Shock 3 Flashcards
what is the post op care of OHS:
1) monitor fluid volume by foley
2) may need to replace electrolytes (K, Ca, Mg)
3) Iv meds to maintain BP (only use eip if have to)
4) warm the pt with the bear hugger
5) give lasix before coming to unit to decrease BP
what can happen if the BP is too high after OHS
can rupture graft
give nitroglycerin to dilate coronary arteries
give amiodarone for rhythm control
what do runs of vatch or heart block mean after OHS
heart is irritated
what is pt on after OHS
- mechanical ventilation until awake
- epicardial wires, medialstinal tubes, central line, foley, swan ganz cath, IV fluids, vasopressor drip
- VS stable before excavated
what does swan ganz cath monitor
- *hemodynamic monitoring (moving blood)
- has many different lines and catheters
- line is put through subclavian to R atrium to R ventricle to pulmonary artery (does NOT go into left side)
what is proper use of invasive catheters
- zero the line to the atmospheric air
- use a pressure bag
- level at phlebostatic axis
- do NOT leave catheter wedged
why do we zero the line to atmospheric air
- tubing is hard and creates a vacuum
- open vent so air can run through tubing
- zero pressure to room air or will have abnormal reading
- zero line at beginning of every shift (calibrates it)
why do we use a pressure bag
prevent blood from backing up into line
why do we level at phlebostatic axis
transducer site has to be leveled to heart
at midaxillary 4th ICS
why can you not leave the catheter wedged
cannot leave balloon wedged because it will act like PE
what is teaching for pt after OHS
- return to work/exercise after 6 wks
- may be on nitro, BB to decrease workload and ACE inhibitor (prevent scar tissue)
- if chest pain use nitro
what is normal systolic BP
90-140
what is normal diastolic BP
60-90
what is a normal mean arterial pressure (MAP)
70-100 mm Hg
what is a normal central venous pressure (CVP)
2-6 mmHg
what is a normal pulmonary artery pressure (PAP)
mean is 25 mmHg
what is a normal pulmonary capillary wedge pressure
4-12 mmHg
what is a normal stoke volume (SV)
50-100 mL
what is an arterial line
art
in the wrist
shows continuous BP reading
what is a swan line
monitors C.O. and SVO2 (systemic venous O2)
nurse in charge of flushing line with NSS
don’t leave balloon wedged
what are potential complications post CABG
- excessive bleeding
- no blood coming from chest tube
- fluid/electrolyte imbalance
- dysrhythmias (PVCs are common)
- hypo/hypertension and decreased cardiac output (BP will be erratic)
- hypothermia (give bear huger)
what to do if excessive bleeding from medial stinal chest tubes post CABG
call Dr if >200 mL, may need to return to surgery (unless pt has just turned/gotten up- positional/relative)
what could no blood out of medial stinal chest tubes post CABG mean
- *EMERGENCY
- tamponade, filling up pericardial wall
- prevents heart from pumping
- *call Dr immediately (cardiothoracic surgeon)
- will have a decrease in BP
- jugular vein distension
- pulse pressure represents SV (vasoconstriction goes overboard, decrease in BP)
what happens in cardiac tamponade
narrow pulse pressure
decrease in BP and C.O.
decrease in CT drainage
other potential complications of CABG
HF, cardiogenic shock, MI, fatal dysrhythmias, pheumonia, atelectasis, CVA, ARF, infection (medianstinitis), stress ulcer, pericardiotomy (pain in pericardium)
describe intraaortic balloon pump
- acts to divert blood back to coronary artery in diastole
- maintains better perfusion so better LV filling and push
- should increase BP and C.O
- do not let balloon move, timed to pt rhythm
