coronary artery bypass graft surgery CABGSunil kumar
coronary artery bypass graft surgery, explanation of CABG on-pump and off-pump procedures, physiotherapy management after surgery. indications of CABG. description of the procedure, investigations before surgery, per operative and post operative management
coronary artery bypass graft surgery CABGSunil kumar
coronary artery bypass graft surgery, explanation of CABG on-pump and off-pump procedures, physiotherapy management after surgery. indications of CABG. description of the procedure, investigations before surgery, per operative and post operative management
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
Valular heart disease is very common in most of Afro Asian counteries mainly due to Rheumatic heart disease..Definitive treatment is surgery.which may be valve replacement or reapir. In this ppp I have discussed this subject in a simple way
Cardiac Rehabilitation has been defined as:
Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
Valular heart disease is very common in most of Afro Asian counteries mainly due to Rheumatic heart disease..Definitive treatment is surgery.which may be valve replacement or reapir. In this ppp I have discussed this subject in a simple way
Cardiac Rehabilitation has been defined as:
Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community
Double valve replacement surgery is better known as heart valve replacement surgery. It is performed to treat the heart by replacing a damaged valve with a healthy one. The valve replacement keeps the heart safe and sound from further damage or infection. The human heart consists of four valves: the mitral valve, the tricuspid valve, the pulmonic valve and the aortic valve. For more information visit at www.surgeryxchange.com
If you've had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery.
Prosthetic Heart Valves from Research Paperdocmutaher
Over the past sixty years, advancements in heart valve replacement surgery have revolutionized patient outcomes, enhancing both survival rates and functional recovery. Innovations in prosthetic valve design, surgical techniques, and multidisciplinary approaches have broadened the scope of treatment options for diverse patient populations. Today, minimally invasive procedures and primary valve repair techniques are commonplace in leading medical centers, ensuring tailored care for individual needs. Collaboration among heart valve teams enables comprehensive evaluation and personalized treatment plans, including the utilization of transcatheter therapies when suitable. Despite these strides, selecting the optimal valve prosthesis remains a complex decision, balancing durability against the risk of complications such as thromboembolism and the need for long-term anticoagulation. Thus, the pursuit of the ideal heart valve substitute continues, driving ongoing research and innovation in cardiovascular medicine.
Pulmonary stenosis (also called pulmonic stenosis) is when the pulmonary valve (the valve between the right ventricle and the pulmonary artery) is too small, narrow, or stiff. Symptoms of pulmonary stenosis depend on how small the narrowing of the pulmonary valve is
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.
Mitral valve repair is a procedure to treat narrowing or leakage of the mitral valve.
In this procedure damaged mitral valve is replaced by either a mechanical or bioprosthetic valve.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. INTRODUCTION
Blood that flows between different chambers of your
heart must flow through a heart valve. Blood that
flows out of your heart into large arteries must also
flow through a heart valve.
These valves open up enough so that blood can flow
through. They then close, keeping blood from flowing
backward.
The introduction of valve replacement surgery in the
early 1960s has dramatically improved the outcome of
patients with valvular heart disease
3. TYPES OF HEART VALVE
There are four valves in your heart:
Aortic valve
Mitral valve
Tricuspid valve
Pulmonic valve
The aortic valve is the most common valve to be replaced. The mitral valve is
the most common valve to be repaired. Only rarely is the tricuspid valve or
the pulmonic valve repaired or replaced.
4. VALVE REPLACEMENT SURGERY
Valve replacement surgery is the replacement
of one or more of the heart valves with either
an artificial heart valve or a bioprosthesis.
(Homograft from human tissue or xenograft
eg pig. )
5. PROSTHETIC HEART VALVE
Despite the improvements in prosthetic valve design and surgical procedures ,
valve replacement does not provide a definitive cure.
Prosthetic Valves are classified as tissue or mechanical
1. Tissue:(homograft,autograft,xenograft)
Made of biologic tissue from an animal (bio prosthesis or heterograft) or
human (homograft or auto graft) source
2.Mechanical(cageball,tilting disk,bileaflets)
Made of non biologic material (pyrolitic carbon, polymeric silicone substances, or
titanium)
Blood flow characteristics, hemodynamic, durability, and thromboembolic
tendency vary depending on the type and size of the prosthesis and
characteristics of the patient
6. HEART VALVE SURGERY
In most cases, heart valve replacement is an open heart operation. This
means that the surgeon opens your chest and heart to remove the
damaged valve. The new artificial (prosthetic) valve is then sewn into
place. In some cases, the valve can be replaced without opening the chest.
Called minimally invasive surgery, the damaged valve is replaced through
a small incision near the "breastbone" or under your right chest muscle.
7. MINIMALLY INVASIVE SURGERY
In which the surgeon replaces the valve
through small incision between two and four
inches in length rather than cutting a six to
ten inch incision down the center of sternum.
Minimally invasive surgery involves shorter
recovery time and more attractive cosmetic
results.
9. AORTIC VALVE REPLACEMENT
The aortic valve is between the left ventricle and the aorta
Aortic stenosis and aortic regurgitation probably makes the need for
aortic valve replacement.
The aortic valve is the most common valve to be replaced.
10. PERCUTANEOUS AORTIC CATHETER
BALLOON VALVULOPLASTY
In which the balloon is inflated fracturing
calcified nodes and increasing the size of the
aortic valve orifice.
But restenosis can occur approximately half of
the patient with in 6 months and balloon
valvuloplasty has been largely abandoned and is
reserved for only those candidates unstable for
surgery.
11. TRANS CATHETER AORTIC VALVE
REPLACEMENT (TAVR)
It is an alternative for high risk and older
patients (age about 75 years).
The catheter may be inserted through the
femoral artery or through a small incision in
the chest and then through a large artery
In TAVR which deliver a new valve to the site of
the diseased valve through a catheter.
Replacement valve is packaged in a way similar
to a stent.
12. AORTIC VALVE REPLACEMENT
PROCEDURE(OPEN HEART SURGERY)
Its carried under general anaestic
Aortic valve replacement is done through median sternotomy.
Once the pericardium has been opened the patient is put on a heart lung machine.
Once the patient is on bypass the surgeon removes the patient’s aortic valve and a mechanical or
tissue valve is put in its place.
Then the aorta will be closed , followed by taken off the heart lung machine.
Trasnsesophageal echocardiogram can be used to verify that the new valve is functioning
properly.
13. MITRAL VALVE
Mitral valve also known as the bicuspid valve or left atrio
ventricular valve. Which lies between the left atrium and
left ventricle.
Valve stenosis or valve regurgitation makes the valve to be
replaced.
Many mitral valves can be repaired instead of replaced,
especially for minimally damaged values.
According to American heart association, the aortic valve
and the mitral valve are the most commonly replaced
valves. Pulmonary and tricuspid valve replacements are
fairly uncommon in adults.
14. MITRAL VALVE REPLACEMENT
Mitral valve replacement is a surgical procedure in which a
patient’s diseased mitral valve is replaced by either a
mechanical or bio prosthetic valve.
15. MITRAL VALVE REPLACEMENT PROCEDURE
Patient receiving general anaesthesia.
Incision is made vertically through sternum
Heart is exposed , reroute blood to a heart lung machine
An incision is made in the left atrium to expose the mitral valve
The valve is then replaced with either a biological or mechanical valve.
Left atrium is then closed and the patient weaned from cardiopulmonary bypass.
After two days the patient may be taken out of intensive care unit.
16. TRANS CATHETER MITRAL VALVE
REPLACEMENT
Trans catheter mitral valve replacement devices are in development.
Mitral valve anatomy is much more complex than the aortic which is
why it has taken more time to develop a trans catheter valve and
deployment system.
Mitral valve repair can be done by minimum invasive surgeries or by
robotic surgeries.
17. TRICUSPID VALVE
The tricuspid or right atrio ventricular valve lies between the right atrium
and the right ventricle.
If the valve is not functioning properly it can affect the blood flow to the
lungs(pulmonary artery) and rest of the body.
Tricuspid valve can be affected by rheumatic fever, congenital abnormalities
etc.
Operations on the tricuspid valve are usually performed in conjuction with
treatment of some other valvular heart disease.
18. TRICUSPID VALVE REPLACEMENT
PROCEDURE(OPEN HEART SURGERY)
Tricuspid valve operations are performed by a mid line sternotomy
↓
Cardiopulmonary bypass is established
↓
The heart arrested by a cold cardioplegic solution administered through a
catheter in the coronary sinus
↓
The tricuspid valve is excised and mechanical or bio prosthetic valve is
attached.
↓
The valve replacement is completed by tying sutures securely.
19. RESEARCH EVIDENCE
According to the article published by Khaled in European journal of cardio
thoracic surgery he stated that the tricuspid valve replacement on a beating heart
has good outcome or reduces the morbidity and mortality rates.
22/01/18
20. MINIMALLY INVASIVE VALVE- IN
VALVE PROCEDURE
Minimally invasive methods which involve smaller incision than those
used in open heart surgery.
Minimally invasive valve in valve procedure is used to replace an
existing replacement tricuspid valve that’s failing.
In this procedure catheter is inserted in a large(femoral) artery and
threaded to the heart .
Once in place a new replacement valve is inserted with in the existing
valve.
21. RESEARCH EVIDENCE
According to the research conducted by kick sung, they found that in tricuspid valve
replacement a low operative mortality can be achieved through optimum perioperative
management in the current area.
22/01/18
22. PULMONARY VALVE
Pulmonary valve is the semilunar valve of the heart that lies between the
right ventricle and pulmonary artery.
Pulmonary valve replacement may be needed in case of pulmonary
regurgitation ,TOF and pulmonary stenosis.
Surgery on the pulmonary valve is always performed in conjunction
with another cardiac procedure usually a repair of mitral valve.
23. PULMONARY VALVE REPLACEMENT
PROCEDURE(ROSSPROCEDURE)(OPEN HEART
SURGERY)
Incision is made in the sternum and allowing the access to sternum.
Heart lung bypass is used.
It is necessary to stop your heart from beating during the procedure and
valve repair or replacement is done on a motionless, blood less field.
24. TRANSCATHETER PULMONARY VALVE
(ROSS PROCEDURE)THERAPY(TPV)
TPV therapy treats narrowed or leaking pulmonary valve with out open heart
surgery.
In TPV therapy a thin catheter with a specially designed heart valve inside is
inserted into a vein and pushed up to your heart.
↓
Were the new valve will replace the old one.
↓
The new valve will then able to help the heart to pump blood correctly.
↓
TPV therapy does not replace open heart surgery but it means to delay the
need for next surgery.
25. WHICH VALVE IS BEST MECHANICAL
OR BIOLOGICAL VALVE?
Made from man made material.
Example
starr-Edwards ,cromie,sutter.
More durable and last longer than
biologic valves.
Increased risk of thrombo embolism,
necessitating long term anticoagulation
therapy.
The main complication is haemorrhage
from the use of anticoagulants.
BIOLOGIC VALVES
Constructed from bovine, porcine
and human cardiac tissues and
usually contain some man made
materials. Examples cadaver valve.
Less durable due to the tendency for
early calcification, tissue
degeneration and stiffening of the
leaflets
Does not require anticoagulation
therapy due to their low
thrombogenecity.
26. PROSTATIC VALVE
COMPLICATIONS/COMPLICATIONS OF
SURGERY
Paravalvular leaks
bleeding
Thrombosis
Infective endocarditis and other infections
Valve dysfunction in replacement valves.
Heart attacks
Heart rhythm problems
Rejection
28. VALVE REPAIR OR REPLACE
When possible its generally best to repair a valve and preserve a
persons own tissue in the heart.
How ever when the tissue is too damaged a replacement valve may be
used from another human heart an animal or a mechanical valve.
29. TECHNIQUES OF HEART VALVE REPAIR
1.Percutaneous trans luminal balloon valvuloplasty.
PTBV procedure is generally indicated for older adult patients and for
patients who are poor surgery candidates.
Balloon valvuloplasty is used for mitral, tricuspid and pulmonic stenosis
and less often for aortic stenosis.
2.Mitral valve annuloplasty.
30. PERCUTANEOUS TRANSLUMINAL
BALLOON VALVULOPLASTY
The procedure is usually performed in cath LAB.
Involves threading a balloon tipped catheter from the
femoral artery or vein to the stenotic valve.
Balloon may be inflated in an attempt to separate the
valve leaflets.
31. MITRAL VALVE ANNULOPLASTY
Mitral valve annuloplasty is a surgical technique for the
repair of leaking mitral valves.
Due to various factors the two leaflets normally involved in
sealing the mitral valve to retrograde flow may not coapt
properly.
Surgical repair typically involves the implantation of a
device surrounding the mitral valve, called annuloplasty
device, which pulls the leaflets together to facilitate
coaptation and aids to re-establish mitral valve function
32. ADVANTAGES OF VALVE REPAIR
V/S REPLACEMENT
1.Preservation of heart function by retaining hearts natural shape and
function.
2. Freedom from life long medication.
3.Longer durability ;studies have shown that 15 years after surgery 82 to 87
percent of repaired valves compared with 72 to 82 percent of replacement
valves.
33. NURSES RESPONSIBILITY
Enquire whether patient is pregnant.
Ask the patient to stop smoking(if any)
For one week period before surgery the patient may be
asked to stop taking medicines that make it harder for
patients blood to clot eg aspirin.
Conform with physician/ surgeon which drug patient has
to still take on the day of surgery.
Prophylactic antibiotics may be initiated before surgery.
Periodic monitoring of all vital signs are necessary after
surgery.
34. BIBLIOGRAPHY
Woods ‘etal’.cardiac nursing.6th ed.wolters Kluwer;2010.p 707-713.
Lewis’s medical surgical nursing.elsevier;2011.page 876-877.
Internet