Adult Health II: Exam 1: Cardiac surgery/cath & ABGs

What is CABG?

Coronary artery bypass graft surgery used to bypass blocked coronary arteries

Why are CABG patients high infection risk?

Surgery is highly invasive and involves multiple incisions and graft harvest sites

What is the purpose of CABG?

To reroute blood flow around blocked coronary arteries

What vessels can be used for CABG grafts?

Internal mammary artery, radial/brachial artery, saphenous vein

What must nurses monitor after CABG with a saphenous vein graft?

Wound, infection, pulses above and below graft, leg color, and temperature

What limb findings after CABG require notifying the doctor?

Diminished pulses or limb that is pale, cool, or purple

Why are patients with 3-vessel disease not good stent candidates?

Too many vessels blocked, so they need CABG instead

What determines which graft vessel is used in CABG?

Doppler results and which vessel is most viable before surgery

How is LIMA commonly used in CABG?

Often combined with one peripheral graft (saphenous or radial)

Why is the LIMA graft preferred?

Only chest incision needed, lower infection risk, more pliable, near LAD, resists plaque, arteries stay open better, lower mortality

What is an advantage of radial/brachial artery grafts?

Easier to harvest and more resistant to atherosclerosis than vein grafts

What risks exist with radial/brachial graft harvest?

Same donor site risks as other peripheral vessels

What is the main advantage of the saphenous vein graft?

Long vessel that can be used for multiple grafts

What are risks of saphenous vein grafts?

Higher degeneration and occlusion risk plus infection, bleeding, and hematoma at donor site

What complications can result from cardiopulmonary bypass?

Hemodynamic instability, stroke, ileus, AKI, glucose instability, cardiogenic shock, sepsis

Why does hemodynamic instability occur after bypass?

Bleeding, fluid overload, or decreased cardiac output

Why can stroke occur after bypass?

Decreased mobility and instability, especially with many transfusions

Why can ileus occur after bypass?

Decreased gut motility, narcotics, and pressor use

Why can AKI occur after bypass?

Pressor use and unstable blood pressure

Why can glucose instability occur after bypass?

Shock response causes hyperglycemia or hypoglycemia

What is the first ICU priority after cardiac surgery?

Stabilize airway and breathing

What lines/drains must be checked post-op?

Swan-Ganz, chest tubes, external pacemaker, wound vac, and drains

What assessments are required immediately after surgery?

Attach monitors, assess vitals, check bleeding, labs, glucose, drips, cardiac output, PA pressures, and outputs

What outputs must be monitored post-op?

Chest tubes, drains, Foley urine output

What is cardiac catheterization used for?

Gold standard diagnostic test for CAD and acute MI

What ACT level is required before pulling a cath sheath?

Less than 150

How should the cath site be checked before removal?

With two nurses

How long must a patient lie flat after cath?

Two hours

What should be done if the cath site bleeds?

Apply pressure

What must be assessed after cath removal?

Circulation and pulses distal to the site

What are normal ABG values?

pH 7.35-7.45, CO2 35-45, HCO3 22-26

What does ROME mean in ABG interpretation?

Respiratory Opposite, Metabolic Equal

What meds can affect respiratory ABGs?

Opioids

What questions should be asked when reading ABGs?

Respiratory or metabolic, acidosis or alkalosis, and is there compensation

How do you determine respiratory vs metabolic on ABG?

Look at CO2 and HCO3

How do you determine acidosis vs alkalosis?

Look at pH

What values indicate respiratory acidosis?

pH

What values indicate respiratory alkalosis?

pH >7.45, CO2

What values indicate metabolic acidosis?

pH

What values indicate metabolic alkalosis?

pH >7.45, HCO3 >26, CO2 normal if uncompensated

What does full compensation mean on ABG?

Body corrected imbalance and pH is normal

What does partial compensation mean on ABG?

Both CO2 and HCO3 abnormal because other system is trying to help

What does uncompensated mean on ABG?

One system abnormal and the other normal