every two hours. A blood pressure reading must be taken immediately before and 5
minutes after the patient is raised. If the blood pressure drops after the patient is raised,
the head of the bed and the patient must be returned to horizontal for at least 30
minutes before the procedure is repeated. The coronary artery patient is usually kept in
dorsal recumbent position for 48 hours before any attempt is made to change his
position because, up to that time, turning the patient as little as 15 degrees to one side
may cause a serious drop in blood pressure. When turning is permitted, the coronary
artery patient should be turned from back to right side (and vice versa) every 2 hours.
e. Pain. Ribs that were retracted during surgery are the major sources of
postoperative pain in the CV surgical patient. During the first 24 to 48 hours, Demerol is
given on a schedule and in a quantity sufficient to keep him reasonably comfortable but
not enough to depress his mental outlook and cough reflex. After this initial period,
other causes for continued restlessness--such as oxygen deprivation, fear, and
positional discomfort--should be looked for and corrected.
f. Cough. After stabilization, CV surgical patients should be encouraged to
raise deeply lodged secretions by coughing with support in the same manner as other
surgical patients. Such coughing is usually effective, but if it is not, endotracheal
suctioning must be employed. Sometimes a mucolytic agent applied in aerosol form
may be helpful.
g. Underwater Seal Drainage. Nursing care with regard to CV patients with
underwater seal drainage is generally the same as that for other chest patients with
such drainage equipment in place. Drainage of about 400 to 500 ml of bloody fluid is to
be expected from heart surgery patients during the first 24 hours. Absence of drainage
fluid in the water seal setup indicates that fluid may be accumulating in the thorax.
Thus, drainage volume must be carefully observed and recorded.
h. Gastric Suction. Temporary gastric distention is a common occurrence in
CV surgical patients. The stomach is intubated and suction applied to reduce distention
and relieve any pressure exerted on the heart by the distended stomach.
i. Diet. With permission of the physician, fluids may be given as soon as the
patient can tolerate them. The first fluids given should be lukewarm and should not be
fruit juices, as they may cause nausea. Cardiovascular surgical patients are normally
markedly thirsty, and they will drink large quantities of fluids. If fluid is retained, intake
may have to be restricted. Nursing personnel must diligently monitor and record fluid
intake and output. Also, it may be necessary to weigh the patient daily. The physician
probably will permit returning the patient to a soft or normal diet as soon as the patient
desires solid food. Solid food should be withheld from the coronary artery surgery
patient until abdominal cramps and gas no longer persist.
j. Exercise. The patient, upon regaining consciousness, is encouraged to
breathe deeply through the nose deliberately and quietly to ventilate and expand the
lungs. Care must be taken not to tire the patient. Other voluntary body movement and