Heart Surgery

1
Heart Surgery

• Georgia Baptist College of Nursing
• NUR 351 Critical Care Nursing
• Dr. Kathy Plitnick

2
Coronary Artery Bypass Surgery

• Definition
• Surgical revascularization procedure
• Restores blood flow to ischemic heart
• Goals
• Relieve symptoms
• Improve quality of life

3
Indications for Surgery

• Intractable Angina
• Left main stenosis
• Unsuccessful PTCA, thrombolytics
• VSD
• Risk Factor Modification

4
CABG Procedure

• Midline sternotomy
• Anticoagulation
• Cardiopulmonary bypass
• Hypothermia induced
• Aortic cross-clamping Cardioplegia
• Graft retrieval
• Wean from CPB
• Internal defibrillation
• Rewarming Heparin reversal

5
Cardiopulmonary Bypass

• Provides bloodless operative field
• CPB machine
• Venous reservoir, filters, oxygenator, heat
  exchanger, roller pump, sensors
• Physiologic Variables
• Hemodilution
• Hypothermia
• Hemodynamics

6
Complications of CPB

• Coagulation altered
• RBCs damaged
• Increased capillary permeability
• Microembolism
• Increased SVR
• Alteration in carbohydrate metabolism

7
Post-operative Complications

• Myocardial infarction
• Low cardiac output state
• Hemorrhage
• Cardiac tamponade
• Dysrhythmias
• Thrombotic/embolic complications
• Respiratory complications
• Coagulation problems

8
Post-operative Complications

• Renal dysfunction
• Fever/infection
• Altered CNS

9
Nursing Preoperative Care

• Psychological preparation
• Reduce anxiety
• Teaching
• ICU environment
• Incisions dressings
• Awakening from anesthesia
• Expected discomfort
• Appearance
• Postop respiratory care
• Visiting hours

10
Nursing Postoperative ICU Care

• Ventilation and Oxygenation
• Hemodynamics
• Regulate HR, rhythm, BP, CO
• Chest drainage Bleeding
• Urine output
• Temperature regulation
• Neurological status
• Postoperative pain