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CARDIAC_SURGERY_0408

CARDIAC_SURGERY_0408 - CARDIAC SURGERY Karen L OBrien RN...

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CARDIAC SURGERY Karen L. O’Brien, RN, MSN Saint Xavier University School of Nursing
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CARDIAC SURGERY
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Cardiac Surgery: History First performed in 1967, CABG or myocardial revascularization Now, one of the most frequently performed operations, main surgical treatment for CAD, after medical management has failed Over half a million CABG performed annually in the U.S. Palliative, not curative : improved outcomes, QOL, survival
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Cardiac Revascularization Surgery: Types Coronary Artery Bypass Graft (CABG) or CABS Cardiac Valve Replacement Minimally Invasive Cardiac Surgery Off-Pump CABG Transmyocardial Laser Revascularization
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Cardiac Surgery: CABG-Anatomy Arteries and veins can be used as grafts Arteries have better patency rates than veins Arteries used for grafting: internal thoracic or internal mammary artery Veins used for grafting: saphenous
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Cardiac Surgery: CABG-Anatomy
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Cardiac Surgery: CABG-Anatomy
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Cardiac Surgery: CABG-Phases Pre-operative Intra-operative Post-operative: Intensive Care Intermediate Cardiac Care Home Care
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Cardiac Surgery: CABG- Pre-operative Care Pre-operative Teaching is of utmost importance for patient AND family Baseline Diagnostic Tests: Blood: CBC, electrolytes, BUN/CR, coagulation studies (PT/PTT), cardiac enzymes, Type and Cross CXR EKG PFT (if smoking hx or lung disease) Weight and Vital signs
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Cardiac Surgery: CABG- Pre-operative Care Other Diagnostic Tests: Cardiac Catheterization : test pressures in heart chambers, visualize structures with dye and x-ray Coronary Arteriography : in conjunction with CC, catheter into aorta, dye injected into coronary arteries Echocardiogram : US visualizing structures/movement, valves, chamber size, ventricular function Stress Test: determine cardiac status prior to surgery Chemical (dobutamine, persantine, adenosine) vs exercise Thallium Stress Test: radioactive isotopes, ischemic cells uptake less and slower d/t reduced coronary blood flow
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Cardiac Surgery: CABG- Pre-operative Care Other Diagnostic Tests: Venous Mapping: patency, size, length Doppler Studies : carotid arteries (high risk for stroke) Positron Emission Tomography (PET) Scan : non- invasive: detect , localize, describe the extend of CAD impairing blood flow to myocardium, identifies injured myocardium and viability of tissue for revascularization Cardiac MRI: (new) 3-D images, no dye injection or x-ray, can evaluate anatomy, contractility, perfusion, valve function
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Cardiac Surgery: CABG- Pre-operative Care Pre-operative Teaching Before Surgery: Tests, skin prep, NPO, C/DB, Incentive Spirometry, leg exercises, arrival time During Surgery: Type of procedure, time in OR, waiting area for family, how family will be contacted After Surgery: Name and location of ICU, External devices: ET tube and ventilator, NG tube, ECG monitor, pulmonary artery catheter, arterial line, pacing wires, chest tubes, foley catheter, IABP Procedures: ET tube suctioning, pain management, blood administration
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Cardiac Surgery: CABG- Pre-operative Care PRE-OP Nursing Diagnoses: Knowledge Deficit Anxiety
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