CC Cardiac surgeries

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Author:
kbryant86
ID:
278312
Filename:
CC Cardiac surgeries
Updated:
2014-07-06 21:46:36
Tags:
cardiac surgeris
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Description:
cardiac surgeries exam II
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  1. CABG
    • coronary artery bypass graph
    • surgical Tx of CAD when angioplasty or stent will not work well enough

    • use cold K to stop heart
    • one a cardio-pulmonary bypass machine
  2. pre-op consideration of CABG
    • any heart disease
    • anxiety response (inc HR, BP, and RR) puts stress on heart
    • Trigger of SNS response
  3. CABG incision site
    mid-sternal
  4. CABG vessels used
    • Saphenous Vein
    • Internal Mammary Artery
    • Radial artery
    • gastric epiploic artery
  5. saphenous pros and cons
    • most common
    • from leg

    • pros: easy access
    • good patency
    • can use on multiple locations

    • cons: b/c it's a vein, fibrotic hyperplasia (scars) can occur
    • risk of infection in leg
  6. Internal Mammary Artery pros and cons
    • also common
    • from subclavian vein

    • pros: best patency
    • access via sternum which is already open

    • cons: longer bypass pump time b/c single doc to harvest and trans vessel
    • more pain associated with this graft
    • single use
  7. Saph vein can now be harvested via endoscopic procedure
  8. bypass risks
    • inc risk with inc time > 2 hrs
    • dramatic inc if >3-4 hrs

    can activate SIRS response
  9. complications of bypass

    3 H's
    • hypothermia
    • Hemo-dilution
    • Heparinization
  10. hypothermia
    • to dec O2 consumption
    • effects SVR - inc b/c vasoconstrict
    • Myocardial depression

    NTG given to reverse/ vasodilate
  11. hemo-dilution
    to improve micro-circulation with crystalloid solutions

    • fluid shifting
    • lyte imbalances
  12. hepariniztion
    • to prevent clost in circuit
    • imbalance b/w heparine and protamine
    • monitoring for pTT post op needed
  13. chest tubes after CABG:

    mediastinal

    Plural
    • M= placement required to drain bld and fluid around heart
    •  =prevents cardiac tamponade

    • P= needed when pleural space has been entered (IMA)
    •  =prevents pnuemothorax
  14. Off pump Cabg
    • slowed HR but not stopped
    • no bypass used
    • 3 H's not done

    fewer complications and faster recovery
  15. Minimally invasive direct coronary artery bypass (MIDCAB)
    • thoraScopic approach
    • can only use IMA graft

    • poor visualization
    • MORE PAIN!
  16. reasons for valve surgeries
    • wear and tear is most common
    • endocarditis damage
    • congenital anomalies
    • advanced stage Syphilis
  17. Valve replacement
    • Mitral or Aortic valves most often b/c of workload
    • pig and cow most common
    • is mechanical, use anti-coag lifelong
  18. commissurotomy
    Mitral valve repair for STENOSIS

    incision on leaflets to improve mobility
  19. Annuloplasty
    mitral valve repair for REGURGITATION

    repair annulus ms at base of mitral to improve stability
  20. nsng priorities:
    decreased CO:

    risk factors
    goals
    • risk factors: Hx of CAD, A fib,
    • inc risk of ischemia, tamponade, shock, HTN, CHF

    • goals:
    • Tx HR/rhythm - A fib common post op --> aggressive Tx
    • Tx preload - want to inc preload
    • Tx afterload - inc SVR  post op expected, give NTG
    • Tx contractility - dobutamine as + inotrope
  21. nsng priorities:
    fluid volume deficit:
    risk: bld loss, post-op bld, diuresis

    • gaols:
    • Tx coagulopathy b/c of haparinization
    • Tx fluid loss
  22. nsng priorities:
    Hypothermia:
    risk: surg cooling and exposure

    • goals:
    • rewarm at 1 C/hr to prevent rebound
    • do not heat all the way to 98.6
    • Taper NTG down as BP dec's b/c vasorelaxes as temp inc's
    • Tx shivers iwth morphine or valium
  23. nsng priorities:
    impaired gas exchange
    risks: atelectasis

    • goals:
    • ABG nl
  24. sternal precautions post-op
    • lifting < 10 lbs
    • avoid pushing and pulling
    • do NOT use arms to stand from chair
    • follow progressive exercise
    • limit stairs to one flight BID
  25. diabetic considerations for heart surg
    • maintain Bld Sugar 110-150
    • very tight control
    • insulin drip std order

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