CARING FOR PTS UNDERGOING CV SURGERY

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CARING FOR PTS UNDERGOING CV SURGERY

• CHAPTER 35

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OVERVIEW

• Before the 1950s, few attempts at cardiac surgery
  were made.
• Initially, hypothermia and crude mechanisms for
  oxygenating blood outside the body were used.
• 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

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OVERVIEW

• 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.

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Cardiac Surgical Procedures

• Cardiac surgery is used to correct and treat
  various cardiac disorders.
• 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.

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MYOCARDIAL REVASCULARIZATION

• Myocardial revascularization refers to surgical
  techniques that improve the delivery of
  oxygenated blood to the myocardium for clients
  who have CAD.
• It is accomplished by performing one or more
  coronary artery bypass grafts.
• CABG improves myocardial oxygenation by bypassing
  or detouring around the occluded portion of one
  or more coronary arteries with a relocated blood
  vessel.

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MYOCARDIAL REVASCULARIZATION

• The saphenous vein in the leg is the vessel most
  often used for grafting.
• 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).

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MYOCARDIAL REVASCULARIZATION

• CABG is reserved for client with CAD who are not
  candidates for less invasive procedures like
  PTCA.

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MYOCARDIAL REVASCULARIZATION

• CABG performed when
• (1) the client has multiple coronary artery
  occlusions
• (2) the atheromas are calcified and
  noncompressible
• (3) the anatomic location of the occlusion(s)
  interferes with the safe insertion of a coronary
  artery catheter.

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Vascular Grafts pg. 536

• 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.
• The replacement graft may be made of synthetic
  fiber, such as Dacron or Teflon, or may be human
  tissue harvested from cadavers.

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Embolectomy Thrombectomy

• Embolectomy Thrombectomy when thrombi or
  emboli occlude a major vessel, a thrombectomy
  (removal of a thrombus) or embolectomy (removal
  of an embolus) is performed.
• The vessel is opened about the clot, the clot is
  removed, and the vessel is sutured closed.
• May be emergent surgery because complete
  occlusion results in loss of blood supply to an
  area.

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ENDARTERECTOMY

• Endarterectomy is the resection and removal of
  the lining of an artery.
• This type of surgery is performed to remove
  obstructive atherosclerotic plaques from the
  carotid, femoral, or popliteal arteries. (fig.
  35-10 pg. 537)

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NURSING PROCESS

• ASSESSMENT
• Obtains medical and surgical hx.
• Performs physical exam
• Determines drug allergies
• Weigh the client
• Records V/S and measures I O
• Prepares for extensive diagnostic testing

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NURSING PROCESS

• After surgery
• Palpate the peripheral pulses or uses a doppler
  ultrasound device if the pulses are not palpable.
• Check for inadequate tissue perfusion, such as a
  weak or absent pulse, cold or cyanotic extremity,
  or skin mottling.
• Asses BP and pulse rate in both arms after
  thoracic surgery.
• Inspect IV sites and infusions

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NURSING PROCESS

• Hourly IO
• Neurologic assessment every 30 minutes (LOC,
  pupils, movement in both arms and legs, verbal
  response, and status or orientation)

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Care Plan

• Go over the care plan on pg. 538 540.
• Client and family teaching 35-1 pg 541.
• Nutritional, pharmacologic and gerontologic
  considerations.