CP Final: Cardiac Surgery Flashcards
What is a CABG?
coronary artery bypass graft- which uses a vein or artery graft to resupply blood distally to an area of stenosis or complete blockage
What are the three places these grafts are usually cut for?
- Saphenous vein
- radial artery
- LIMA artery
What is the cut made to do the surgery?
medial sternotomy
What is patient put on during the surgery?
heart and lung pump. heart is cooled and stopped
What happens when surgery is complete?
temporary pacemaker put in and a lot of fluid is added to keep blood volume up and protect organs
What are time intervals post-op?
extubated within one day, transfered out of ICU in 1-2 days
temporary pacemaker out 2-3 days
When do PT come for evaluation?
usually at 3 days but nurses should begin mobilizing as soon as off of ventilation
What should PT watch for in these pts?
theses patients must be diuresed before treatment, watch for OTN
usually discharged on days 4-5
What are complications of CABG?
decreased depth of breath, ineffective cough, decreased TV, atelectasis, infection risk, post -op anesthesia
What are general sternal precautions?
- no push , pull, lifting more than 5-10 pounds
- avoid strenuous UE activity or overstretching
- any arm movement must be bilateral with no WB
How long do these precautions last?
6-8 weeks
What are other PT implications?
- saphenous vein site- check skin integrity
- post-op arrhythmias- A-fib and PVC are common, can be medically managed
- post-op edema- can cause pleural effusions
- respiratory complications- atelectasis
What is a valve replacement?
open heart procedure during to repair seriously insufficient or stenotic valves to improve C.O
What kind of valves are used in these surgeries?
mechanical or animal valves (porcine)
When is a heart replacement used?
at end stage CHF
What are the two types of heart transplants?
- orthoptic- donor heart is sewed in to replace old heart
2. Heterotopic transplant- piggybacking new heart to diseased heart
What are two important PT implications?
- What was the pre-surgery functional status?
2. be aware of immunosuppression/ steroid myopathy and watch for signs of rejection
What is the main consequence of a heart transplant?
the vagus nerve is cut which leads to denervation of the heart resulting in an abnormal HD response
Why is the HD response abnormal?
because the heart is relying on catecholamines to raise HR with activity , therefore a decreased response and delayed cool down, as well as no steady state
overtime this becomes new efficient but still abnormal
What are other activity considerations are there for post op pts?
higher resting HR, lower max HR, decreased peak BP, increased DBP at rest
What is needed in an exercise prescription for heart transplants pts?
- increased warm up and cool down needed (5-10 mins)
- avoid using HR for ex. prescription
- watch BP- as it still should increase
Anesthesia = ?
atelectasis
