Graft sites/CABG approaches
Why are arterial grafts preferred over venous grafts when possible?
They remain patent longer, can withstand higher pressure
Postop CABG patient presents with temperature of 94F. The patient is seen shivering. What medication should be given and why.
should give sedatives to stop shivering
shivering increases oxygen demand and cardiac workload/stress on heart
This complication is suspected when chest tube output suddenly decreases and the patient becomes hypotensive with rising CVP.
What is cardiac tamponade
This intervention helps prevent atelectasis following cardiac surgery.
what is suctioning, IS, TCDB
In what ways can the nurse ensure fluid balance for a postop CABG patient
Swan numbers
UOP: at least 30ml/hr
assess electrolytes
Monitor H+H and provide replacements if needed
What patient position must be avoided when SVG site accessed
dont cross legs
What medication can be given in low doses improve renal and mesentery vasodilation. What is important to monitor when giving this medication
- high doses can cause severe tachycardia
- make sure patients HR is less than 70
Postop CABG patient is most at risk for these dysrhythmias
Sinus tachycardia (treat cause-fever, pain, etc)
Afib (usually PAC's before, imp: prophyl BB)
Heart blocks (imp:pacing?)
What must the nurse educate the postop CABG patient when asked when it is okay to resume sexual activity
resume activity when 2 flights of steps w/o symptoms
explain the reason why a post op MIDABG would be in great deal of pain
this method goes through the ribs which can harm the nerves and create painful postop nerve pain
This medication is commonly used post-CABG, especially with SVG grafts, to reduce the risk of graft occlusion by preventing platelet aggregation.
What is Aspirin
A patient with low cardiac output postoperatively is started on dobutamine. This medication primarily improves cardiac output by affecting this physiologic mechanism.
What is increased myocardial contractility?
Six hours postoperatively, chest tube drainage is 250 mL in one hour and continues at this rate. This complication should be suspected.
What is postoperative hemorrhage?
Post op CABG patient needing fluid replacement with an low H+H. What is the suspected fluid replacement?
PRBC's
Overt (obvious): oozing sites, increased chest tube drainage, low BP, high HR, etc.
Covert (hidden): subtle tachycardia/hypotension, chest tube not draining
This CABG approach uses cardiopulmonary bypass and requires the heart to be temporarily stopped.
What is on-pump CABG
The OR nurse is recovering an on-pump CABG patient. What medication will the nurse need to give to reverse the anticoagulation of the patient
protamine sulfate
Post op CABG patient presenting with oliguria, poor peripheral vascular status, decreased level of consciousness and low CO. What is the suspected complication and what interventions are needed?
HF
- imp: +inotropes (lowest amount to prevent graft site stress/heart workload)
A postop CABG patient returns to the unit intubated and sedated. To gather an accurate neurological assessment, what intervention can the nurse implement
pause or titrate the sedation down
A nurse is educating the postop patient regarding incisional vs. anginal pain. How should the nurse describe each so the patient can identify it?
Incisional pain: localized, increased with movement/breathing, does not radiate
Anginal pain: radiates, not localized, not affected by breathing/movement
A patient with renal failure is to have CABG in the soon future, which CABG approach/method should be avoided and why
Should avoid on pump because it is hard on the kidneys, possibly requires the patient post op for temporary dialysis
List the vasodilators and what are the precautions with each one
Nitroglycerin: tolerance w/in 48 hours, contraindicated if head trama/increased ICP, erectile dysfunction medications
Nitroprusside: only short term use, metabolizes into cyanide
Clevidipine: mixed in phospholipids-contraindicated if egg/soy allergy, need to also monitor triglyceride levels, very short 1/2 life (1 min)
A post-CABG patient reports chest pain that worsens with inspiration and improves when leaning forward several days after surgery. 12 lead shows global ST segment elevation. This complication is suspected and what interventions to treat it
What is pericarditis?
treatment:
- bacterial: ABX, no steroids
- not bacterial: NSAIDS/steroids
-pericardial window
Postop CABG patient comes to ICU with temp of 94.5F. The charge nurse observes his nurse rewarming the patient at 1.9F/hr. What education needs to be given to this nurse and why?
Rewarming the patient must be at 1.8F/hr and not faster
- fast: painful, drastic SVR drop=drastic BP drop
What signs should the nurse monitor for when postop CABG patient is suspected with cardiac tamponade
- CXR: widened mediastinum
- Swan/BP numbers equalize
- Becks Triad: JVD, muffled heart sounds, Pulsus paradoxus (decreased BP w/inspiration)
- decreased UOP, suddent chest tube drainage cessation