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<3surgery/pacemakers
NP4 Test 2
| Question | Answer |
|---|---|
| Properative Care for cardiac surgery includes (initial, night before, morning of) | -Initial: Cath, labs, echo, 12 lead EKG, PFT's, T&C -Night before: Shower, NPO after mn, pre-op teaching, consents, psychological support, sleeping aid -Morning of: pre-op meds, IV starts, pyschological support |
| Primary prevention of cardiac surgery- surgical procedures | coronary artery bypass (CABG), valve repair/replacement, aneurysm resection (cardio myopathy), repair of septal defects, antiarrhytmic surgery, congenital repair, cardiac transplantation |
| Leading contributor to coronary artery disease is | artherosclerosis which leads to CABG |
| Open thoracotomy consists of | vein removal (usually the saphenous vein (leg) but can use internal mammary artery, attached proximal and distal to occlusion |
| How effective (time wise) is the saphenous vein and internal mammary artery after thoracotomy | Saphenous vein- 1 yr. = 90% open 10 yrs. < 50% open Mammary atery- 10 yrs. 90% patency; larger vessel, lasts longer but more difficult sx |
| The heart lung machine "cardiac bypass machine" | provides ability to stop the heart, circulates and airates the blood, run by a perfusionist, cannulation of inferior and superior vena cava and the aorta, pt. is 100% heparinized, during sx 95F to decrease oxygen demand, causes 3rd spacing |
| Complications of CABG include | low CO from fluid cross shifting & clamping aorta, Acute MI, dysrthmias afib, hemorrhage big deal, pulmonary embolus, electrolye imbalbance (K,Mg,Ca), cerebral infarction, ARDS, renal failure, cardiac tamponade |
| Cardiac output | amt of blood ejected from the heart in one minute (4-8 L/min) |
| Stroke volume | amt of blood ejected from the ventricle with each contracion (60-130 ml/beat) |
| Cardiac Output = (formula) | HR x SV |
| Factors that effect cardiac output includes | heart rate, stroke volume, preload (stretch), contractility (force), afterload (pressure) |
| Drugs effecting cardiac output | *Dopamine: Low -(1-5mcg) increases renal artery perfusion Mod -(5-10 mcg) increases CO by up HR & contractility High -(>10mcg) vasoconstriction (up bp) *Dobutamine: increases contractility, therefore CO w/o increasing HR, 2-20mcg, titrated to pt respons |
| Valve replacement | *longer than bypass sx Either biological (human, swine, bovine) or mechanical (ball-n-cage, bi-leaflet, tilting disc) |
| Intra-Aortic ballon pump (IABP) is | counterpulsation device, sits in the descending aorta, inflates when the ventricles are resting, forces blood back toward the coronary sinuses, assist to refill the coronary arteries, for pt. with poor CO and servere pulmonary |
| Indications for intra-aortic ballon pump (IABP) | LV failure, mechanical dysfunction secondary to AMI, uncontrolled ventricular arrhythmias, unstable angina, septic/cardiogenic shock, prophylactically |
| What does a pacemaker do? | initiate a "P" wave (atrial contraction), initiate a "QRS" (ventricular contraction), or both |
| What are pacemakers made out of? | lithium |
| Pacemaker parts include | *the generator- power source *the brain- electronic circuit *the lead- screw into ventricle or atrium *the electrode |
| Indications for a pacemaker include | *slow rates: bradycardia (symptomatic), Type 1-2 degree AVB (wenckebach),Type 2 AVB (classical), Complete HB, Bifasicular blocks, A-fib w slow ventricular response *Fast rates: Tachycardia (PAT, A-flutter, A-fib) |
| Types of pacing includes: | Trancutaneous (Endoardial) outside heart, Epicardial (Myocardial) transvenous inside heart, Esophageal |
| Asynchronous pacing | fixed rate pacing, extremely dangerous; rarely seen |
| Demand/Inhibit pacing | fires as needed |
| Capture pacing | causes atrial/ventricular contraction |
| Sense/sensitivity | ability of the pacer to see the electrical impulse of the heart |
| Threshold | least amt. of electrical energy to create capture |
| Type's of pacemakers include | *single channel- can only do one function *double channel- can pace both |
| Pacemakers are manipulated by: | output- milliamps (mA) controls the speed of electrical impulse going down to heart sensitivity- millivolts (mV) |
| what does Identification Coding (ICHD) first three letters identify? | 1. chambers paced 2. chamber sensed- chamber watched 3. mode of response |
| For the first idenification coding (ICHD, chamber paced what are the abbrv. used? | V- ventricle A- atrium D- dual (A & V) O- none |
| For the second identification coding (ICHD), chamber sensed what are the abbrv. used? | V- ventricle A- atrium D- dual (A&V) O- none |
| For the third indentification coding (ICHD), mode of response whar abbrv. are used? | T- triggered I- inhibited D- dual triggered/inhibite O- none |
| Failure to capture of a pacemaker means | pacemaker fires but doesnt make heart jump |
| Failure to pace of a pacemaker means | dead battery, broken lead |
| Failure to sense/oversensing of a pacemaker means | pacemaker needs to be adjusted |
| Pacemaker mediated tachycardia indicates | a runaway pacemaker caused by magnuts |
| Diaphragmatic/muscle stimulation indicates | too much voltage |
| Patient teaching for pacemaker consists of | *daily pulse check *incision cleanliness *avoid lifting, tugging, pulling *no swimming *microwaves *avoid batteries/magnetic feilds *security device *"medi-alert" band |
| Indications for an automatic internal cardiac defibrillator (AICD) includes | *those at risk for sudden cardiac death *documented recurrant VT *structural heart disease *CAD *Poor LV function *cardiomyopathy |
| Placement of AICD (automatic internal cardiac defibrillator) includes | Endocardial- lg. vein to heart Epicardial- actually sew pads onto heart |
| Nursing managment for AICD (automatic internal cardiac defibrillator) includes | *in emergency* -turn on/off (dougnut magnut) "on" high pitched/random beats "off" constant r-wave tones -VT or Vfib if "on" observe pt, if "off" or "ineffective" follow emergency procedures |
Created by:
stilsl
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