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Chapter029

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 29: Caring for Clients Undergoing Cardiovascular Surgery Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Cardiac Surgical Procedures • Purpose: Revascularize the Myocardium – Repair, replace • Cardiac valves • Ventricular aneurysm • Heart tumors; Heart trauma • The heart itself Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Question Is the following statement true or false? The purpose for cardiac surgeries is to revascularize the pericardium. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Answer False. The purpose for cardiac surgeries is to revascularize the myocardium. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Cardiac Surgical Procedures Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Myocardial Revascularization • Surgical techniques: Improve delivery of oxygenated blood to the myocardium for clients with CAD • Risk of cardiopulmonary bypass • Coronary artery bypass graft; Saphenous vein; Alternative graft vessels • Conventional technique for performing CABG: Cardioplegia • OPCAB; MIDCAB; PACAB Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Question Is the following statement true or false? There are less potential complications if surgery occurs on a beating heart than if cardioplegia is utilized. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Answer True. There are less potential complications if surgery occurs on a beating heart than if cardioplegia is utilized, avoiding negative “pump consequences.” Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. CABG Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Myocardial Revascularization • Conventional Coronary Artery Bypass Graft – Procedure – Double, triple, or quadruple bypass – Advantages; Disadvantages: Chest arteries • Off-pump Coronary Artery Bypass (OPCAB) – Similar to CABG – Heart keeps beating slowly – No bypass machine; Advantages Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Myocardial Revascularization • Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) – Beating heart procedure: Minimally invasive – Small incision: Use of endoscope – Limitations • Graft 1 or 2 vessels: Not obese and coronary arteries not calcified – Eliminates risks of cardiopulmonary bypass – Cosmetically more acceptable Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Myocardial Revascularization • Port Access Coronary Artery Bypass (PACAB) – Eliminates sternal incision – Thorascope: Visualize the operative area after the heart is stopped – Robotic hand; Shortened operative procedure – Reduced mortality rates – Full recovery is much faster Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Myocardial Revascularization • Valvular Repairs – Heart valves need surgical repair when narrowed; Commissurotomy-thoracotomy procedure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Myocardial Revascularization • Valvular Repairs (Cont’d) – Valvuloplasty, annuloplasty: Tighten incompetent valves – Mechanical valve: Excise, replace diseased valve – Advantages of minimally invasive approaches • Less surgical trauma; Decreased blood loss; Less mechanical ventilation • Reduced postoperative pain; Shortened hospital stay; Improved cosmetic appearance Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Myocardial Revascularization • Repair of Ventricular Aneurysm – Infracted area of myocardium balloons outward; Thrombi formation • Lethal complication – Motion of myocardium: Ruptures the aneurysm – Early surgery: Difficult to differentiate healthy tissue from necrotic tissue; Sutures not retained • Removal of Heart Tumors – Primary tumors: Rare; Benign and malignant; Operative procedure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Aneurysm Repair Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Cardiac Surgical Procedures • Repair of Heart Trauma – Nonpenetrating chest injury; Penetrating chest injury; Cardiac tamponade – Thoracotomy: Control blood loss • Heart Transplantation – Indicated for cardiomyopathy, end-stage CAD – Severe congenital cardiac defect in infants – Certified candidate for transplantation – Two methods of heart transplantation • Orthotopic heart transplant Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Cardiac Surgical Procedures • Heart Transplantation (Cont’d) – Rejection signs: Dose of immunosuppressives is increased – High cost; Insurance – CAD: Common problem – Transplanted heart beats faster than natural heart • 100 - 110 beats/minute – Survival rate Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Question Is the following statement true or false? A transplanted heart beats at the same rate as a native heart. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Answer False. A transplanted heart beats at a faster rate (100-110 bpm) than a native heart. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Vascular Surgical Procedures • Vascular Grafts – Used to bypass or replace diseased sections of systemic vessels: Aorta or femoral arteries – Components of replacement graft • Fiber; Human tissue harvested from cadavers – Cardiopulmonary bypass • Depends on the area involved Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Vascular Surgical Procedures Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Vascular Surgical Procedures • Embolectomy and Thrombectomy – Used when thrombi or emboli occlude a major vessel – Procedure; Emergency surgery • Endarterectomy – Resection and removal of the lining of an artery – Removal of plaque from carotid, femoral, and popliteal arteries Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Vascular Surgical Procedures Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Hemodynamic Monitoring • Assesses volume, pressure of blood in heart, vascular system via surgically-inserted catheter – Assess cardiac function, circulatory status; Detect fluid imbalances; Adjust fluid infusion rates; Evaluate client response to therapeutic measures • Direct BP monitoring: Catheter in peripheral artery • Central venous pressure (CVP); Pulmonary artery pressure (PAP); Pulmonary capillary wedge pressure (PCWP) Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. Nursing Process • Assessment – Client’s medical, surgical, and drug history – Physical examination – Client’s understanding – Vital signs; Measure intake and output – Signs and symptoms of potential complications – Neurologic assessment – Monitor IV therapy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Nursing Process • Assessment (Cont’d) – Prepare client for extensive diagnostics – Conduct general cardiovascular assessments – Obtain comprehensive surgical report from the anesthetist – Assesses blood pressure • Diagnosis, Planning, and Interventions – Deficient knowledge; Anxiety; Acute pain • Expected outcomes; Evaluation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 28. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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