Date of Degree

5-1996

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Program

Nursing

Advisor

Katherine Gallia

Advisor

Brenda Jackson

Advisor

Barbara Herlihy

Abstract

Postoperative pulmonary complications and management are recognized as major problems following coronary artery bypass graft and valve repair surgery. Pulmonary complications include hypoxemia, reduction in air volume capacity, atelectasis, fever, tachycardia, tachypnea, and pneumonia. However, little is known about specific therapeutic interventions in nursing related to the amelioration of postoperative pulmonary complications in cardiac surgical patients. The study evaluated the outcomes of preoperative teaching of target volume breathing exercises in the prevention of hypoxemia and reduction of lung volume capacity for coronary artery bypass graft (CABG) and valve repair patients. Thirty-four patients aged 50-77 years undergoing CABG or valve repair surgery were randomly assigned to two types of preoperative teaching. A 2x2 factor, parallel group design was used in this intervention study. Arterial oxygen saturation and pulmonary function tests of forced vital capacity, forced expiratory volume in one second, and forced expiratory flow were measured preoperatively, 24 hours postextubation, and at the fifth postoperative day. A pulse oximeter was used to measure oxygen saturation. The Collins incentive spirometer and the Respirodyne were utilized for the pulmonary function tests. Inferential statistics of t test and analysis of variance were used to analyze the data. Postoperatively, the experimental subjects attempted to reach 80% of their preoperative forced vital capacity on the incentive spirometer. Preoperative teaching of target volume breathing exercises resulted in statistically significant differences in percentages of oxygen saturation and forced vital capacity 24 hours postextubation for the experimental group. No significant differences were found between groups for the second and the fifth postoperative day in forced expiratory volume in one second and forced expiratory flow. The data analysis also demonstrated significant reductions in all pulmonary function tests for those patients having an internal mammary graft versus a saphenous graft. In conclusion, preoperative teaching of target volume breathing exercises may cautiously be said to provide a goal for a prescriptive therapeutic nursing intervention in the reduction of postoperative pulmonary complications in the cardiac surgical client at least during the critical 24 hours postsurgery. Further research is recommended with larger samples to validate the efficacy of target volume breathing exercises in defying the risk factors associated with postoperative pulmonary complications in CABG and valve repair patients.

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