CP LEC 5: SURGERY Flashcards by Chavez Girls

An angioplasty is typically done following what?

Imaging like coronary-angiogram or MRI to confirm the location of the blockage

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What is an angioplasty?

Balloon tipped catheter goes through femoral artery or radial artery

goal is to open up closed CAD artery and increase BF by pushing plaque against lumen

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If you have an angioplasty what are your exercise precautions?

No vigourous exercise for 5-7 days

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After they use the balloon in the angioplasty to push the plaque out of the way, what do they do next?

Put stent in to keep space open

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What is the major risk involving angioplasty patients?

Bleeding

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Any time we quickly re-establish blood supply the risk of _________ is increased

ventricular arythmias

This risk is present for about a day or 2

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What is the problem with stents in coronary angioplasties?

Stents collect plaque and blockage can reappear

Drug eluting stents fix this problem by releasing drugs from the stent that stops blockages from occuring

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How do hospitals manage the risk of bleeding for patients with angioplasty+stents

Continous pressure+ice pack for several hours to stop bleeding

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Patient comes to you and says “I had an angioplasty 3-4 days ago!” in out patient, what do you say?

😡 GET OUT!!! GET OUT RIGHT NOW!!!!!!!! 😡

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What is an arthectomy?

Simular to angioplasty. Now they have a drill that pushes through the plaque. For plaques that are thicker and larger

Note: still a risk of bleeding

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True or false: Coronary Artery Bypass graph is a percutaneous surgery

False

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Patient’s who have a coronary artery bypass graft have what precautions?

Sternal precautions

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What are 3 places that surgeons can source a graft from for a CABG

Internal mammary artery

radial arteries

saphenous vein

NOTE: these locations must also heal before mobilizing patients

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What are the complications of a CABG

2-4% of paients have heart attack

-myocardial stunning (low CO, can use inotropic meds or LVAD or balloon pump)

-arythmias, may need temporary pacing

infection
bleeding, 30% need blood transfusion after
PLEURAL EFFUSIONS
pericardial effusion

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The longer the time the patient is on heart machine or under anesthesia….

the more deconditioned their respiratory function may be, and the longer it may take them to become active again

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How can myocardial stunnng be managed after a CABG

Left ventricular Assistive Device

Inotropic medications

Intraaortic balloon pump

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Pleural effusions occur in __% of patients with a CABG

90%

THIS IS WHY NEED FOR MOBILIZATION IS CRITICAL

the trauma of surgery causes an inflammation response that leads to fluid build up

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How long do sternal precautions last? What are the precautions?

6-8weeks

stay in the tube - no lifting arms above the head or behind back, no pushing or pulling or lifting more than 5lbs, avoid excesssive heat and cold

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If sternal precautions are too restricting what can happen?

frozen shoulder/adhesive capsilitis

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when inspecting a patient with sternal precautions surgical scar what should you be on the look out for?

drainage of wound/pus

make sure bandages are clean and dry

Prevent infections! Infections will be catastrophic

Note: they can get gentle scar massage after a couple of days

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What is an intra-aortic balloon pump

Restores cardiac output by inflating during diastole to allow blood to come in and DEFLATES during systole to push blood out.

Typically inserted through femoral artery

Note: can increased CO up to 40%. a rate of 1:1 inflation is considered full assistance

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can someone with a femoral intraortic balloon pump be ambulated?

hellllll nawwww

but maybe an axillary one can be ambulated, just maybe

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Itra-aortic balloon pump inflates during _____

deflates during _________

inflates during diastole

deflates during systole

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what is the purpose of percutaneous procedures?

reestablish blood supply!

what is the purpose of an intraortic balloon pump?

help heart thats failing

what is the most commonly replaced valve?

aortic valve

true or false: most of the time physicians seek to repair the valve instead of replace it

true why? because then they wont need blood thinners for the rest of their life. They would if it was a replacement

What is the ross procedure?

using pulmonary valve to replace aortic valve then pulmonary valve is replaced by donor

true or false: tricuspid and mitral valve rarely need to be replaced

true

What are the advantages of a bioproshesis instead of a mechanic valve?

reduces risk of stroke Only patients with a mechanical valve will need blood thinners for rest of life!

why is it hard/impossible to repair the aortic valve

pressure is too high

what is the purpose of an annuloplasty?

flexible ring placed around mitral valve for support, reinforced annulus prevents dilation of valve

valve repair procedures are usually done how?

minimally invasive percutaneous procedure where a catheter goes through femoral vein

what is the risk of catheter based valve repair procedures

risk of bleeding fatigue may be issue usually patients can go home from hospital after a day or 2

what is "something to think about" when a patient is coming off of a heart/lung machine

fatigue may be issue

True or false: Mitral valve repair typically does better than replacement

True Also: Patients with repair dont have to use blood thinners for as long

what is the problem with anticoagulation medication for long periods of time?

bleeding

What is a cardiac ablation?

destroys ectopic cells in myocardium that cause arrhythmias produces scar on myocardium typically radiofrequency or cryotherapy note: very good for a-fib, can be used for v-fib too

What needs to happen before a cardiac ablation procedure

electrophysiological mapping to find the arrythmia

Cardiac ablation patients typically need ____ days of rest

4-7 days of rest

what is a pace maker primarily for?

slow rhythm and heart blocks OR fast rhythm in UPPER chamber

whats the most important thing to know about a patients pacemaker

what their particular pace maker is for 1. always works to maintain regular rate 2. only works if rate is below certain amount 3. or if they are used stop the atrias from going to fast

what are the 2 kinds of pace makers

Unipolar- one electrode (- at myocardium and + at pacemaker box) bipolar (Biventricular) - 1 lead on right atrium, 2 at ventricles, (3 total leads)

what is an Implantable cardioverter defibrillator for?

Used to correct life threatening arrythmias (designed for fast ventricular arrythmias)

What will you see on an ECG if the patient has a pacemaker?

Pacemaker spikes if spike is infront of P-wave- the pace maker is working at atria If spike is infront of QRS- pace maker is working at ventricles

If a patient comes to PT and says theyve recently been shocked by their ICD what do u say

go talk to your physician before PT

What is important to know for a patient with a pacemaker/ICD

Need to know at what heart rate their device is designed to deploy stay 10-20 BPM below that

Endocardial vs epicardial pace makers

endocardial- inside the right atrium and ventricle epicardial- more often used in patients undergoing heart surgery often only used for temporary pacing

If a patient has a surgically placed pace maker what is a common precaution associated with this

no raising arm overhead no contact sports no lifting more than 10lbs

What is a temporary ICD (vest)

patient who has had an MI in the past, there is a risk of arthmyias but as the heart heals the risk of arthymia drops

When looking at a ECG for someone with a pacemaker, what does it mean if you see the pacemaker spike before the p wave? what about QRS?

Before Pwave- atrial pace maker before QRS- ventricular pace maker

Abdominal aortic aneurysm repair is indicated for aneurysm's larger than...

5cm

If a patient get's an abdominal aortic aneurysm repair where there is a midline incision at the xiphoid process, what is a common precaution youll see?

No thoracic extension 4-6 weeks

If a patient has an abdominal aortic aneurysm repair, what does PT need to teach them?

bronchiole hygene techniques. this patient cannot use their abdominals to huff or cough!!! no huffing or coughing! note: you can teach them how to huff later on

Where is the incision for a posterolateral thoracotomy?

T4 and scapula to 5-6th intercostal space divides the serratus anterior makes it difficult to breathe

where is the incision for an anterolateral thoracotomy?

4-5th intercostal space to midaxillary line (pec major is incised, serratus anterior fibers separated)

where is the incision for a lateral thoracotomy?

near nipple line extending toward scapula

where is the incision for a thoracoabdominal incision?

8th,9th IC space at post axillary line to midline of abdomen transection of : lats, SA, External oblique, rectus abdominus note: with this patient you cannot activate these muscles too aggressively at first allow them to heal

what are post-op difficulties for thoracoabdominal incision?

-coughing -deep breathing -thoracic extension -80% experience ipsilateral shoulder pain, referred pain from phrenic nerve NO AGGRESSIVE STRETCH OR STRENGTHENING