Case study 3 - CABG Flashcards
explain the pathway of blood in the heart from lungs to body
- 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
name nerves in the heart
- 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)
what is a myocardial infarction
heart attack caused by blockage in arteries
what causes a coronary artery disease
- plaque depositis build up in the arteries
- this is called athlerosclerosis
- therefore arteries cannot supply oxygen rich blood to the heart
where is left descending artery
branches of left coronary artery and supplies blood to the front of the left side of the heart
name the arteries of the heart
- 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
what is coronary bypass grafting
- 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
what is the progression of mobility after CABG
- 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.
what arteries would the graft most likely been taken from?
- arm: radial artery
- chest: internal mammory artery
- leg: saphernorus vein
What assessment would you do for decreased chest expansion?
- 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)
How would you treat decreased chest expansion?
- use incentive spirometer
- teach ACBT technques
What evidence is there for treatment of decreased chest expansion using incentive spirometer
- 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
What assessment would you do for secretion retention in left lower lobe?
- sputum sample
- auscultation (hear crackles left lobe and diminished sounds left lower lobe due to atelectasis)
- vocal fremitus
- cough strength
How would you treat secretion retention?
- postural drainage (right side lying)
- ACBT technique
- supported cough
What evidence is there to treat secretion retention?
- 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
what is atelectasis?
- 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
what are the causes of atelectasis?
- smoking
- anesthesia
- duration of surgery
- prolonged bed rest
- ventilators
what is prolonged standing hypertension?
- increased hypertrophy of the left ventricular artery
what are the symptoms of prolonged standing hypertension?
- severe headaches.
- chest pain.
- dizziness.
- difficulty breathing.
- nausea.
- vomiting.
- blurred vision or other vision changes.
how would you assess decreased exercise tolerance
- 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.
how would you treat decreased exercise tolerance
- 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
what evidence is there to show how is mobilising patient with respiratory acidosis is okay for treatment
- 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
what does the left anterior descending artery do.
The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.
what are the layers of the heart
- epiocardium
- myocardium
- endocardium
what does it mean if Ed has ABG values of:
pH: 7.30, PaCo2: 6.5, Pao2: 8, HC03: 24
ph = low
PaCo2 = high
HCO3 = normal
= respiratory acidosis
