Complications week 2 Flashcards
What is Coronary artery bypass graft (CABG)
a surgical procedure to restore normal blood flow to an obstructed coronary artery. They take a vein / artery from somewhere in the body and connect it in the heart so it blood can bypass the areas of the heart that are damaged. This can be a single, double, triple or quadruple bypass.
Describe the process of coronary artery bypass graft
The heart is stopped by potassium injected into the coronary arteries
Patient is put on coronary artery bypass machine where the venous blood is filtered and oxygenated, then put back into the body.
Bolus heparin is used to prevent clots in the tubing
We want to make the patients hypothermic so they do not need as much O2
Once the graft is completed, protamine is used to reverse the heparin
Complications of CABG
Hypovolemia d/t decreased CO Persistent bleeding Cardiac tamponade Fluid overload Hypothermia - warm slowly Hypertension Tachyarrhythmias Bradycardia Cardiac failure MI Kidney failure d/t low perfersion Electrolyte imbalance Hepatic failure Infection
Why do all patients come back from CABG with epicardial pacemaker?
because patients can be bradycardic after
Describe the bleeding goal after CABG
Patient should not bleed more than 200mL/hr the first 4-6 hours
- evaluated with chest tube or JP drain
- bleeding should slowly decrease, not abruptly stop
Patho heart failure
Inadequate pumping/filling of heart— not enough blood to meet tissue oxygen demands. Impaired CO – from preload, afterload contractility or heart rate changes
Describe the difference between left sided and right sided heart failure
Left sided = fluid in lungs
Right sided = fluid in periphery
Heart failure assessment
Vitals Breath sounds Increased respiratory effort / cough Edema - peripheral or dependent, ascites, pulmonary, pitting Perfusion to extremities
What are s/s heart failure in general
sleeps on 2 pillows or recliner paroxysmal nocturnal dyspnea SOB with exertion fatigue nocturia chest pain rapid weight gain
Describe the appearence of someone with HF
Appearance anxiety paleness cyanosis confusion restless
heart faliure is what kind of issue?
perfusion
Heart failure interventions
O2 Diuretics Inotropic cardiac meds Fluid restration Na restriction Cardiac rehab and rest Support counseling = lifelong
Why do we not want to give a diuretic PO to someone with heart failure
Does not work fast enough - IV faster
When could we give someone with HF a diuretic PO
if they are maintaining Right sided HF
Heart failure complications
Respiratory distress –pleural effusions Dysrhythmias Cardiogenic shock Skin breakdown-edema Hepatomegaly Renal failure (in R or L HF because poor perfusion to kidneys) Cardiopulmonary failure
Medications heart failure: Morphine
Acute- morphine (sedation vasodilation) because decreases preload, want that volume to stay peripherally because right now heart can’t handle it coming back to heart, also helps with anxiety
Medications for HF: dig
?
meds for HF: furosemide
to get rid of fluid
med for HF: milrinone
IV medication, need to be in critical care
meds for HF: lisinopril
ACE — more
meds for HF: vasodilators
?
med for HF: KCL
IF RECEIVING Lasix, K+ is going to drop, assess K+ and then administer correct amount to make sure it is balanced
Heart failure education: FACES
Fatigue activity changes cough congestion edema SUB
These are things patient needs to recognize to catch changes early
Listen to heart sounds on slide 9
listen to heart sounds on slide 9
Modalities for treatment of the heart
Ultrafiltration Cardiac resynchronization therapy Implantable cardiac defibrillators Ventricular access devices Heart transplant
Surgical interventions for cardiomypoathy
Septal myectomy and alcohol septal ablation Mechanical circulatory support IABP ECMO VAD TAH (Total Artificial Heart) Heart transplant
What is acute heart failure and pulmonary edema?
happens very suddenly
What are s/s of acute HF and pulmonary edema?
Restless / anxious Frothy sputum- pink Crackles Cold moist skin \+ JVD
What are medications for acute HF and pulmonary edema?
Medications for preload after-load reduction- diuretics, vasodilators, and -pressors (?)
Cardiogenic shock patho
inadequate perfusion
body is in shocked state
– can occur post MI and during HF
Cardiogenic shock management
Improve O2 perfusion BR O2 Cardiac support devices Ventilation sedation Vasoactive meds for preload afterload
What is pericardial effeusion and cardiac tamponade?
Fluid accumulates and compresses heart
Cardiac tamponade and pleural effusion s/s
fullness in chest, dyspnea, cough, hypotension, pulses paradoxus > 10mm/Hg, friction rub, CVP increase, JVD, muffled heart sounds
Medical and nursing management for pericardial effusion and cardiac tamponade?
Pericardiocentesis
– Cath. That drains fluid off
Pericardiotomy
Open up window in pericardial sac so it can’t encapsulate the heart, and that fluid will be sent out into check and reabsorbed
