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GNURS725- Cardio/Thoracic > Cardiac Surgical Patient > Flashcards

Cardiac Surgical Patient Flashcards

1
Q

Why is there perioperative risks?

A
  • Major hemodynamic stress
  • Changes in cholinergic activity
  • Changes in catecholamine activity
  • Body temperature fluctuations
  • Fluid shifts
  • Pain
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2
Q

Risks of anesthesia?

A
  • Decrease systemic vascular resistance

- Decrease Stroke Volume

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3
Q

What does induction of general anesthesia do to your systemic arterial pressure?

A
  • Lowers by 20-30 %

- Anesthetic agents lower cardiac output by 15%

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4
Q

What does tracheal intubation to do your blood pressure?

A

-Increases by 20-30mmHg

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5
Q

Many anesthetic lower CO by what percent?

A

10-15%

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6
Q

In addition to identifying the presence of pre-existing manifested heart disease it is essential to define disease _________, _________, and _______ _________.

A

Severity, stability, and prior therapy

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7
Q

What is the main factor that can help you determine cardiac risk?

A

Functional Capacity

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8
Q

What type of surgical procedures are considered higher risk?

A

Vascular procedures and prolonged, complicated thoracic, abdomen, and head and neck procedures

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9
Q

The presence of _______ maybe also place a patient at a higher perioperative risk

A

Anemia

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10
Q

In addition to CAD and CHF, a history of what co-morbidities increases perioperative cardiac morbidity?

A

Cerebrovascular Disease, preop elevated creatinine greater than 2mg per deciliter, insulin treatment for DM, and high risk surgery

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11
Q

What are the 4 cornerstones of preoperative cardiac evaluation?

A
  • review of history
  • physical examination
  • diagnostic tests
  • knowledge of the planned surgical procedure
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12
Q

Evaluation of Cardiac Risk

A

See Slide 13

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13
Q

What is included in evaluation of cardiac risk- valvular heart disease

A
  • Dyspnea, Orthopnea, PND
  • Embolic Events
  • Hemoptysis
  • Heart Failure, Palpitations
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14
Q

What would you look for in the general appearance of the physical exam that would be concerning?

A

Cyanosis, pallor, dyspnea during conversation or minimal activity, nutritional status, obesity, skeletal deformities, tremor and anxiousness

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15
Q

What is included in a detailed cardiac exam?

A
  • JVD, Pedal edema
  • Capillary Refill
  • Displaced apical impulse (cardiomegaly)
  • S3 Gallop (increased LVEDP)
  • S4 (decreases compliance)
  • Presence of murmurs
  • Pulmonary Edema
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16
Q

What is a MET or metabolic equivalent defined as?

A

The ratio of a person’s working metabolic rate relative to the resting metabolic rate

17
Q

T/F: one MET represents the oxygen consumption of a resting adult (3.5ml/kg/min)

A

True

18
Q

If patients reduce exertion because of cardiac symptoms but still meet a 4-MET threshold clinicians will under or over estimate risk?

A

Underestimate

19
Q

Non cardiac functional limitations (ex: knee or back pain) may falsely over or under estimate cardiac risk?

A

Overestimate

20
Q

What range is considered poor, moderate and good for METS.

A

Poor <4 METS
Moderate 4-7 METS
Good >7-10 METS

21
Q

Measurements on a treadmill inducing ischemia at low-level exercise (<5 MET) or heart rate <100/min identifies what

A

A high risk group

22
Q

The achievement of more than 7 MET (or heart rate >130/min) without ischemia identifies what?

A

A low-risk group

23
Q

The presence of abnormalities on ECG such as Q waves and non sinus rhythms have been shown to correlate with that?

A

Adverse Postoperative Cardiac Events

24
Q

What can alter an ECG tracing?

A
  • Metabolic
  • Electrolyte Disturbances
  • Medications
  • intracranial disease
  • Pulmonary disease
25
Q

What is considered the gold standard for risk indices?

A

ACC/AHA

26
Q

What are considered major disease processes?

A
  • Unstable coronary Syndromes
  • Decompensated Heart Failure
  • Significatn Arrhythmias
  • Severe Valvular Disease
  • see slide 26
27
Q

What are considered intermediate disease processes?

A
  • Mild angina
  • History of MI, pathologic Q’s
  • Compensated our prior CHF
  • Diabetes Mellitus
  • Renal Insufficiency(CKD)
28
Q

What disease processes are considered minor?

A
  • Advances age
  • Abnormal ECG (LVH, LBBB, ST-T abnormalities)
  • Rhythms other than sinus (AF)
  • Low functional capacity
  • History of stroke
  • Uncontrolled systemic hypertension
29
Q

High risk surgeries (5% risk of perioperative death or MI) include:

A

Emergent major surgery, peripheral vascular or aortic surgery, prolonged surgery involving excessive blood loss

30
Q

Moderate risk surgeries (1-5% risk of perioperative death or MI) include:

A

Carotid endarterectomy, urologic, ortho, uncomplicated abdominal, head, neck or thoracic operations

31
Q

Low risk surgeries (<1% risk of perioperative death or MI) include:

A

Cataract removal, endoscopy, superficial procedure, cosmetic procedures, and breast surgery

32
Q

Indications for preoperative cardiac testing

A
  • patients with intermediate clinical predictors
  • prognostic assessment of patients undergoing initial eval for suspected or proven CAD
  • Eval of patients with a change in clinical status
  • Eval of adequacy of medical treatment
  • Prognostic assessment after acute coronary syndrome
33
Q

Noninvasive cardiac tests

A
  1. Transthoracic ECHO
  2. Exercise tests and pharmacologic tests
  3. Exercise stress test
  4. Dobutamine stress ECHO
  5. Adenosine stress test
  6. Ambulatory ECG monitoring
34
Q

What are some strategies to reduce risks?

A
  • General vs Regional anesthesia
  • Temperature Monitoring
  • Invasive monitoring: PAC, TEE
  • Laparoscopic vs Open
  • Endovascular
35
Q

What are some medical management ways to reduce risk?

A
  • use of beta blockers
  • Other anti-ischemic medications
  • Lipid lowering agents
36
Q

Class I: preoperative coronary angiogram/coronary intervention

A

See slide 40

37
Q

Evidence based practice parameters: Classes

A 
Class 1: benefits greatly outweigh the risks
Class 2a: reasonable to consider
Class 2b: may be reasonable to consider
Class 3: not indicated
Level A: highest level of evidence 
Level C: lowest level of evidence

GNURS725- Cardio/Thoracic (2 decks)

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