Exam #2: Cardiac Surgery Flashcards
Valvular Heart Disease includes
- Mitral Stenosis
- Mitral Insufficiency (Regurgitation and Prolapse)
- Aortic Stenosis
- Aortic Insufficiency (Regurgitation and Prolapse)
Procedures for Valvular Heart Disease include
- Valvular repair/reconstruction (nothing to repair insufficient valves therefore they may need valve replacement)
- Valvular replacement:
- mechanical valve (do not want in young females because they would have to be on long term anticoagulant therapy)
- biological valves
Percutaneous Transluminal Balloon Valvuloplasty
- Procedure for a stenotic, calcific aortic valve.
- Look at pictures on PowerPoint
Biological Heart Valves
- Most common
- Slow heart rate down
- Sutured in place = risk for clotting. Therefore, they may need low molecular weight heparin for 6-12 weeeks
Aortic Aneurysms
- Outpouching or dilation of the arterial wall.
- May involve the aortic arch, thoracic aorta and/or the abdominal aorta. (Most found in abdominal aorta)
True Aneurysm
Thinning of arterial wall that causes an outpouching
True Aneurysm: Fusiform
..
False Aneurysm
Protrusion (which is actually a clot) d/t torn part of artery wall
Look up better definition
Clinical Manifestations of Throracic Aneurysms
- Thoracic aneurysms are often asymptomatic with the first sign being rupture
- Symptoms may include pain in the back, neck, and substernal area that may only occur when lying supine
- The client may experience dysphagia and dyspnea, stridor, or cough when pressing on the esophagus or laryngeal nerve
Clinical Manifestations of Abdominal Aneurysms
- Abdominal aneurysms may also be asymptomatic until ruputre
- The client may report a “heartbeat” in the abdomen when lying down
- A pulsating abdominal mass may be present
- Moderate to severe abdominal or lumbar pain may be present (severe pain may be a sign of impending rupture).
- The client may experience claudication
- Cool or cyanotic extremities may be noted
- Systolic bruit may be heard
Dissecting Aneurysms: Clinical Manifestations
- Present with sudden, severe, and persistent pain described as “tearing” or “ripping” in the anterior chest or the back
- Pain may extend to the shoulder, epigastric area, or abdomen
- Pallor, sweating, and tachycardia will be evidence
- Initially the client may have an elevated BP that may be different in one arm from the other
- Possible syncope and paralysis of lower extremities may be present
Complications of Aortic Aneurysm: If rupture occurs posteriorly into the retroperitoneal space,
- Bleeding may be tamponaded by surrounding structures, preventing exsanguination and death.
- Patient often has severe back pain and may or may not have back or flank ecchymosis
Complications of Aortic Aneurysms: If rupture occurs anteriorly into the abdominal cavity,
Death from massive hemorrhage
Aortic Aneurysm: Diagnostic Studies include
- Chest x-ray
- Ultrasound
- CT scan
- MRI
- ECG
- Angiography
Aortic Aneurysm: Overall Goals
- NO RUPTURE
- Normal tissue perfusion
- Intact motor and neurologic function
- No complications of surgical repair
Treatment for Aortic Aneurysm
- Surgical repair is aneurysm is over 5cm.
- Conservative therapy for those with an aneurysm <5 cm: Decrease blood pressure (systolic between 90-92) using ACE inhibitors, etc.
Role of Nurse in Preoperative Teaching of Patient Undergoing Cardiac Surgery
- Appearance of patient after surgery and reasons
- Incision and chest tube care
- Pain and discomfort management
- Coughing and deep breathing and use of incentive spirometry
- Importance of early mobilization and progression
Aortic Aneurysm Surgery: Intraoperative Phase
- Surgical approach
- Cardiopulmonary Bypass
- Completion of surgery
Early complications After Cardiac Surgery:
- Cardiovascular:
- Postop Bleeding
- Cardiac Tamponde
- Myocardial Depression
- Myocardial Infarction
- Dysrhythmias - Pulmonary
- Renal (i.e AKI)
- GI (i.e paralytic ileus)
- Endocrine (i.e adrenal insufficiency)
- Infection
Key Assessment Areas: Early Postoperative Period of Cardiac Surgery
-Assess VS, ECG monitor, ABC survey, neuro status
-Assess peripheral circulation and sensation
-Assess incisions, chest tube systems
-Assess hemodynamic parameters
-Assess fluid, electrolyte, and coagulation status (UO!! Because may have decreased perfusion to kidneys)
-Assess rewarming efforts
Assess for pain
-Monitor for complications
