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19 Cards in this Set
- Front
- Back
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Potential for heart failure interventions |
-assessment -monitoring for signs of poor organ perfusion -hemodynamic monitoring |
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What accounts for most in-hospital deaths after an MI? |
Cardiogenic shock |
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Cardiogenic Shock |
-necrosis of more than 40% of the L ventricle -tachycardia -hypotension -BP <90mmHg or 30mmHg under baseline -Urine output under 30mL/hr |
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Cardiogenic Shock manifestations |
-cold, clammy skin -poor peripheral pulses -agitation, restless, confusion -pulmonary congestion (ronchi) -tachypnea -continuing chest discomfort |
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Medical Management of Cardiogenic Shock |
-pain relief and decreased myocardial oxygen requirements through preload and afterload reduction -IV morphine -oxygen, intubation, ventilation -intra-aortic balloon pump -immediate reperfusion |
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Nursing Care after Percutaneous Transluminal Coronary Angioplasty (PTCA) |
-artery can re-occlude after surgery, look for symptoms -Monitor for acute closure of vessel, bleeding from insertion site, reaction to dye, hypotension, hypokalemia, dysrhythmias -long-term nitrate, CCB and aspirin therapy -Beta blocker and ACE inhibitor if MI -infusions of GPIIa/IIIb inhibitors |
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Indications for Coronary Artery Bypass Graft Surgery (CABG) |
-patient not responsive to medical treatment -disease progression is evident -patient symptoms -results of catheterization
-artery can re-occlude after surgery, look for symptoms
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CABG postop care |
Management of: -fluid and electrolytes (hypokalemia) -hypotension -hypothermia -hypertension -bleeding -cardiac tamponade -altered LOC -pain |
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How long after surgery do you look for signs/symptoms of re-occlusion? |
24-48 hours |
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S/S of cardiac tamponade |
* Anxiety, restlessness
* Sharp chest pain that is felt in the neck, shoulder, back, or abdomen * Chest pain that gets worse with deep breathing or coughing * Problems breathing * Discomfort, sometimes relieved by sitting upright or leaning forward * Fainting, light-headedness * Pale, gray, or blue skin * Palpitations * Rapid breathing * Swelling of the abdomen or other areas |
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Advantages of off-pump robotic heart surgery |
-smaller incision, less pain -shorter hospital stay -eliminate need of CPB machine -eliminate tremors of surgeon's hands -increases ability to reach inaccessible sites -improves depth perception visual acuity -greater patient acceptance -less anxiety for patient -use of robotics enable surgeons to perform telesurgery |
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Disadvantages of off-pump robotic surgery |
-computer failure -skills and ability of the surgeon -length of surgery time increased |
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After heart surgery, what to monitor for postoperatively? |
-ventilation provided for 3-6 hours postop -supraventricular dysrhythmias commonly occur -sternal wound infections -mediastinitis -postpericardiotomy syndrome (increased pain, elevated temp, pericardial friction rub may be audible, dysrhythmias) |
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#1 Postoperative complication |
atelectasis |
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MIDCAB |
minimally invasive direct coronary artery bypass (like CABG but less invasive, less recovery time)
don't need bypass for the heart during surgery
incision in ribcage area, rib removed during surgery and then replaced
more painful than CABG because of where the incision is in the rib area |
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Transmyocarial laser revascularization |
-for people who are not candidates for CABG or MIDCAB |
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Health Teaching/Risk Factor modification after heart surgery |
-incisional care -smoking cessation -diet control (low sodium, low fat, no caffeine) -complementary and alternative therapies -physical activity (increase per doctor's orders) -sexual activity (resume as advised by doctor) -control BP and glucose -cardiac medications -self-monitoring; seeking medical assistance if needed |
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Teaching after heart surgery: When to seek assistance? |
-HR less than 50 upon arising -Wheezing, difficulty breathing -weight gain of 3lbs in one week, or 1-2 lbs overnight -persistent NTG use -dizziness, fainting, SOB with activity |
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When to call 911 with heart patients? |
-chest discomfort not relieved after 20 mins, or 3 NTG tablets -extremely severe chest or epigastric discomfort with weakness, nausea or fainting -other associated symptoms such as fatigue or nausea |
