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Cardiac Surgery
Nursing Management of the Patient Undergoing Cardiac Surgery
| Question | Answer |
|---|---|
| At what volume of chest tube drainage post-CABG should you call the Dr.? | Mediastinal chest tube drainage greater than 150 cc/hr. |
| S/S of Cardiac Tamponade | Elevated and equilized filling pressures (CVP &PCWP) Decreased CO Decreased BP JVD Pulsus Paradoxus Muffled Heart Sounds Sudden Cessation of CT drainage Wide cardia silhouette on XRay (BEX TRIAD) |
| Intervention for Cardiac Tamponade. | Sternotomy Return to OR for clot evacuation |
| Effects of HYPOthermia on body systems? | DECREASED myocardial contractility INCREASED bleeding risk Hypertension (Increased SVRI) |
| Target time for extubation post CABG? | 4-8 hours post op |
| What drug is given at the end of CABG surgery to reverse neuromuscular blockade? | Neostigmine |
| What anesthesia is used at the termination of surgery? | Not narcotics!!! Short acting anesthetic agents like PROPOFOL (DIPRIVAN) |
| Drug used to treat sleep deprivation post CABG? | Benzodiazepines |
| What temperature post-CABG should be investigated? | 38.3C/101F |
| Drug used to maintain UOP? | Lasix - maintain 30cc/hr and if urine is pink-tinged. |
| Purpose of CABG? | Revascularize the myocardium Repair or replacement of anatomical pathologies |
| Viable blood vessels for CABG? | Saphenous vein grafts Internal mammary artery Radial artery Gastric artery |
| What is CPB? | Cardiopulmonary Bypass Mechanical means of oxygenating and circulating blood during CABG surgery. |
| How does CPB work? | Cannula in SVC or RA removes unoxygenated blood and takes it to the machine. Machine oxygenates the blood and then returns it through another cannula in the aorta. |
| What factors lead to decreased CO in CABG? | Hypothermia Preexisting cardiac pathology Increased SVRI |
| Methods of maintaining HR post-op CABG? | Temporary pacing with epicardial wires Beta blockers or Ca channel blockers to slow HR Keep K+ in high normal range (4.0ish) Monitor serum Mg+ |
| Methods of maintaining Preload post-op CABG? | Volume - Crystalloid, colloid, and RBC - Autotransfuse Keep PCWP slightly higher to ensure adequate filling pressures Avoid A. Fib and flutter (~20% decrease in CO) |
| Methods of maintaining Afterload post-op CABG? | Temperature: hypothermia leads to vasoconstriction. HTN can lead to bleeding from mediastinal chest tubes High SVRI leads to increase myocardial workload Use Nipride or fenoldopan to keep SBP b/t 100-130 to decrease SVRI and increase CO. |
| Antidote for heparin? | Protamine Sulfate |
| Neuroconcerns with CABG? | Permanent Neuro deficits post-op secondary to ministrokes from air bubbles and small clots. |
| Types of Cardiac Surgeries? | Coronary Artery Bypass Grafting(CABG) Minimally Invasive CABG Transmyocardial Revascularization Valvular Repairs Septal Defect Repairs Ventricular Aneurysm Radiofrequency Ablation |
| Three parts of the cardiovascular system? | 1)Pipes - arteries and veins 2)Pump - Heart 3)Fluid - Blood |
| When should the post cardiac patient ambulate? | As soon as possible |
| Purpose of Cardiac Surgery? | Revascularize the myocardium Repair or replacement of anatomical pathologies |
| Revascularization of what veins or arteries? | Saphenous vein grafts, internal mammary artery, radial artery, gastric artery |
| What type of heart valves are used? | Mechanical and tissue valves (porcine) |
| What is a Minimally Invasive Cardiac Surgery? | Visualization and repair through a scope. |
| What is Cardiopulmonary Bypass (CPB)? | Mechanical means of oxygenating and circulating blood during surgery. A cannula is put in the superior vena cava to remove blood from the body to the Cardiopulmonary Bypass machine for oxygenation. |
| What is Cardiopulmonary Bypass (CPB)2? | Blood is returned through a cannula in the aorta. Cardioplegia (cold, K rich fluid) is used. |
| What causes Fluid Volume Deficit (FVD) and Hypotension with CPB? | Third spacing, diuresis and vasodilators |
| What causes third spacing with CPB? | Decreaseds plasma proteins and increased capillary permeability |
| What causes decreased Cardiac output (myocardial depression)with CPB? | Hypothermia, Preexisting cardiac pathology, Increased SVRI (afterload) |
| What causes Hemolysis with CPB? | Pump Damage |
| What causes Hyperglycemia with CPB? | Decreased in insulin release and glycogenolysis |
| What causes Bleeding (coagulopathy) with CPB? | Heparin, Platelet trauma, hypothermic liver |
| What causes hypokalemia and hyperkalemia with CPB? | Intracellular shifts/cell damage |
| What causes decreased LOC, sensory deficit with CPB? | Microemboli to brain and decreased cerebral tissue perfusion. |
| What causes Hypertension with CPB? | Hypothermia and Catecholamine release |
| What causes a stroke with CPB? | Anticoagulated but small clot formations |
| Preoperative Care of the Cardiac patient: | Teaching, ICU environment, postoperative care |
| Postoperative Care of the Cardiac Patient: | First 15 minutes: Assessment, Vital signs, |
| What causes Hemolysis with CPB? | Pump Damage |
| What causes Hyperglycemia with CPB? | Decreased in insulin release and glycogenolysis |
| What causes Bleeding (coagulopathy) with CPB? | Heparin, Platelet trauma, hypothermic liver |
| What causes hypokalemia and hyperkalemia with CPB? | Intracellular shifts/cell damage |
| What causes decreased LOC, sensory deficit with CPB? | Microemboli to brain and decreased cerebral tissue perfusion. |
| What causes Hypertension with CPB? | Hypothermia and Catecholamine release |
| What causes a stroke with CPB? | Anticoagulated but small clot formations |
| Preoperative Care of the Cardiac patient: | Teaching, ICU environment, postoperative care |
| Postoperative Care of the Cardiac Patient: | First 15 minutes: Assessment, Vital signs, |
| Effects on the body from cardiac surgery. 1. FVD (hypotension) | causes: thrid spacing (edema, weight gain), diuresis, vasodilators (from drugs, from rewarming) |
| effects on body from cardiac surgery 2. Third spacing (edema, weight gain) | decreased plasma proteins increase capillary permeability |
| effects on the body from cardiac surgery. 3. decreased CO (myocardial depression) | hypothermia, preexisting cardiac pathology, increased SVRI |
| effects on the body from cardiac sugery. 4. hemolysis | pump damage - RBC damage |
| effects on body from card. surg. 5. hyperglycemia | decrease insulin release, glycogenolysis stimulation |
| effects on body from cardiac surgery 6. bleeding (coagulopathy) | systemic herparin, platelet trauma (mechanical), hypothermic liver which leads to decrease in clotting factors |
| effects on body from cardiac surgery 7. hypokalemia | intracellular shift/cell damage |
| effects on body from cardiac surgery 8. decreased LOC, sensory deficit | microemboli to brain from air, plaque fragments decreased cerebral tissue perfusion |
| 9. hypertension | causes: hypothermia causing vasoconstriction, and catechomine relase |
| Effects on the body from cardiac surgery. 1. FVD (hypotension) | causes: thrid spacing (edema, weight gain), diuresis, vasodilators (from drugs, from rewarming) |
| effects on body from cardiac surgery 2. Third spacing (edema, weight gain) | decreased plasma proteins increase capillary permeability |
| effects on the body from cardiac surgery. 3. decreased CO (myocardial depression) | hypothermia, preexisting cardiac pathology, increased SVRI |
| effects on the body from cardiac sugery. 4. hemolysis | pump damage - RBC damage |
| effects on body from card. surg. 5. hyperglycemia | decrease insulin release, glycogenolysis stimulation |
| effects on body from cardiac surgery 6. bleeding (coagulopathy) | systemic herparin, platelet trauma (mechanical), hypothermic liver which leads to decrease in clotting factors |
| effects on body from cardiac surgery 7. hypokalemia | intracellular shift/cell damage |
| effects on body from cardiac surgery 8. decreased LOC, sensory deficit | microemboli to brain from air, plaque fragments decreased cerebral tissue perfusion |
| 9. hypertension | causes: hypothermia causing vasoconstriction, and catechomine relase |
| Effects on the body from cardiac surgery. 1. FVD (hypotension) | causes: thrid spacing (edema, weight gain), diuresis, vasodilators (from drugs, from rewarming) |
| effects on body from cardiac surgery 2. Third spacing (edema, weight gain) | decreased plasma proteins increase capillary permeability |
| effects on the body from cardiac surgery. 3. decreased CO (myocardial depression) | hypothermia, preexisting cardiac pathology, increased SVRI |
| effects on the body from cardiac sugery. 4. hemolysis | pump damage - RBC damage |
| effects on body from card. surg. 5. hyperglycemia | decrease insulin release, glycogenolysis stimulation |
| effects on body from cardiac surgery 6. bleeding (coagulopathy) | systemic herparin, platelet trauma (mechanical), hypothermic liver which leads to decrease in clotting factors |
| effects on body from cardiac surgery 7. hypokalemia | intracellular shift/cell damage |
| effects on body from cardiac surgery 8. decreased LOC, sensory deficit | microemboli to brain from air, plaque fragments decreased cerebral tissue perfusion |
| 9. hypertension | causes: hypothermia causing vasoconstriction, and catechomine relase |
| Postop Care from cardiac surgery | 15 minutes= assessment, VS, CVP, PA pressure, Rhythm, Incision, Dressing, CT drainage, peripheral pulses, UOP, Heart sounds, Lung sounds, Neuro (LOC, movement, strength, follow commands) |
| Post op care complete cardiac profile | CO, CI, SVRI, LVSWI every 8hours |
| what to report after cardiac surgery | drop in CO or down ward trend, hypo or hypertension, cessation of ct drainage, excess ct drainage, onset of ST segment and T wave changes Muffling heart sounds, decrease in UOP |
| How to maintain CO | By HR, Preload, afterload, and contractility |
| Maintaining CO by HR | temporary pacing - epicardial pacing wires if < 80 in adults, beta blockers or calcium channel blockers to slow rate under 110,monitor serum K- keep in high normal range to prevent venticular ectopy, monitor serum Mg to decrease incidence of dysrythmia |
Created by:
keelerd
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