CP LEC 5: SURGERY COPY Flashcards
An angioplasty is typically done following what?
Imaging like coronary-angiogram or MRI to confirm the location of the blockage
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
If you have an angioplasty what are your exercise precautions?
No vigourous exercise for 5-7 days
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
What is the major risk involving angioplasty patients?
Bleeding
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
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
How do hospitals manage the risk of bleeding for patients with angioplasty+stents
Continous pressure+ice pack for several hours to stop bleeding
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!!!!!!!! 😡
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
True or false: Coronary Artery Bypass graph is a percutaneous surgery
False
Patient’s who have a coronary artery bypass graft have what precautions?
Sternal precautions
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
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
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
How can myocardial stunnng be managed after a CABG
Left ventricular Assistive Device
Inotropic medications
Intraaortic balloon pump
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
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 excessive heat and cold
If sternal precautions are too restricting what can happen?
frozen shoulder/adhesive capsilitis
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
What is an intra-aortic balloon pump
a balloon inserted in heart used to restore cardiac output during severe HF, post-op cardiac surgery, cardiogenic shock
Typically inserted through femoral artery
Note: can increased CO up to 40%. a rate of 1:1 inflation is considered full assistance
can someone with a femoral intraortic balloon pump be ambulated?
hellllll nawwww
but maybe an axillary one can be ambulated, just maybe
Itra-aortic balloon pump inflates during _____
deflates during _________
inflates during diastole
deflates during systole
what are complications of an IABP?
the balloon goes through the aorta which can block BF to the extremities, so check capillary refill and pulses
can also cause damage to the vessel itself - cause arterial thrombus