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a behavioral or mental pattern that may cause suffering or a poor ability to function in life.US notforprofit organization dedicated to promoting a better understanding of health care information and management systems.The patient undergoing CABG surgery deserves to have confidence that the professional nurse is knowledgeable, caring, efficient, and effective in providing necessary perioperative care.Proper preparation of the patient and significant others, expertise during the intraoperative phase, and a thorough knowledge base combined with skill and compassion of the nursing staff during the postoperative phase increase the likelihood of a positive outcome for the patient.The Preoperative Phase.Preoperative preparation of patients and significant others is a well established protocol in most institutions.Research has shown that education of the patient prior to surgery assists with recovery, increases patient contentment, and decreases postoperative complications.Appropriate timing of preoperative preparation is helpful for the patients information retention.Because impending open heart surgery is anxiety provoking to most patients, it is imperative for the nurse to assess the patient for individual learning needs and provide the information in a timely manner to minimize as much anxiety as possible.It has been suggested that state anxiety levels are lower 5 to 1.CABG surgery, which makes this an ideal time for teaching.A high anxiety level is not conducive to retention of information.Benefits of preoperative teaching may be maximized when information is presented during the period when the patient has the lowest anxiety.Many patients are admitted on the day of surgery.Bringing them into the hospital for preadmission testing several days before surgery and completing the preoperative teaching during this time may be effective.Some patients want specific details about the perioperative experience, whereas others seem to need only the reassurance that a knowledgeable and compassionate caregiver will provide the needed perioperative care.The skilled professional nurse individualizes preoperative instruction to meet the specific needs of that patient.Information when conducting preoperative teaching with a patient scheduled for CABG surgery may include sights and sounds that will be experienced, invasive lines that will be inserted, anticipated sensations from preoperative medications, and anticipated length of the operation.During the preoperative teaching session, the nurse should also provide information related to postoperative expectations.Reassurance that pain will be managed during the postoperative period is important to communicate to the patient and significant other.Teaching about incision splinting and availability of effective pain medications should be emphasized.Patients should be informed that an endotracheal tube will probably be in place postoperatively, resulting in a temporary inability to speak.Assure the patient that a competent caregiver will be in close proximity during the immediate postoperative recovery period and will be able to anticipate and provide for needs.The patient should be assured that the endotracheal tube will be removed as soon as it is no longer needed.Pulmonary care is an important part of the postoperative care of the patient after CABG surgery.Preoperative practice with the equipment such as an incentive spirometer that will be used postoperatively is helpful.Teaching in the preoperative period assists the patient to comprehend the necessity of coughing effectively in spite of incisional pain to achieve positive outcomes postoperatively.Early mobilization is effective in improving postoperative pulmonary outcomes.Preoperative teaching might include information related to the potential for mobilization to a chair during the first evening postoperatively.The significant other may be anxious and this may intensify as hisher loved one is taken to surgery.Separation is inevitable, but communication with the significant other during the intraoperative period is helpful to minimize anxiety.There are often questions about the length of the operation, the condition of the patient, and when the anticipated reunion will be possible.Nursing interventions important for significant others include teaching them about the expected patient appearance.The patient may appear pale, cool, and edematous.The nurse should also discuss equipment that will be connected to the patient.This equipment will include the ventilator, chest tubes, nasogastric tube, invasive lines, and urinary catheter see Table 1.The Intraoperative Phase.The intraoperative events during cardiac surgery influence nursing care postoperatively.A typical scenario will be discussed to assist the nurse in understanding rationale for postoperative care.Prior to initiation of anesthesia, most cardiac surgery patients undergo the insertion of a large bore peripheral intravenous catheter, an arterial line, and a pulmonary artery catheter.These are needed so intravenous fluids can be administered and hemodynamics monitored during the operation and in the postoperative period.After the insertion of the invasive lines, anesthesia will be administered.It is important to provide anesthesia, analgesia, and amnesia with agents utilized during the operation.These effects may be accomplished with inhalation and intravenous agents.After anesthesia is induced the patient will be given a neuromuscular blocking agent, such as pancuronium or rocuronium, to facilitate endotracheal intubation and relax the skeletal muscles.Inhalation agents and intravenous narcotics are given to induce anesthesia.Examples of inhalation agents are desflurane and sevoflurane.Inhalation agents can be cardiodepressive, so providing the minimum dose for the therapeutic effect is desired. 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