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Heart Surgery

Heart Surgery. Georgia Baptist College of Nursing NUR 351 Critical Care Nursing Dr. Kathy Plitnick. Coronary Artery Bypass Surgery. Definition Surgical revascularization procedure Restores blood flow to ischemic heart Goals Relieve symptoms Improve quality of life.

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Heart Surgery

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  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 • RBC’s 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

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