My husband had CABG -HELP!

[Dori or Chris Green]

My husband had a mi (BIG anteriolateral) in 1-91. Had a cath on 7/24 and
5vessel /mitral valvuloplasty on 7/26. Nothing in my 25 years of critical
care nursing has prepared me for the "at home" part of this. He has so
musch pain! How do you differentiate anginal pain from normal post op
pain now that he is revascularized. How much neurological defecit is
normal (hallucinations, personality changes, etc)? He was on bypass for
about 160 minutes, and failed the first weaning. How long until he
atleast STARTS to feel like himself. Or how long until I stop feeling
numb and scared? Any help is greatly appreciated.

[Blackie Lawless]

On Tue, 06 Aug 1996 14:32:55 -0700, in sci.med.nursing you sed:

>My husband had a mi (BIG anteriolateral) in 1-91. Had a cath on 7/24 and
>5vessel /mitral valvuloplasty on 7/26. Nothing in my 25 years of critical
>care nursing has prepared me for the "at home" part of this. He has so
>musch pain! How do you differentiate anginal pain from normal post op
>pain now that he is revascularized.

That is the 24,000 dollar question. In the CVICU, we look at other
signs that there might be a problem. We happen to have the
convenience of monitoring equipment, but you as a nurse at home can
use your assessment skills to determine if there is a problem I must
assure you that stenosis of the bypass grafts 2 weeks after surgery is
rare. If it is an acute occlusion it usually happens within a day or
so of surgery. There are a few (very small number) of unfortunate
souls that occlude their grafts within the first year. To determine
if your husband is having iscemia do some of the following.

1. follow his BP, is is lower than usual indicating an impaired CO,
or is it higher than usual indicating stress.

2. be aware of how much he urinates. Is he urinating less than
usual, also indicating a possibly reduced CO, however this could also
be a fluid problem if his PO intake is less than adequate.

3. how do his lungs sound as compared to baseline? Are there rales?
If he is complaining of chest pain and also demonstrating signs of
failure, it is best to get it checked out. Going to the Dr. and
having an EKG done would be helpful.

>How much neurological defecit is
>normal (hallucinations, personality changes, etc)? He was on bypass for
>about 160 minutes, and failed the first weaning. How long until he

160 minutes is one hell of a long run. He is experiencing pump
psychosis, or as we call it in the business "pump head". I am not
sure of the exact physics involved, but in my experience in caring for
individuals with this syndrome, it can take several weeks to clear for
some people. Don't get alarmed at this point. Two weeks post op is
not much time when looking at this problem. I have seen patients act
off the wall for up to two months, especially if their post op coarse
was very complicated. Do not take it personally if your husband
lashes out at you. THe chances are that he won't remember much of it
once he regains his faculties.

Considering that he had a large MI, and a very long pump run, you ARE
very fortunate that he is well enough to be at home so soon. I have
seen patients with similar circumstances be in the ICU at least that
long.

>atleast STARTS to feel like himself. Or how long until I stop feeling
>numb and scared? Any help is greatly appreciated.

It is difficult to say. Think about all of the confused patients you
have cared for and the effects their confusion has had on thier
family. What have you done to eleviate *their anxiety? This may give
you some insight into what will work for you. I really don't know
what to tell you. It is difficult to care for someone so dependent.
Can make your feel powerless. The strength you have is that you ARE
an ICU nurse. Use your knowlege and skills to try to objectively
assess situations. One other thing that might be helpful is that most
hospitals that do heart surgery have a "Mended Hearts" group. These
groups are other patients who have had surgery. Most are more than
helpful in sharing their experiences and support. Check with your
local hospital and find out who the contact person is.