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Published byGeorge Bruce Modified over 8 years ago
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Heart Surgery Georgia Baptist College of Nursing NUR 351 Critical Care Nursing Dr. Kathy Plitnick
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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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Indications for Surgery Intractable Angina Left main stenosis Unsuccessful PTCA, thrombolytics VSD Risk Factor Modification
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CABG Procedure Midline sternotomy Anticoagulation Cardiopulmonary bypass Hypothermia induced Aortic cross-clamping – Cardioplegia Graft retrieval Wean from CPB Internal defibrillation Rewarming – Heparin reversal
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Cardiopulmonary Bypass Provides bloodless operative field CPB machine Venous reservoir, filters, oxygenator, heat exchanger, roller pump, sensors Physiologic Variables Hemodilution Hypothermia Hemodynamics
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Complications of CPB Coagulation altered RBC’s damaged Increased capillary permeability Microembolism Increased SVR Alteration in carbohydrate metabolism
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Post-operative Complications Myocardial infarction Low cardiac output state Hemorrhage Cardiac tamponade Dysrhythmias Thrombotic/embolic complications Respiratory complications Coagulation problems
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Post-operative Complications Renal dysfunction Fever/infection Altered CNS
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Nursing – Preoperative Care Psychological preparation Reduce anxiety Teaching ICU environment Incisions & dressings Awakening from anesthesia Expected discomfort Appearance Postop respiratory care Visiting hours
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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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