Chest examination:
a. Auscultation:
1 Clear
2 Diminished
3 Absent
4 Wheezes
5 Rhonchi
6 Rales
7 Pleural rub
b. Size and shape of chest:
c. Excursion:
d. ETT size, route, depth:
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CABG CASE STUDY
4. Physical observations:
Respiratory Peripheral Cough Sputum Sputum Sputum
Distress Cyanosis Edema Quality Amount Consistency Color Clubbing
None None None Clear None Thin Clear None
Mild Nail beds +1 Tight Small Thick White Mild
Mod. Fingers +2 Loose Mod. Viscid Yellow Mod.
Severe Lips +3 Croupy Large Frothy Green Severe
Tongue Harsh Brown
Toes Pink
Severe Bloody
5. Vital Signs:
Normal
Value Hourly Post-op
Date/Time
HR
RR
BP
Temp
SpO2
FiO2
Input
Output
CVP
PAP
PCWP
6. Other observations:
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CABG CASE STUDY
H. Ventilator Checks
First
Post-op Hourly Post-op
Date/Time
FiO2
Mode
RR set
RR spont
RR total
VT set
VT mand
VT spont
IT
I:E
PEEP
PS
PIP
PPLAT
CDYN
Cs
PETCO2
I. Arterial Blood Gas Analysis
Baseline Post-op
Date/Time
pH
PaCO2
HCO3-
PaO2
SaO2
FiO2
Vent Settings
Interpretation
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RSPT 2266-2267
CABG CASE STUDY
J. Laboratory Studies
Normal
Value Admission Post-op
Date/Time
Hb
Hct
Na
Cl
Ca
WBC
Total protein
Albumin
Glucose
BUN
Creatinine
Bilirubin
Treponin
Creatine
Phosphokinase
(CPK, CK)
K. Other
Normal
Values Admission Post-op
Date/Time
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CABG CASE STUDY
L. Pharmacology
1. List all drugs the patient has received. Describe the action, dosage and frequency of each drug. Also identify
possible cardiopulmonary side-effects of each drug.
Dosage/
Drug Route Freq Action Cardiopulmonary Side-Effects
M. Assessment
1. From your analysis of the subjective/objective information obtained, list all of the data that supports the need for
CABG surgery in this patient. Be specific and complete.
N. Post-Op Evaluation
1. Complete the following diagram of this patients grafts.
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CABG CASE STUDY
2. Describe other procedures that, in some patients, may be an alternative to a CABG operation.
3. What is the purpose for deliberate hypothermia during the operative CABG procedure?
4. How does hypothermia affect the oxyhemoglobin dissociation curve? Include in your discussion, the effects on
hemoglobin affinity for oxygen, PaO2 and tissue oxygenation.
5. How is your patient being warmed in ICU?
6. Does your patient have a chest tube? Describe its purpose and location.
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CABG CASE STUDY
7. How soon will this patient most likely be weaned from mechanical ventilator support?
8. What weaning parameters must be met before the ventilator is discontinued? Be specific (parameters and
normal values).
9. List potential complications that may arise from the CAB operation and the mechanical ventilation. What
respiratory care would be required to prevent/treat each potential complication? Include goals for each
respiratory care procedure described.
10. When will this patient be ambulated?
11. Describe the modifications this patient will need to make in his lifestyle (diet, exercise, stress levels, etc.) to
remain healthy.
