Indications For Cardiac Surgery Flashcards
What are the three major treatment strategies used to prevent ischemic damage to the heart?
Medical therapy, percutaneous revascularization and surgical revascularization
What are the most important goals of therapy for atrial fibrillation?
Alleviate symptoms and reduce the risk of stroke
What are the two purposes of cardiac revascularization?
Alleviate angina symptoms and prolong the life of the patient
What diagnoses does the American Heart Association indicate for CABG? (There are 8)
mild angina / stable angina / unstable angina with non-ST elevated myocardial infarction / STEMI / Poor left ventricular function / presence of life-threatening ventricular dysrhythmia / failed PCI / previous CABG
When would a patient need the Maze procedure?
When surgical intervention is needed for atrial fibrillation.
Is surgical intervention more effective in localized or diffuse myocardial damage?
Surgical intervention is more appropriate for localized myocardial damage
How long after developing mitral regurgitation is an untreated patient expected to live?
6-24 months
Steps to Manage Post Op Hypertension (Bojar, Pg. 496)
- Insure satisfactory oxygenation and ventilation
- Use a vasodilator if the patient has good cardiac output
- Use and inotrope along with a vasodilator if the patient has poor cardiac output
- Administer sedation if extubation is not possible
- Control shivering
What is a common cause of hypertension in the postop patient?
Elevated systemic vascular resistance (SVR). DO NOT assume that hypertension is the result of hyperdynamic heart. !!!Withdrawing inotropic support from a patient when their hypertension is caused by vasoconstriction can lead to rapid hemodynamic deterioration!!!
What are common causes of hypertension in the postop patient?
- Hyperadrenergic state following CPB
- Vasoconstriction
- Fever anxiety pain or agitation
- Abnormal ABG
- Manipulation of the pharynx such as ET tube placement or removal, NG-tube or TE placement or removal
- Hyperdynamic ventricular function
- altered function of the baroreceptors
- Acute hypoglycemia
What should the nurse assessed to determine hypertension (Bojar, 495)?
Breath sounds, peripheral perfusion, hemodynamic parameters, ABG, serum potassium, hematocrit, 12 lead EKG, and drainage of the mediastinal chest tube
What are seven interventions to lower a patient’s potassium level?
Give calcium gluconate, K-exalate, Lasix, Insulin or sodium bicarb / CRRT or dialysis / albuterol treatment
Is it okay for a patient to receive both a pressor or positive inotrope while receiving a beta blocker?
NO!
What NSAID is indicated for pericardial friction rub and what are some considerations when giving?
Toradol (IV)
Do not give a tour at all if patient has AKI as a Toradol always bumps creatinine levels
If morphine will depress respirations how long will the onset take?
7 min
It is also common for morphine to lower the blood pressure cause nausea and increase sedation
What is an acceptable rate to push Lasix and why?
10mg per min
Avoid ototoxicity»_space; tinnitus
What does the ABCDE Bundle stand for?
Awakening trials Breathing trials Care coordination Delirium assessment Early exercise
How many layers can be between the 2 S. patient and their mattress?
4 layers
When should post op Foley removal occur according to SCIP measures?
Day 1 or Day 2, unless a clinically necessary reason is documented
What is the goal time on 2South for patient extubation after cardiac surgery?
4 hrs unless otherwise contraindicated
What are the three branches of the ascending aorta?
- Anominid / brachiocephalic
- L common carotid
- L subclavian
What coronary vessel is related to posterior and lateral myocardial infarction?
Circumflex artery
What vessel is related to inferior myocardial infarction?
Right coronary artery
What vessel is associated with an anterior myocardial infarction?
Left anterior descending artery
