cardiac surgery Flashcards
1
Q
surgical procedures
A
- Coronary artery bypass (CABG)
- valve repair/ replacement
- aneurysm resection
- repair of septal defects
- antiarrhythmic surgery
- congenital repair
- cardiac transpantation
2
Q
coronary artery bypass
A
- AKA CABG
- coronary artery disease
- atherosclerosis is the leading contributor
3
Q
modifiable risk factors
A
- high cholesterol
- high BP
- lack of exercise
- smoking
- stress
- obesity
- diabetes
4
Q
nonmodifiable risk factors
A
- heredity
- race
- age
- sex
5
Q
preop care (CABG)
A
-the initial work up: cath, labs, echo, 12 lead EKG, PFT’s,
T&C, chest X-ray, labs
-the night before surgery: shower, NPO after midnight,
pre-op teaching, consents, psychological support,
sleeping aid
-the morning of surgery: pre-op meds, IV starts, psychological support
6
Q
the procedure
A
- open thoracotomy: coronary bypass, saphenous vein
- use of heart-lung machine: cannulate inferior/superior vena cava and aorta, oxygenates the blood
- MIDCAB procedure- less invasive, a few small cuts instead of sternotomy
7
Q
compications of CABG
A
- low cardiac output
- acute MI
- dysrhthmias ( AFib- most common)
- hemorrhage
- pulmonary embolus
- electrolyte imbalance (K+,Mg+, Ca+)
- cerebral infarction
- ARDS
- renal failure
- cardiac tamponade
8
Q
Cardiac output
A
- amount of blood ejected from the heart in one minute
- 4-8L/min
- cardiac output= HR X SV
9
Q
stroke volume
A
amount of blood ejected from the ventricle with each contraction
– ml/beat
10
Q
dopamine
A
- effects CO
- low dose (1-5 mcg/kg/min): increases renal artery perfusion
- moderate dose (5-10 mcg/kg/min): Beta [increases CO by increased HR and contractility]
- high dose (>10mcg/kg/min): Alpha [vasoconstriction-elevated BP]
11
Q
dobutamine
A
- increases contractility, therefore CO without increasing HR
- 2-20 mcg/kg/min
- titrated to pt. response
12
Q
valve replacement
A
- biological: human, porcine, bovine
- Mechanical: ball-n-cage, leaflet, will be on anticoagulants for life
13
Q
intra-aortic balloon pump (IABP)
A
- counter-pulsation device
- assist to refill coronary arteries
- inflates when ventricles are resting
- placed via femoral artery
14
Q
indications for IABP
A
- LV failure
- mechanical dysfunction 2nd degree AMI
- uncontrolled ventricular arrhythmias
- unstable angina
- septic/cardiogenic shock
- prophylactically
15
Q
nursing diagnoses post op
A
- impaired gas exchange
- impaired verbal communication
- pain
- fluid volume excess/deficit
- potential for infection
- impaired mobility
- sleep pattern disturbance
- sensory-perceptual alteration
- fear/ anxeity
