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
