Exam #2: Cardiac Surgery Flashcards

1
Q

Valvular Heart Disease includes

A
  • Mitral Stenosis
  • Mitral Insufficiency (Regurgitation and Prolapse)
  • Aortic Stenosis
  • Aortic Insufficiency (Regurgitation and Prolapse)
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2
Q

Procedures for Valvular Heart Disease include

A
  • Valvular repair/reconstruction (nothing to repair insufficient valves therefore they may need valve replacement)
  • Valvular replacement:
    • mechanical valve (do not want in young females because they would have to be on long term anticoagulant therapy)
    • biological valves
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3
Q

Percutaneous Transluminal Balloon Valvuloplasty

A
  • Procedure for a stenotic, calcific aortic valve.

- Look at pictures on PowerPoint

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4
Q

Biological Heart Valves

A
  • Most common
  • Slow heart rate down
  • Sutured in place = risk for clotting. Therefore, they may need low molecular weight heparin for 6-12 weeeks
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5
Q

Aortic Aneurysms

A
  • Outpouching or dilation of the arterial wall.

- May involve the aortic arch, thoracic aorta and/or the abdominal aorta. (Most found in abdominal aorta)

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6
Q

True Aneurysm

A

Thinning of arterial wall that causes an outpouching

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7
Q

True Aneurysm: Fusiform

A

..

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8
Q

False Aneurysm

A

Protrusion (which is actually a clot) d/t torn part of artery wall

Look up better definition

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9
Q

Clinical Manifestations of Throracic Aneurysms

A
  • Thoracic aneurysms are often asymptomatic with the first sign being rupture
  • Symptoms may include pain in the back, neck, and substernal area that may only occur when lying supine
  • The client may experience dysphagia and dyspnea, stridor, or cough when pressing on the esophagus or laryngeal nerve
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10
Q

Clinical Manifestations of Abdominal Aneurysms

A
  • Abdominal aneurysms may also be asymptomatic until ruputre
  • The client may report a “heartbeat” in the abdomen when lying down
  • A pulsating abdominal mass may be present
  • Moderate to severe abdominal or lumbar pain may be present (severe pain may be a sign of impending rupture).
  • The client may experience claudication
  • Cool or cyanotic extremities may be noted
  • Systolic bruit may be heard
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11
Q

Dissecting Aneurysms: Clinical Manifestations

A
  • Present with sudden, severe, and persistent pain described as “tearing” or “ripping” in the anterior chest or the back
  • Pain may extend to the shoulder, epigastric area, or abdomen
  • Pallor, sweating, and tachycardia will be evidence
  • Initially the client may have an elevated BP that may be different in one arm from the other
  • Possible syncope and paralysis of lower extremities may be present
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12
Q

Complications of Aortic Aneurysm: If rupture occurs posteriorly into the retroperitoneal space,

A
  • Bleeding may be tamponaded by surrounding structures, preventing exsanguination and death.
  • Patient often has severe back pain and may or may not have back or flank ecchymosis
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13
Q

Complications of Aortic Aneurysms: If rupture occurs anteriorly into the abdominal cavity,

A

Death from massive hemorrhage

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14
Q

Aortic Aneurysm: Diagnostic Studies include

A
  • Chest x-ray
  • Ultrasound
  • CT scan
  • MRI
  • ECG
  • Angiography
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15
Q

Aortic Aneurysm: Overall Goals

A
  • NO RUPTURE
  • Normal tissue perfusion
  • Intact motor and neurologic function
  • No complications of surgical repair
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16
Q

Treatment for Aortic Aneurysm

A
  • Surgical repair is aneurysm is over 5cm.
  • Conservative therapy for those with an aneurysm <5 cm: Decrease blood pressure (systolic between 90-92) using ACE inhibitors, etc.
17
Q

Role of Nurse in Preoperative Teaching of Patient Undergoing Cardiac Surgery

A
  • Appearance of patient after surgery and reasons
  • Incision and chest tube care
  • Pain and discomfort management
  • Coughing and deep breathing and use of incentive spirometry
  • Importance of early mobilization and progression
18
Q

Aortic Aneurysm Surgery: Intraoperative Phase

A
  • Surgical approach
  • Cardiopulmonary Bypass
  • Completion of surgery
19
Q

Early complications After Cardiac Surgery:

A
  1. Cardiovascular:
    - Postop Bleeding
    - Cardiac Tamponde
    - Myocardial Depression
    - Myocardial Infarction
    - Dysrhythmias
  2. Pulmonary
  3. Renal (i.e AKI)
  4. GI (i.e paralytic ileus)
  5. Endocrine (i.e adrenal insufficiency)
  6. Infection
20
Q

Key Assessment Areas: Early Postoperative Period of Cardiac Surgery

A

-Assess VS, ECG monitor, ABC survey, neuro status
-Assess peripheral circulation and sensation
-Assess incisions, chest tube systems
-Assess hemodynamic parameters
-Assess fluid, electrolyte, and coagulation status (UO!! Because may have decreased perfusion to kidneys)
-Assess rewarming efforts
Assess for pain
-Monitor for complications