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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 29: Caring for Clients Undergoing Cardiovascular Surgery
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• Purpose: Revascularize the Myocardium
– Repair, replace
• Cardiac valves
• Ventricular aneurysm
• Heart tumors; Heart trauma
• The heart itself
Cardiac Surgical ProceduresCardiac Surgical Procedures
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Is the following statement true or false?
The purpose for cardiac surgeries is to revascularize the pericardium.
QuestionQuestion
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False.
The purpose for cardiac surgeries is to revascularize the myocardium.
AnswerAnswer
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Cardiac Surgical ProceduresCardiac Surgical Procedures
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Myocardial RevascularizationMyocardial 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
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QuestionQuestion
Is the following statement true or false?
There are less potential complications if surgery occurs on a beating heart than if cardioplegia is utilized.
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AnswerAnswer
True.
There are less potential complications if surgery occurs on a beating heart than if cardioplegia is utilized, avoiding negative “pump consequences.”
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CABGCABG
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Myocardial RevascularizationMyocardial 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
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Myocardial RevascularizationMyocardial 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
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Myocardial RevascularizationMyocardial 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
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Myocardial RevascularizationMyocardial Revascularization• Valvular Repairs
– Heart valves need surgical repair when narrowed; Commissurotomy-thoracotomy procedure
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Myocardial RevascularizationMyocardial 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
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Myocardial RevascularizationMyocardial 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
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Aneurysm RepairAneurysm Repair
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Cardiac Surgical ProceduresCardiac 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
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Cardiac Surgical ProceduresCardiac 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
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QuestionQuestionIs the following statement true or false?
A transplanted heart beats at the same rate as a native heart.
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AnswerAnswerFalse.
A transplanted heart beats at a faster rate (100-110 bpm) than a native heart.
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Vascular Surgical ProceduresVascular 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
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Vascular Surgical ProceduresVascular Surgical Procedures
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Vascular Surgical ProceduresVascular 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
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Vascular Surgical ProceduresVascular Surgical Procedures
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Hemodynamic MonitoringHemodynamic 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)
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Nursing ProcessNursing 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
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Nursing ProcessNursing 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
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End of Presentation