CARING FOR PT'S UNDERGOING CV SURGERY

466 views
401 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
466
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

CARING FOR PT'S UNDERGOING CV SURGERY

  1. 1. CARING FOR PT’S UNDERGOING CV SURGERY CHAPTER 35
  2. 2. OVERVIEW <ul><li>Before the 1950s, few attempts at cardiac surgery were made. </li></ul><ul><li>Initially, hypothermia and crude mechanisms for oxygenating blood outside the body were used. </li></ul><ul><li>In the 1960s , the technique for mechanically circulating and oxygenating blood outside the body, called extracorporeal circulation or cardiopulmonary bypass (Fig. 35-1) pg. 531 </li></ul>
  3. 3. OVERVIEW <ul><li>Removing blood from the venae cavae, circulating it through an oxygenator, and returning it to the aorta or femoral artery provides a nearly bloodless area while the beating heart is stopped. </li></ul>
  4. 4. Cardiac Surgical Procedures <ul><li>Cardiac surgery is used to correct and treat various cardiac disorders. </li></ul><ul><li>It is done to revascularize the myocardium, repair or replace cardiac valves, repair ventricular aneurysm, remove heart tumors, manage heart trauma, and replace the heart with one from a human donor. </li></ul>
  5. 5. MYOCARDIAL REVASCULARIZATION <ul><li>Myocardial revascularization refers to surgical techniques that improve the delivery of oxygenated blood to the myocardium for clients who have CAD. </li></ul><ul><li>It is accomplished by performing one or more coronary artery bypass grafts. </li></ul><ul><li>CABG improves myocardial oxygenation by bypassing or detouring around the occluded portion of one or more coronary arteries with a relocated blood vessel. </li></ul>
  6. 6. MYOCARDIAL REVASCULARIZATION <ul><li>The saphenous vein in the leg is the vessel most often used for grafting. </li></ul><ul><li>It is harvested by making a long incision on the medial aspect of the leg or by removing the vein endoscopically through one to three small (1 inch) leg incisions. (fig. 35-2). </li></ul>
  7. 7. MYOCARDIAL REVASCULARIZATION <ul><li>CABG is reserved for client with CAD who are not candidates for less invasive procedures like PTCA. </li></ul>
  8. 8. MYOCARDIAL REVASCULARIZATION <ul><li>CABG performed when: </li></ul><ul><li>(1) the client has multiple coronary artery occlusions </li></ul><ul><li>(2) the atheromas are calcified and noncompressible </li></ul><ul><li>(3) the anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter. </li></ul>
  9. 9. Vascular Grafts pg. 536 <ul><li>Vascular Grafts: Just as grafts are used to bypass a disease section of a coronary blood vessel, vascular grafts are used to bypass or replace diseased sections of major systemic blood vessels such as the aorta or femoral arteries. </li></ul><ul><li>The replacement graft may be made of synthetic fiber, such as Dacron or Teflon, or may be human tissue harvested from cadavers. </li></ul>
  10. 10. Embolectomy & Thrombectomy <ul><li>Embolectomy & Thrombectomy: when thrombi or emboli occlude a major vessel, a thrombectomy (removal of a thrombus) or embolectomy (removal of an embolus) is performed. </li></ul><ul><li>The vessel is opened about the clot, the clot is removed, and the vessel is sutured closed. </li></ul><ul><li>May be emergent surgery because complete occlusion results in loss of blood supply to an area. </li></ul>
  11. 11. ENDARTERECTOMY <ul><li>Endarterectomy is the resection and removal of the lining of an artery. </li></ul><ul><li>This type of surgery is performed to remove obstructive atherosclerotic plaques from the carotid, femoral, or popliteal arteries. (fig. 35-10 pg. 537) </li></ul>
  12. 12. NURSING PROCESS <ul><li>ASSESSMENT: </li></ul><ul><ul><li>Obtains medical and surgical hx. </li></ul></ul><ul><ul><li>Performs physical exam </li></ul></ul><ul><ul><li>Determines drug allergies </li></ul></ul><ul><ul><li>Weigh the client </li></ul></ul><ul><ul><li>Records V/S and measures I & O </li></ul></ul><ul><ul><li>Prepares for extensive diagnostic testing </li></ul></ul>
  13. 13. NURSING PROCESS <ul><li>After surgery: </li></ul><ul><ul><li>Palpate the peripheral pulses or uses a doppler ultrasound device if the pulses are not palpable. </li></ul></ul><ul><ul><li>Check for inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremity, or skin mottling. </li></ul></ul><ul><ul><li>Asses BP and pulse rate in both arms after thoracic surgery. </li></ul></ul><ul><ul><li>Inspect IV sites and infusions </li></ul></ul>
  14. 14. NURSING PROCESS <ul><li>Hourly I&O </li></ul><ul><li>Neurologic assessment every 30 minutes (LOC, pupils, movement in both arms and legs, verbal response, and status or orientation) </li></ul>
  15. 15. Care Plan <ul><li>Go over the care plan on pg. 538 –540. </li></ul><ul><li>Client and family teaching 35-1 pg 541. </li></ul><ul><li>Nutritional, pharmacologic and gerontologic considerations. </li></ul>

×