CP Final: Cardiac Surgery

Question 1

What is a CABG?

Answer 1

coronary artery bypass graft- which uses a vein or artery graft to resupply blood distally to an area of stenosis or complete blockage

Question 2

What are the three places these grafts are usually cut for?

Answer 2

1. Saphenous vein
2. radial artery
3. LIMA artery

Question 3

What is the cut made to do the surgery?

Answer 3

medial sternotomy

Question 4

What is patient put on during the surgery?

Answer 4

heart and lung pump. heart is cooled and stopped

Question 5

What happens when surgery is complete?

Answer 5

temporary pacemaker put in and a lot of fluid is added to keep blood volume up and protect organs

Question 6

What are time intervals post-op?

Answer 6

extubated within one day, transfered out of ICU in 1-2 days

temporary pacemaker out 2-3 days

Question 7

When do PT come for evaluation?

Answer 7

usually at 3 days but nurses should begin mobilizing as soon as off of ventilation

Question 8

What should PT watch for in these pts?

Answer 8

theses patients must be diuresed before treatment, watch for OTN

usually discharged on days 4-5

Question 9

What are complications of CABG?

Answer 9

decreased depth of breath, ineffective cough, decreased TV, atelectasis, infection risk, post -op anesthesia

Question 10

What are general sternal precautions?

Answer 10

1. no push , pull, lifting more than 5-10 pounds
2. avoid strenuous UE activity or overstretching
3. any arm movement must be bilateral with no WB

Question 11

How long do these precautions last?

Answer 11

6-8 weeks

Question 12

What are other PT implications?

Answer 12

1. saphenous vein site- check skin integrity
2. post-op arrhythmias- A-fib and PVC are common, can be medically managed
3. post-op edema- can cause pleural effusions
4. respiratory complications- atelectasis

Question 13

What is a valve replacement?

Answer 13

open heart procedure during to repair seriously insufficient or stenotic valves to improve C.O

Question 14

What kind of valves are used in these surgeries?

Answer 14

mechanical or animal valves (porcine)

Question 15

When is a heart replacement used?

Answer 15

at end stage CHF

Question 16

What are the two types of heart transplants?

Answer 16

1. orthoptic- donor heart is sewed in to replace old heart

2. Heterotopic transplant- piggybacking new heart to diseased heart

Question 17

What are two important PT implications?

Answer 17

1. What was the pre-surgery functional status?

2. be aware of immunosuppression/ steroid myopathy and watch for signs of rejection

Question 18

What is the main consequence of a heart transplant?

Answer 18

the vagus nerve is cut which leads to denervation of the heart resulting in an abnormal HD response

Question 19

Why is the HD response abnormal?

Answer 19

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

Question 20

What are other activity considerations are there for post op pts?

Answer 20

higher resting HR, lower max HR, decreased peak BP, increased DBP at rest

Question 21

What is needed in an exercise prescription for heart transplants pts?

Answer 21

1. increased warm up and cool down needed (5-10 mins)
2. avoid using HR for ex. prescription
3. watch BP- as it still should increase

Question 22

Anesthesia = ?

Answer 22

atelectasis