Case study 3 - CABG Flashcards

1
Q

explain the pathway of blood in the heart from lungs to body

A
  • deoxygenated blood into right atrium
  • tricupsid valve
  • right ventricle
  • pulmonary artery
  • lungs
  • oxygenated blood into pulmonary vein
  • left atrium
  • mitral valve
  • left ventricle
  • aorta
  • body
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2
Q

name nerves in the heart

A
  • sinoatrial node (cause atria to contract)
  • atrioventricular node (cause ventricles to contract)
  • bundle of HIS (electrical conduction in the heart)
  • punkunje fibres (electrical impulse to the ventricles)
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3
Q

what is a myocardial infarction

A

heart attack caused by blockage in arteries

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4
Q

what causes a coronary artery disease

A
  • plaque depositis build up in the arteries
  • this is called athlerosclerosis
  • therefore arteries cannot supply oxygen rich blood to the heart
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5
Q

where is left descending artery

A

branches of left coronary artery and supplies blood to the front of the left side of the heart

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6
Q

name the arteries of the heart

A
  • left + right coronary arteries
  • circumflux artery (supply back of heart)
  • left anterior descending arteries (blockage of these are most common in heart failure)
  • right posterior descending arteries
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7
Q

what is coronary bypass grafting

A
  • surgery to treat coronary artery disease
  • ## Involves taking a blood vessel (graft) usually forearm or chest and attaching it to coronary artery above or below blockage
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8
Q

what is the progression of mobility after CABG

A
  • Generally, you should be able to sit in a chair after 1 day, walk after 3 days, and walk up and down stairs after 5 or 6 days.
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9
Q

what arteries would the graft most likely been taken from?

A
  • arm: radial artery
  • chest: internal mammory artery
  • leg: saphernorus vein
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10
Q

What assessment would you do for decreased chest expansion?

A
  • tactile fremitus feeling for equal chest epansion (likely to feel decreased in anterior + posterior lower lobes due to atelectasis)
  • palpation of accessory muscles feeling for hypertorphy
  • observe respiratory rate, likely to be decreased due to respiratory acidosis (hypoventilation)
  • use dyspnoea scale (rate of perceived exertion)
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11
Q

How would you treat decreased chest expansion?

A
  • use incentive spirometer
  • teach ACBT technques
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12
Q

What evidence is there for treatment of decreased chest expansion using incentive spirometer

A
  • Sum et al, 2019
  • help him to increase his chest expansion use 3-5 seconds, 10x an hour for 8 hours a day.
  • Edmond has left lower lobe atelectasis, this evidence supports the use of incentive spirometer and decreasing the risk of developing pulmonary complications.
  • Using this will help diminish atelectasis and prevent micro-atelectasis as well as other complications, such as pneumonia
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13
Q

What assessment would you do for secretion retention in left lower lobe?

A
  • sputum sample
  • auscultation (hear crackles left lobe and diminished sounds left lower lobe due to atelectasis)
  • vocal fremitus
  • cough strength
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14
Q

How would you treat secretion retention?

A
  • postural drainage (right side lying)
  • ACBT technique
  • supported cough
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15
Q

What evidence is there to treat secretion retention?

A
  • Zisi et al 2022
  • explain aim, method, findings, conclusion
  • ACBT is effective in increasing the expectorated sputum volume, in reducing viscoelasticity of the secretion.
  • He can then expectorate secretions by using supported cough technique
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16
Q

what is atelectasis?

A
  • complete or partial collapse of lung
  • there are 6 types
  • most common is obstructive when there is obstruction from sputum decreasing area for gaseous exchange.
  • but also could be due to surgery
17
Q

what are the causes of atelectasis?

A
  • smoking
  • anesthesia
  • duration of surgery
  • prolonged bed rest
  • ventilators
18
Q

what is prolonged standing hypertension?

A
  • increased hypertrophy of the left ventricular artery
19
Q

what are the symptoms of prolonged standing hypertension?

A
  • severe headaches.
  • chest pain.
  • dizziness.
  • difficulty breathing.
  • nausea.
  • vomiting.
  • blurred vision or other vision changes.
20
Q

how would you assess decreased exercise tolerance

A
  • use dyspnoea scale/rate of percieved exertion
  • respiratory rate
  • 5 times STS, should be able to complete 5 within 3.6 to 4.2 second. Likely to find this difficult, back up by evidence fromZhang et al 2018.
21
Q

how would you treat decreased exercise tolerance

A
  • marches on spot, sit and rest
  • progress to mobilise patient with WZF to sit on in chair
  • Teach ACBT to ensure breathing pattern is maintained and risk of pulmonary complication decreased
  • outcome measure using dyspnoea scale used.
  • this will also help to improve his left lower lobe atelectasis
22
Q

what evidence is there to show how is mobilising patient with respiratory acidosis is okay for treatment

A
  • Bailey et al 2007
  • explain aim, method, findings, conclusion
  • early activity is feasible and safe in respiratory failure patients.
  • therefore, mobilising Amiel is important to help increase exercise tolerance and decrease risk of muscle weakness
23
Q

what does the left anterior descending artery do.

A

The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.

24
Q

what are the layers of the heart

A
  • epiocardium
  • myocardium
  • endocardium
25
Q

what does it mean if Ed has ABG values of:
pH: 7.30, PaCo2: 6.5, Pao2: 8, HC03: 24

A

ph = low
PaCo2 = high
HCO3 = normal
= respiratory acidosis