Use of Stents CABG Coronary Artery Bypass Graft 2 5 Grafts MIDCAB Minimally

Use of stents cabg coronary artery bypass graft 2 5

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A. Use of StentsCABG- Coronary Artery Bypass Graft(2 - 5 Grafts)MIDCAB- Minimally Invasive Direct CABG - small incisions between the ribsRobot-Assisted Cardiothoracic SurgeryTrans-myocardial Laser Revascularization
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Pre-Operative Nursing CareNPOAllergiesConsent for procedureExplain post-op careBaseline labs
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Percutaneous Coronary Intervention (PCI) procedureUsed to relieve symptoms of angina, MI and high risk surgical clientsUsed to treat severe stenosis >50%Previous bypass graft occlusionsSingle or double vessel disease90% success but 20 - 40% re-occludePlacement of a coronary artery stent
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Nursing Care post Stent placementStents are placed to maintain patency of arterial lumen after angioplastyMonitor for re-occurence of chest pain - possible closure of vesselMonitor for bleeding at catheter insertion sitePossible reaction to dye Dysrhythmias
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Coronary Artery Bypass Graft (CABG) procedureAngina with >60% occlusion of left main coronary arterySevere 2 - 3 vessel diseaseAcute MIMI with failed Percutaneous Coronary Intervention (PCI)
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Nursing Care post CABG procedureA saphenous vein is harvested and sutured into the ascending aorta near the native coronary artery opening and then sutured to the coronary artery distal to the blockage.Risk for infection at the surgical sites.Monitor sutures at donor sites.Report excess drainage at sitesDressing changes as orderedAdminister antibiotics on time
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MIDCAB procedureMinimally invasiveA thoracoscope or robotic assistance is used for the procedure. Decreased risk for infectionProphylactic Antibiotics must be administered on time.Patient is on bed rest post procedure
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Post - Operative Nursing CareMonitor vital signs, HemodynamicsMonitor for Bradycardia or Heart BlocksBleedingDecreased urine outputPain managementMonitor graft donor site incision
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Question3. Match the medication in the left column with the rationale in the right column.___ NitroglycerineA. Reduce cholesterol level___ Morphine B. Inhibit cardiac response to physical activity___ Aspirin C. Dilate coronary arteries___ Beta Blocker D. Minimize pain, decrease workload___ Statin E. Prevent platelet aggregation
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Let’s review the CAD case study
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Myocardial Infarction
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Myocardial InfarctionEtiologyMyocardial tissue is damaged or destroyed in areas deprived of blood supply and O2 (ischemia) due to decrease coronary artery blood flowIrreversible myocardial cell death (necrosis) results
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Myocardial InfarctionSigns and SymptomsChest discomfort with lightheadedness, fainting, sweating, nausea or SOB
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Myocardial InfarctionSigns And SymptomsChest pain, chest pressure, fullness squeezing or pain lasting more than a few minutes not relieved by NitroglycerineNausea and VomitingSOB WeaknessShockDysrhythmiasAnxietyPain spreading to neck, shoulders or arms
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Myocardial InfarctionAffected sitesMost common: Anterior
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