Jordan Nursing Council Abd Alhadi Ibrahim Hasan

1. Jordan Nursing Council Abd Alhadi Ibrahim Hasan Rehabilitation program post coronary bypass graft (CABG) surgery -Review of related literature- Abd Alhadi Hasan RN , MSN

2. Outline: • Introduction. • Significant of review. • Finding. • Conclusion. • Recommendation

3. Introduction: Coronary artery bypass graft surgery is a surgical procedure in which one or more Blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. The internal mammary arteries, radial arteries or reversed segments of the patients own saphenous vein can be used to bypass coronary artery stenoses (Milto, 2007).

4. Background: heart disease and coronary artery bypass surgery affect the life of patients and their significant others. Following surgery, some patients may feel their quality of life is poor significant others are a major source of Support for patients;therefore,it is important to know how will improve quality of life post surgery.

5. In Jordan, the number of coronary artery graft surgeries has been increased dramatically. In 1990, the number of CABG surgeries in Queen Alia Heart Institute (QAHI), a pioneer military center in the region in performing CABG surgeries, was 306 • surgeries (JAF, RMS.199). However, in 2006 the number of the CABG surgeries performed was 1306 surgeries (JAF, RMS.2006) and Prince Rashid Military Hospital also performed CABG surgeries in recent years as well

6. Johanston (2002) define cardiac rehabilitation is "the coordinated sum of interventions required to ensure the best physical, psychological and social conditions so that patients with chronic or post-acute cardiovascular disease may by their own efforts, preserve or resume optimal functioning in society and, through improve health behaviors, slow or reverse progression of disease.”

7. Purpose To identify the factors that used in previous interventional studies to design cardiac rehabilitation program for the purpose of improving patients recovery at the period of post CABG surgery.

8. Findings: the reviewing of related studies have revealed major factor of rehabilitation program post CABG surgery is diet , physical activity , emotional support and smoking cessation.

9. Diet Diet is the amount of cholesterol, triglycerides in the food. The benefit of diet regimen post CABG surgery to reduce LDL, increase HDL,reduce TG and decrease Cholesterol. Kuduvalli (2007) reported adhere patient to diet management is less risky for complication from non-adhere patient ( reduce dyslipidemia and reduce revascularization).

10. American Heart Association (AHA) guidelines for CABG surgery recommend lipid-lowering therapy plus a low-fat diet for all post-CABG patients. AHA recommends that all post-CABG patients attempt to maintain a body weight that is appropriate for their height and age (AHA,2007).

11. Exercise The exercise or structured physical activity was started in phase II which emphasized about the following: progressive ambulation to minimize fatigue, exercise to reduce edema, improve, lung function and prevent stiffness in joints. While phase III, walking was advised to improve the aerobic capacity, beside to the exercise energy conservation methods were also taught to the patients during their ambulation particularly climbing stairs.

12. American Heart Association (AHA) Guidelines for CABG patient at least three session per week , every session 20-30 minute.

13. Emotional and psychosocial aspect • Social support came from several sources, hospital and rehabilitation staff, peers at the rehabilitation classes and from family and close friends and was experienced whilst in the hospital and long after discharge. Patients felt the proactive support from staff invaluable, particularly the follow-up phone calls during the first few weeks post discharge. These made patients feel that they were still important and being looked after by the hospital; they had not been abandoned (Dunckley,2006).Depression and anxiety have been associated as risk factors for atherosclerotic heart disease and may affect post-CABG outcomes (Pignay,2008).

14. Comparatively with patients who are not depressed, depressed patients are not significantly tending to adhere to prescribed medications, follow life style recommendation (e.g smoking cessation, exercise), practice self management (e.g. adjust diuretic dose in heart failure), and even follow up, or receive recommended cardiac testing (sunamm, 2007). Early intervention in the form of anti depress and therapy, psychotherapy or psychosocial management has been associated with a reduction in hospital length of stay, analgesic use, and post operative morbidity (ranuman,2006).

15. Smoking cessation Patients who continue to smoke following CABG surgery have an increased risk of premature graft closure, post operative myocardial ischemia and infraction, repeat hospitalization and death compared to patients who stop smoking. It has been estimated that 25 to 50% of smokers undergoing CABG will stop smoking o their own without the aid of a formal cessation intervention.Unfortunately, 50 to 75% of smokers undergoing CABG will resume smoking after their surgery

16. According to AHA guidelines, smoking cessation is the single most important risk modification goal. • Nicotine transdermal patches a lone or in combination with nicotine gum have been used successfully to achieve smoking cessation. The antidepressant bupropion has also been found to be an effective smoking cessation therapy (AHA,2007).

17. Conclusion: designing cardiac rehabilitation program will focus major factors diet , physical activity , emotional support and smoking cessation to improve quality of life.the related literature has identified factors of cardiac rehabilitation program post CABG surgery , nurse should play a vital role in improving quality of life post surgery through providing information and follow up. As nurse future

18. Recommendations: • Frequent- educational and training course for nurses specially critical care nurses about the cardiac rehabilitation program. • Try to establish aa specialized cardiac rehabilitation unit , and depend on this literature review paper as abase for that. • Depending on the up to date researches , try to conduct the results of these researches to the jordan hospital administration, medical and nursing administration and discuss with them the importance of this program to the patients future and hospital itself by maintain the health condition and decrease the number of readmission , which lead to decrease the cost for patient care.

19. Try to use different ways for offering the informations such as pamphlet, audiovisual materials ,..., to reach what we want to reach for cardiac patients in different way's. • Try to use different ways for offering the informations such as pamphlet, audiovisual materials ,..., to reach what we want to reach for cardiac patients in different way's