Cardiac surgery

Question 1

SURGICAL PROCEDURES

Answer 1

• coronary artery bypass
• valve repair/replacement
• aneurysm resection
• repair of septal defects
• antiarrythmic surgery (maze procedure)
• congenital repair
• cardiac transplantation

Question 2

CORONARY ARTERY BYPASS(CABG)

Answer 2

• coronary artery disease

Question 3

RISK FACTORS

Answer 3

NOT CHANGEABLE

• heredity
• race
• age
• sex

CHANGABLE

• high cholesterol
• high BP
• lack of exercise
• smoking
• stress
• obesity
• diabetes

Question 4

PEROPERATIVE CARE

Answer 4

1. The initial work up
2. The night before surgery
3. The morning of surgery

Question 5

THE INTITAL WORK UP

Answer 5

• cath, labs, echo, 12lead ekg, pft’s, T&C, chest x-ray,

Question 6

THE NIGHT BEFORE SURGERY

Answer 6

• shower
• npo after midnight
• pre-op teaching
• consents
• psychological support
• sleeping aid

Question 7

THE MORNING OF SURGERY

Answer 7

• pre op medications
• IV starts
• psychological support

Question 8

NURSING DIAGNOSES PRE-OP

Answer 8

1. knowledge deficit
   - ICU routine, OETT, ventilator, CT’s, pain control , monitors, Foley, incentitive spirometer, Early ambulation, ACE wraps, pacing wires
2. Fear/ Anxiety
   - the unknown, pain , will I wake up?
   - cardiac temponade

Question 9

THE PROCEDURE

Answer 9

Open thoracotomy

• coronary bypass
• saphenous vein (out of leg)

Use of heart and lung machine

• cannulate inferior/superior vena cava and aorta
• oxygenates the blood
• machine must be primed with 5-7L of fluid before used
• pt absorbs all of that fluid plus their own( swelling )

MIDCAB procedure

Question 10

COMPLICATIONS OF CABG

Answer 10

• low cardiac output
• acute MI
• dysrrythmias
• hemorrhage
• pulmonary embolus
• electrolyte imbalance
• cerebral infarction
• ARDS
• renal failure
• cardiac tamponade ( chest tube stops draining)

Question 11

NURSING DIAGNOSIS -ALTERED CARDIAC OUTPUT

Answer 11

-CARDIAC OUTPUT
amount of blood ejected from the heart in one minute (4-8L/min)

-STROKE VOLUME
amount of blood ejected from the ventricle with each contraction (60-130ml/beat)

Question 12

CARDIAC OUTPUT

Answer 12

HR X SV

Question 13

DRUGS EFFECTING CARDIAC OUTPUT : DOPAMINE

Answer 13

-low dose (1-5mcg/kg/min)
increases renal artery perfusion

-moderate dose(5-10mcg/kg/min)
increases CO by increasing HR and contractility

-high dose(>10 mcg/kg/min)
vasoconstriction (elevated BP)
20 is the max

Question 14

DRUGS EFFECTING CARDIAC OUTPUT: DOBUTAMINE

Answer 14

• increases contractility, therefore CO without increasing HR
• 2-20mcg /kg/min
• titrated to patient response

Question 15

VALVE REPLACEMENT

Answer 15

BIOLOGICAL

• human
• porcine
• bovine

MECHANICAL

• ball n cage
• leaflet

Question 16

INTRA-AORTIC BALLOON PUMP (IABP)

Answer 16

• counter pulsation device
• assist to refill the coronary arteries
• inflates when the ventricles are resting
• placed via femoral artery

Question 17

INDICATIONS FOR IABP

Answer 17

• LV failure- left HF
• mechanical dysfunction
• uncontrolled ventricular arrhythmias
• unstable angina
• septic / cardiogenic shock
• prophylactically

Question 18

NURSING DIAGNOSES POST-OP

Answer 18

impaired gas exchange 
impaired verbal communication 
pain
fluid volume excess/deficit
potential for infection
sleep pattern disturbance
sensory-perceptual alteration 
fear/anxiety

Question 19

TERTIARY PREVENTION -POSTOPERATIVE CARE

Answer 19

incisional/ wound care
progressive activity
diet modification
medication education
sternal healing
exercise
smoking cessation

Question 20

POST -OPERATIVE CARE

Answer 20

• no lifting,pulling,tugging (nothing >10 lbs)
• sternal precautions
• incisional healing
• medication education
• signs and symptoms to report to MD
• no driving for 6 months