الفهرس 
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Abstract
Coronary artery bypass graft surgery is the corner stone for the treatment of patient with CAD. Coronary artery bypass grafting has advantages not only of bypassing chronic occlusions and complex stenosis but also, of achieving complete revascularization. CABG surgery is a palliative not curative treatment for CAD and patients remain at risk for subsequent ischemic events as a result of native CHD progression and the development of vein graft atherosclerosis so it is of great importance that patients underwent CABG maintain their adherence to therapeutic regimen.
Adherence to therapeutic regimen post CABG has been defined as the extent to which a person’s behavior with respect to taking medications, following therapeutic diet, practice exercises, maintain wound care and periodic follow up corresponds with agreed recommendations from a health care provider. Patients with CABG who not comply with therapeutic regimen always readmitted to hospital with complications such as graft occlusion, bleeding, dysrhythmias, recurrent myocardial infarction, heart failure, stroke, sternum nonunion, drugs side effects and sudden cardiac arrest.
Nurse plays an important role in facilitating patient adherence to therapeutic regimen. As they are responsible for helping patients gain knowledge, skills and change attitude necessary to maintain compliance.
The aim of this study was:
To identify adherence to therapeutic regimen among patients undergoing coronary artery bypass graft surgery.
Research design:
Descriptive research design was utilized to meet the aim of the present study.
Setting:
The study was conducted at the Cardiothoracic Surgery Outpatient Clinic at Alexandria Main University Hospital.
Subjects:
Based on Epi Info program, a convenience sample of 70 adult patients from both sexes admitted to the above mentioned setting and underwent coronary artery bypass graft surgery were selected according to the following criteria:
• Age group from 21> 60 years old.
• Agree to participate in the study.
• Were within three months after CABG surgery.
• Able to communicate verbally.
Tools of the study:
In order to fulfill the aim of the study, two tools were used for data collection.
Tool I: Patients’ Socio-Demographic characteristics and Clinical Data Structured Interview Schedule.
This tool was developed by the researcher after reviewing of related literature. It was divided into two parts:
Part I: Patients’ socio-demographic characteristics including: age, gender, marital status, residence, educational level, occupation and monthly income.
Part II: patient clinical data as family history, past history, present history, and patient daily health related habits such as smoking.
Tool II: Adherence to Therapeutic Regimen among Patients Undergoing CABG Surgery Structured Interview Schedule.
This tool was developed by the researcher after a review of related literature to identify the patient’s adherence to therapeutic regimen. It divided into five parts which include: Adherence to therapeutic diet, prescribed medications, physical activity and exercise, wound self-care and follow up.
Data collection:
a convenience sample of 70 adult patients post CABG surgery who met the inclusion criteria were selected from the above mentioned setting, then each patient was interviewed individually once from 30 to 45 minutes by the researcher to collect the necessary data related to adherence to therapeutic regimen at the reception of Cardiothoracic Surgery Outpatient Clinic at Alexandria Main University Hospital.
Statistical analysis of the data:
After completion of data collection, statistical tests were carried out using SPSS, version 25 for both data presentation and statistical analysis of the result. The number and percentage used for describing and summarizing qualitative data. Mean and standard deviation used to present the quantitative data.
The main results of the study were as the following:
• The majority of the studied patients (81.45%) were in the age group (50>60) years.
• The majority of the studied patients (82.9 %) were male.
• More than three quarters of the studied patients (77.1%) were married.
• The majority of the studied patients (85.7%) were living in urban areas.
• More than half (57.1%) of the studied patients treated on the expense of the country, while (34.3%) of them treated by their health insurance.
• All of the studied patients (100%) had previous hospitalization that related to cardiac catheterization.
• More than half (58.6%) of the studied patients were taking over the counter medications.
• More than two thirds (68 %) of the studied patients had insufficient monthly income to fulfill the daily requirements from patients point of view.
• More than half of the studied patient (62.9%) had the disease from 1year to less than 5 years.
• All of the studied patients (100%) were complaining of chest pain, majority of them were complaining of dyspnea, while only 2.9% were complaining of diaphoresis.
• More than three quarters of the studied patients (76.8%) had history of hypertension and more than half of them (58.9%) had history of diabetes mellitus.
• More than one third (41.4%) of the studied patients were smokers, while (25.7%) of them were quitter.
• All of the studied patients (100%) were receiving health education about therapeutic regimen from physician.
• Half of the studied patients (50%) were highly adherent to therapeutic diet.
Nearly two thirds of the studied patients (64.3%) were highly adherent to prescribed medications.
• More than half of the studied patients (57.1%) were highly adherent to follow up.
• The majority of the studied patients (82.9%) had low adherence to perform physical activity and exercise.
• Less than two third of studied patients (62.9%) had low adherence to wound self-care.
• One fifth (21.4%) of the studied patients were highly adherent to therapeutic regimen, while less than half of the studied patients (48.6) had low adherence to therapeutic regimen.
• There was highly statistical significant relationship between patient’s gender, marital status, educational level, occupation, income and overall adherence to therapeutic regimen.
The main recommendations based on the findings of the present study were as the follow:
o Develop health teaching program to improve CABG surgery patients’ knowledge regarding the therapeutic regimen.
o Prepare colored illustrated booklet, should be available and distributed to each patient undergoing CABG surgery toward the therapeutic regimen.
o Prepare illustrated manual for nurses as a guideline for recent and updates in therapeutic regimen for patients undergoing CABG surgery, it should be available in the cardiothoracic surgery outpatient clinics.
o Conduct regular scientific meetings for health care providers (physicians and nurses) who provide direct care for CABG surgery patients to discuss patients’ problems and barriers of adherence to the therapeutic regimen.
o Study factors that affecting patients’ adherence to CABG surgery therapeutic regimen.
o Study the impact of CABG surgery health teaching program on the patient’s adherence to the therapeutic regimen