CARING FOR PT’S UNDERGOING CV SURGERY

CHAPTER 35

OVERVIEW Before the 1950s, few attempts

at cardiac surgery were made. Initially, hypothermia and crude

mechanisms for oxygenating blood outside the body were used.

In the 1960s, the technique for mechanically circulating and oxygenating blood outside the body, called extracorporeal circulation or cardiopulmonary bypass (Fig. 35-1) pg. 531

OVERVIEW

Removing blood from the venae cavae, circulating it through an oxygenator, and returning it to the aorta or femoral artery provides a nearly bloodless area while the beating heart is stopped.

Cardiac Surgical Procedures

Cardiac surgery is used to correct and treat various cardiac disorders.

It is done to revascularize the myocardium, repair or replace cardiac valves, repair ventricular aneurysm, remove heart tumors, manage heart trauma, and replace the heart with one from a human donor.

MYOCARDIAL REVASCULARIZATION Myocardial revascularization refers to

surgical techniques that improve the delivery of oxygenated blood to the myocardium for clients who have CAD.

It is accomplished by performing one or more coronary artery bypass grafts.

CABG improves myocardial oxygenation by bypassing or detouring around the occluded portion of one or more coronary arteries with a relocated blood vessel.

MYOCARDIAL REVASCULARIZATION The saphenous vein in the leg is the

vessel most often used for grafting. It is harvested by making a long incision

on the medial aspect of the leg or by removing the vein endoscopically through one to three small (1 inch) leg incisions. (fig. 35-2).

MYOCARDIAL REVASCULARIZATION

CABG is reserved for client with CAD who are not candidates for less invasive procedures like PTCA.

MYOCARDIAL REVASCULARIZATION CABG performed when: (1) the client has multiple coronary

artery occlusions (2) the atheromas are calcified and

noncompressible (3) the anatomic location of the

occlusion(s) interferes with the safe insertion of a coronary artery catheter.

Vascular Grafts pg. 536

Vascular Grafts: Just as grafts are used to bypass a disease section of a coronary blood vessel, vascular grafts are used to bypass or replace diseased sections of major systemic blood vessels such as the aorta or femoral arteries.

The replacement graft may be made of synthetic fiber, such as Dacron or Teflon, or may be human tissue harvested from cadavers.

Embolectomy & Thrombectomy Embolectomy & Thrombectomy: when

thrombi or emboli occlude a major vessel, a thrombectomy (removal of a thrombus) or embolectomy (removal of an embolus) is performed.

The vessel is opened about the clot, the clot is removed, and the vessel is sutured closed.

May be emergent surgery because complete occlusion results in loss of blood supply to an area.

ENDARTERECTOMY

Endarterectomy is the resection and removal of the lining of an artery.

This type of surgery is performed to remove obstructive atherosclerotic plaques from the carotid, femoral, or popliteal arteries. (fig. 35-10 pg. 537)

NURSING PROCESS

ASSESSMENT: Obtains medical and surgical hx. Performs physical exam Determines drug allergies Weigh the client Records V/S and measures I & O Prepares for extensive diagnostic testing

NURSING PROCESS

After surgery: Palpate the peripheral pulses or uses a

doppler ultrasound device if the pulses are not palpable.

Check for inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremity, or skin mottling.

Asses BP and pulse rate in both arms after thoracic surgery.

Inspect IV sites and infusions

NURSING PROCESS

Hourly I&O Neurologic assessment every 30 minutes

(LOC, pupils, movement in both arms and legs, verbal response, and status or orientation)

Care Plan

Go over the care plan on pg. 538 –540.

Client and family teaching 35-1 pg 541.

Nutritional, pharmacologic and gerontologic considerations.