Exam 24: Cardiac Surgery

Formerly,ventricular assist devices were reserved for those patients who could not be weaned from CPB after open-heart operations,or who had end-stage cardiomyopathy.Current indications and choices have expanded and a variety of active and passive devices are available to support the circulation for short-,intermediate-,and long-term support.Select the statement that best describes a passive method of assisted circulation.

The temporary substitution of a pump oxygenator for the heart and lungs allows the surgeon to stop the heart and perform cardiac procedures under direct vision in a relatively dry,motionless field.It also allows the surgeon to manipulate the heart without the risk of producing ventricular fibrillation and reduced cardiac output that jeopardize perfusion to the myocardial,peripheral,and cerebral tissues.In traditional cardiopulmonary bypass (CPB),systemic venous return to the heart flows by gravity drainage through cannulae placed in the superior and inferior venae cavae or through a single two-stage cannula in the right atrium into tubing connected to the bypass machine.Blood is oxygenated,filtered,warmed or cooled,and pumped back into the systemic circulation through a cannula placed in the:

Identify the correct path of the cardiac conduction system.

An aneurysm of the left ventricle (LV)can develop after a severe myocardial infarction.The affected area of the myocardium is replaced by thin scar tissue that can rupture.The LV undergoes remodeling when the scar stretches as a result of the left ventricular pressure and forms an aneurysm.Left ventricular aneurysmectomy (LVA)is the excision of an aneurysmal portion of the left ventricle.LVA is a form of left ventricular reconstruction undertaken to optimize cardiac function.Select the appropriate nursing actions in preparation for LVA surgery.

During the preoperative nursing assessment for a patient scheduled for cardiac surgery,the perioperative nurse reviews the patient's medication history with particular attention to medications that can affect the surgery or cause complications.Select the true statement about specific medications that can affect surgery or cause complications.

Among the treatment options for tricuspid valve disease are suture annuloplasty,ring annuloplasty,and valve replacement with either a biologic or a mechanical prosthesis.Like the mitral valve,the tricuspid annulus is saddle-shaped and techniques to repair the valve should consider this anatomic configuration for optimal repair.Patients with significant tricuspid stenosis,regurgitation,or failed tricuspid (suture or ring)annuloplasty may require insertion of a prosthetic biologic or mechanical valve.Because there are no specific tricuspid prosthetic valves available,what type of prosthetic graft would be created or implanted?

In the pulmonary circulatory system,blood is pumped from the right ventricle (RV)through the pulmonary valve into the main pulmonary artery (PA).The PA divides into the right and left pulmonary arteries,which further subdivide into the arterioles and capillaries of the lungs.Where does the blood from the lungs flow next?

Disturbances of the conduction system affect the rate,rhythm,and effectiveness of the contracting heart.Surgical techniques have been developed to treat a variety of supraventricular dysrhythmias and both ischemic and nonischemic ventricular tachydysrhythmias.Preprocedural electrophysiologic mapping of the patient's conduction pathways identifies and locates aberrant pathways,or ectopic foci.A catheter is inserted percutaneously into the femoral vein or artery and threaded retrograde to the right or left atrium and ventricle.Various areas of the heart are tested in an attempt to reproduce the dysrhythmia;then the area of the heart where the rhythm disturbance originates is ablated.What directed energy source is employed to produce this selective ablation effect?

Thoracic aortic aneurysmectomy is excision of an aneurysmal portion of the ascending aorta,aortic arch,or descending thoracic aorta and replacement with a prosthetic graft,valve-graft conduit,or intra-aortic prosthesis.Aneurysms may be caused by atherosclerosis,trauma,infection,or cystic medial degeneration.What presenting conditions will indicate that surgical intervention is necessary?

This retractor is used to elevate the sternal border to expose the:

Select the diagnostic test that represents an invasive cardiac study.

During the preoperative assessment of an adult with a previously corrected congenital heart defect,the perioperative nurse should be aware of anatomic anomalies associated with the original defect,or its subsequent repair,that may alter the current surgical plan for a patient who had prior pediatric cardiac surgery.What is an appropriate nursing response when the assessment reveals the adult patient has undergone prior pediatric cardiac surgery? Select all that apply.

Camilla Armstrong,a 59-year-old woman with multiple prior cardiac procedures for congenital cardiac anomalies at birth,is scheduled for an open approach coronary artery bypass graft.During the preoperative interview and assessment,the perioperative nurse reviewed Camilla's hematologic tests,including a detailed coagulation profile to uncover possible hemorrhagic disorders.During the assessment the nurse learned of Camilla's many varied co-morbid conditions,including prior vascular procedures,fibromyalgia,diabetes,and eczema.The nurse noted one of Camilla's many nursing diagnoses as:Risk for Bleeding related to surgical incision(s),tissue dissection,altered coagulation function,and inadvertent hypothermia.As a result of this diagnosis,the nurse implemented measures to have blood available,measure and report blood loss,assist with the use of the autotransfusion system per protocol,and have topical hemostatic agents available.The patient will be free from excessive bleeding as evidenced by (select all that apply):

Complete heart block and bradydysrhythmias are the most common indications for pacemaker implantation.A permanent pacemaker (pulse generator and electrodes)initiates atrial or ventricular contraction,or both.What therapy might be used for acute forms of heart block and dysrhythmias that occasionally occur during and after cardiac surgery?

During Shelbie Wilson's valve repair,the surgeon realized that the torn leaflet was too damaged to be repaired and Shelbie would be better served with a bioprosthetic replacement valve.The perioperative nurse selected the implant from its secure storage area and transferred it in its storage solution to the sterile back table.What is the appropriate risk reduction strategy to prepare the bioprosthetic valve for implantation?

Select the noninvasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function.

A percutaneous method of instituting femoral vein-femoral artery CPB can be used for minimally invasive (or conventional open)procedures and in emergency situations where the environment is not conducive to traditional CPB methods.Select all the areas where percutaneous CPB would be indicated.

The internal mammary arteries are frequently used as grafts during coronary bypass surgery.Where are they located?

What statements regarding vascular clamps are true? Select all that apply.

An implantable cardioverter defibrillator (ICD)is an electronic device designed to monitor cardiac electrical activity and deliver prompt defibrillation.These devices are capable of pacing as well as defibrillating,consisting of a generator and sensing and defibrillator electrodes.Myocardial or thoracic subcutaneous patches may be added if the transvenous catheters alone do not adequately defibrillate the heart.Patients with previously implanted defibrillator patches may present for removal of a patch or patches.What nursing action would be appropriate during this procedure? Select all that apply.