CARDIOVASCULAR SURGERY

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CARDIOVASCULAR SURGERY
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Today we will look at

• CABG
• Valve Replacements
• Vascular Surgeries
• aortic aneurysm

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Basic Principles during a CABG

• Heart most often placed on bypass machine
• Vein harvested from leg for grafting purposes
• Internal mammary arteries also used
• Grafted veins, arteries used to re-plumb the
  coronary vessels

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Pre-operative Teaching for Open Heart Surgery

• Basic explanation of the procedure
• Expected length of CCU/hospital stay
• Pain
• Tubes
• Ventilator and paralysis
• Sounds - Noise level, alarms

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ImmediatePost-op Goals

• Oxygenation
• Hemodynamic Stability

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Oxygenation

• Ventilator
• Chest Tube
• ABGs
• Oxygen Saturations

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Hemodynamic Stability

• Assess and monitor cardiac rhythm

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Hemodynamic Stability

• Assess and monitor cardiac rhythm
• Monitor hemodynamics
• CO or CI
• SVR
• MAP
• PAOP, PCWP
• CVP

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Hemodynamic Stability

• Assess and monitor cardiac rhythm
• Monitor hemodynamics
• Monitor fluid balance

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Bypass Machine
Renin- angiotension- aldosterone
mechanism
Capillary permeability
Fluid retention
Fluid shift to interstitial space - Edema
Hemodilution
Colloid osmotic pressure
Intravascular hypovolemia
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Hemodynamic Stability

• Assess and monitor cardiac rhythm
• Monitor hemodynamic status
• Monitor fluid balance
• Administer cardiac agents

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Cardiac Agents

• Hypertension - Nitroprusside/Nitroglycerin
• Hypotension
• Volume expansion
• Vasopresser - Dopamine (beta stimulator)
• Arrhythmias - Antiarrhythmics

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Post-op Complications

• Bleeding
• Arrhythmia
• Cardiogenic Shock
• Respiratory Failure
• Renal Failure
• Neurologic Dysfunction
• Wound Infection

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Step-Down Unit Care

• Pain Management
• Activity Levels, Progressive Ambulation
• Nutrition
• Wound Care
• Discharge Teaching

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Discharge Teaching

• Activity Levels/Cardiac Rehab
• Sexual Recommendations
• Controlling Risk Factors
• Medications
• Nutrition
• No Driving for 6 weeks

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Nutritional Recommendations for CAD

• Goals - Reduce LDL below 130 mg/dl
• -Reduce Total cholesterol gt200
• Reduce obvious sources of saturated fatty acids
  and cholesterol in diet
• Use cooking methods that add little or no fat
  (steaming, baking broiling)

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Valve Surgery

• Valve Replacement
• Valve Stenosis

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Basic Principles of Valve Replacements

• Require Cardiac Bypass during surgery
• Types of Valves
• biological
• mechanical

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Valve Stenosis

• Percutaneous transluminal balloon valvuloplasty
  (PTBV)
• Valve replacement

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Aortic Aneurysms

• Q What are they?
• A Out-pouching or dilation of the arterial wall.
• Q Where are they?
• A Most are found in the abdominal aorta below
  the renal arteries

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Clinical Manifestations

• None - these are usually asymptomatic
• May be detected with abdominal palpation,
  auscultation, or with a diagnostic test for
  unrelated problem.
• If ruptured, may produce intense back pain or
  client may die quickly from massive abdominal
  hemorrhage.

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Surgical Repair of AAA Fast Facts

• Does not require bypass machine
• Clamps are placed above and below aneurysm
• Heparinize patient while clamped
• Graft is placed inside the artery wall

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Postoperative Care

• PC Thromboembolis
• PC Hypovolemia
• PC Arrythmias
• PC Altered Renal Perfusion
• PC Altered Spinal Artery Perfusion
• PC Paralytic Ileus
• PC Graft Rupture

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Post-Op Care

• Nsg. Dx Acute pain
• Nsg. Dx Risk for Infection
• Nsg. Dx Anxiety

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Conclusion.

• Cardiovascular surgery.
• Potential to be extremely helpful for the patient
• True team approach to care multidisciplinary
• Many PCs
• Work together to treat or best Prevent
• Need for long term life style modifications
• Teach and stress the modifiable Risk Factors the
  ones that are changeable