1. Cardiac surgery involves opening the chest and operating on the heart using a heart-lung machine to circulate blood and allow surgeons to operate while the heart is stopped. 2. Post-operative care focuses on promoting cardiovascular, respiratory, renal and neurological function while preventing complications like hemorrhage, infection, and low cardiac output. 3. Care involves careful monitoring, managing fluids and electrolytes, early mobilization, and health education prior to discharge about activity limitations, medication management, and follow-up care.

1. PRE & POST OPERATIVE CARE
OF PATIENT WITH CARDIAC
SURGERY

2. MEANING OF CARDIAC
SURGERY
It is an surgical procedure in
which the chest is opened and
surgery is performed on the
heart. The term "open" refers to
the chest, not to the heart
itself..

3. COMMON DISORDERS
REQUIRING CARDIAC SURGERY
•coronary artery disease
•aortic valve disease
•mitral valve disease
•Congenital heart disease

4. ANOTOMY OF HEART

7. TYPES OF CARDIAC SURGERY
:
Closed
Two types
Open Heart Surgery
Heart Lung Machine or Pump- oxygenator
Operate for longer time
Direct Visualisation

8. Cardiac Surgery- cardioplegia
• To achieve this, the patient is first placed on
cardiopulmonary bypass. This device,
otherwise known as the heart-lung machine,
takes over the functions of gas exchange by the
lung and blood circulation by the heart.
Subsequently the heart is isolated from the rest
of the blood circulation by means of an
occlusive cross-clamp placed on the ascending
aorta proximal to the innominate artery.

9. • During this period of heart isolation the heart
is not receiving any blood flow, and thus no
oxygen for metabolism. As the cardioplegia
solution distributes to the entire myocardium
the ECG will change and eventually asystole
will ensue. Cardioplegia lowers the metabolic
rate of the heart muscle thereby preventing cell
death during the ischemic period of time.

11. PURPOSES OF
HEART LUNG MACHINE
To provide the surgeon with a bloodless
operating field.
 To perform gas exchange functions.
 To filter, re-warm or cool the blood.
 To circulate oxygenated , filtered blood
back to arterial system.

12. TYPES OF OPEN HEART
SURGERY
valve repair
1. Valvular surgery
valve replacement

13. TYPES ….
2. Repair of congenital defects
ASD & VSD
Coarctation of aorta
Tetralogy of Fallot
3. Coronary Artery Bypass Graft (CABG)
Saphenous vein
Use of : Mamary veins
I M A
4. Heart transplant.

15. BEATING HEART SURGERY

16. COMPLICATIONS ….
1. Haemorrhage.
2. Shock
3. Cardiac tamponade
4. Renal Insufficiency & failure due to shock,
haemorrhage and arteriolar
vasoconstriction during ECC procedure.
5. Low cardiac output syndrome ( results
from heart failure & metabolic acidosis)

17. COMPLICATIONS..
6. Hypovolaemia
(due to increase in body temp)
7. Hypervolaemia ( from fluid overload)
8. Cardiac arrhythmias
( from potassium imbalance, hypoxia &
acidosis)
9. Pneumothorax ( inadequate lung expansion
resulting from blockage of chest tubes)

18. COMPLICATIONS…
10. Wound infection
11 . Embolisation leads to convulsions,
hemiplegia)
12. Stress ulcers.( Reaction of the body to
prolonged physiological stress).

19. PRE-OPERATIVE
PREPARATION
Psychological
4 aspects Physiological
Anatomical
Preoperative teaching

20. PSYCHOLOGICAL PREPARATION
Why? To relieve anxiety
Confrontation
3 Psychological stages Self reflection
Resolution
How?
1. Give verbal/ written information concerning health
care facility service.
2. Introduce patient / relatives to health professionals.
3. Reassure.
4. Encourage the person to express what he feels &
think

21. PHYSIOLOGICAL PREPARATION.
1. Laboratory Tests.
(Urine, Urea, Coagulation studies, Blood
grouping, Enzymes, Serum hepatitis, VDRL,
HIV)
2. Diagnostic Studies.
( ECG, Chest X-ray, Ecchocardiogram, Cardiac
catheterisation/ angiography.
3. Daily weight & vital signs, Apical – radial pulse
( to eatablish baseline data).

22. ANATOMICAL PREPARATION
1. Assessment of the teeth by dentist.
2. Skin shaving from neck to toe– Anterior & lateral
trunk.
3. Several showers with anti-microbial soap.
4. Skin prep. with betadine
5. Any skin lesion reported to surgeon
6. Enema in the evening.
7. REMEMBER
8. 1. Anaesthetist visit.
9. 4 donors to bleed on day of operation.

23. PRE-OPERATIVE TEACHING.
1. Chest physiotherapy & leg exercise by
Physiotherapist.
2. Explain location & importance of chest tubes.
3. Explain thet monitoring equipment will restrict
movement.
4. Explain that smoking increases chance post –
operative complications.

24. POST-OPERATIVE CARE.
Goals 0f Post – Op Care
1. Promote:
 CVS function & tissue perfusion.
 Respiratory , Renal & Neurologic functions.
 Fluid, Electrolyte, & Nutritional Balance.
 Rest, Comfort & Relief from pain.
 Early Movement & Ambulation
 Psychosocial Adjustment
2 Prevent:
 Post-operative Complications.

25. Intensive Care Unit
 Check & secure all connections for lines
& tubes.
 Connect endo-tracheal tube to ventilator
ECG to monitoring system.
Patient kept flat until systolic BP is
100mmHg---
Raised gradually & his response noted

26. Promote CVS Functions
1. Assess Arterial BP & record.
2. Irrigate Arterial line ( continuous or at interval)
with heparinised saline.
3. In general BP maintained at 20 mmHg above or
below baseline.
4. Assess all pulses.
Arrhythmias----- CHF
Shock ------Haemorrhage
PULSE Fear.
Fever
Hypoxia.

27. Continued…
Heart Block
Slow Pulse
Severe Anoxia
Apical –Radial pulse deficit Atrial Fibrillation
Absent Pedal pulses peripheral Emboli.
2. Assess CVP.
Hypervolaemia
CVP Ineffective myocardial contractions
CVP Hypovolaemia.

28. CVS Functions Cont….
3. Record temperature.
Infection
Temp. Haemolysis
Atelectasis
Shock
Temp. Cardiac
Decompensation
4. Immediate 12 Lead ECG
5. Observe carefully for abnormal ECG tracings.

29. Promote Respiratory Funct.
1. Adjust Rate, Tidal Volume, & O2 Level of ventilator.
2. Make sure the ventilator alarms are on & functioning
3. Observe whether persons assists the ventilator
( Usually assist light will come on)
4. Observe for dyspnoea
Airway Obstruction
Pain
Anoxia
Dyspnoea
Acidosis
Displaced Tube

30. When Patient is extubated.
1. Observe for respiratory distress.
2. Check rate, depth, & character of
respiration.
3. Note person’s colour & vital signs.
4. ABG to determine whether patient is
breathing adequately.

31. Prevent Pulmonary. Complications
1. Frequent turning & suctioning the intubated patient
2. Help non-intubated patient to turn, take deep
breaths & cough every two hours.
3. Chest physiotherapy to rid the lungs of secretions.
4. Report any abnormality from chest tubes.
 Measure drainage by collecting in calibrated
cylinders
 Abnornal findings include:
-- greater than 2 ml/ kg. bd.wt/ Hr.
-- sustained haemorrhage for more than 2 minutes.
-- Sudden cessation of chest drainage accompanied by
increased CVP, dyspnoea and oliguria.

32. Cont…
5. Milk chest tubes every hour to express clots.
Check
for kinks or bending.
6. Prophylactic antibiotics.
7. Daily portable chest X-ray until lung is
expanded.

33. Promote Fluid, Electrolye & Nutritional
Balance.
1. Prescribed i.v. fluids, blood and plasma expanders.
2. Sips of water every 4 hourly after extubation if
person is fully responsive & not nauseated.
3. Clear liquid first followed gradually by solid food.
4. Watch for signs of abdominal distension and
paralytic ileus.
5. Daily electrolyte studies to determine blood levels
of sodium, potassium and chloride
6. Obtain haemoglobin level, prothrombin time and
blood gasses daily .

34. Promote Renal Function.
1. Carefully observe & document
 Colour
 Volume --- Hourly for the first 8 to 12
hours.
2. Care of indwelling Foley catheter.

35. Promote Comfort & Rest.
1. Relieve pain and restlessness with comfort
measures and judicious administration of
pain medication.
2. Splint incision site during coughing and
deep breathing exercise.
3. Reassurance.

36. Early Movement & ambulation
1. Turning & Exercising.
-- Side to side at intervals for back care
-- Passive exercises and leg flexion every 2
hours.
2. Typical ambulation Schedule.
-- day after surgery : dangles leg over the side
of bed
-- 2nd. Day: sits on bed/ chair for short period.
-- 3rd to 5th. Day :.Begins to ambulate in room
-- 8th to 10th day: Fully ambulatory.

37. Discharge
Health education
Remember : 6/52 for sternotomy to heal.
1. Lift nothing during this period.
2. Not to drive for 6-8 weeks.
3. Individual’s arm not to bear weight while getting
out of bed or chair.
4. Diet: Low salt & Low cholesterol.
5. Teach person or significant others to check pulse
for regularity & rate. Report to physician for a
resting heart rate rise of more than 20 beats / min.
6. Teach person to inspect incision daily. (Betadine
swab).

38. Cont…..
7. Medications:
 Label all medications.
 Explain purposes & side effects
 Pt with prosthetic valve will continue
warfarin. Avoid use of aspirin… interferes with
warfarin
 Activities increased gradually within limits.
 Avoid strenuous exercise until exercise
stress testing.
 Increase walking time and distance each day.