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Cardiac Surgery

Nursing Management of the Patient Undergoing Cardiac Surgery

QuestionAnswer
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