Term
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Definition
Blood unable to escape from pericardial/medaistinal space resulting in an increased pressure on the heart
S/S
hypotension
increasing CVP/PAP pressure
Low CO
Muffled heart sounds
narrowing pulse pressure
vasoconstriction peripherally
sudden decrease in CTOP
Steady oliguria despite diuretics
JVD, ruddy from shoulders up
Pulsus paradoxus (absence of pulses during inspiration)
Pulsus Alternans (alternating large and small arterial waveforms)
equalization of CVP, PAD and PAW
TX: OR immediately, or beside chest opening in ICU |
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Term
| Contents of Chest Crack Cart |
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Definition
Chest instrument tray
wire cutters
suture remover
sterile gloves
epicardial wires
providine-iodine
sterile gowns
masks
headcovers
goggles
NS pour bottle
Yankauer suction tip
5 in 1 connectors
connecting tubing
sterile towels and drapes
internal paddles
ALL CHARGABLE ITEMS |
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Term
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Definition
Innervates the diaphragm
S/S
failure to wean from vent
elevated diaphragm on CXR |
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Term
| Extremity coldness, mottling, discoloration |
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Definition
Caused by:
bleeding
leaking
loss of adequate arterial pressure
impending graft occlusion
embolic event |
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Term
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Definition
S/S of slow bleed at anastimosis
abdominal pain
increasing abodominal grith
Full graft occlusion:
lack of distal pulses |
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Term
| Mesenteric Infarct or Ischemia |
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Definition
S/S
acute abdominal pain
increasing WBC
fever
necrotic tissue sloughed, passed through bowel
Tx: small bowel resection
temp/perm colostomy |
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Term
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Definition
| arteries feeding spinal cord arise from the aorta, might cause ischemia and irreversible damage |
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Term
| Loss of pulses or deterioration as a result of: |
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Definition
hypoperfusion
decreasing filling volumes
increasd swelling
embolus
swelling treated with fasciotomy |
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Term
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Definition
resulting from emboli floating from site of cross clamping, when clamp is release, emboli moves downstream, lodging in foot
S/S
discoloration of toes or areas of foot following vascular surgery |
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Term
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Definition
Due to coagulopathy or graft leak
Watch for:
tamponade
graft leak
internal bleeding indicated by increasing girth, firmness of abdomen, tenderness/pain on palpation
retroperitoneal bleeds from related cath (appear similar to that of aortic surgery, plus pain in flank region) |
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Term
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Definition
Tx:
pacemaker
atropine (ACLS protocol) |
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Term
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Definition
Inadequacy leads to bleeding
atrial dysrhythmias may be an early indication of pt who may experience SVT or change to another rhythm (Afib)
Ventricular dysrhythmia may be result of:
surgical manipulation of heart
myocardial stunning
hypoxia
hypokalemia
malposition of artery catheter whipping in RV |
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Term
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Definition
Notify MD for:
increasing 1st degree block
Type II heart Block
3rd degree |
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Term
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Definition
treat per orders
can stress anastimosis, cause increased bleeding
TX: narcotics, vasoactive agents |
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Term
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Definition
| Ananastimosis strain, lead to heart overdistension, Pulm congestion, heart failure |
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Term
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Definition
S/S
low CVP
Tachycardia
Low CO
Poor peripheral circulation |
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Term
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Definition
Due to Diuresis usually
Monitor UO closely
Low K+ disposes pts to dysrhythmias |
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Term
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Definition
Can lead to:
metabolic acidosis
inadequate O2 delivery
poor peripheral adn organ perfusion
poor graft perfusion
Categories
1. volume depletion: due to blood/fluid loss
s/s: low CVP, low PAD, low PAW, Low BP, Low CO2, high PVR, high SVR, tachycardia, cool clammy skin, altered LOC, low UO
tx: replace volume with crystalloid, volume expanders, and blood products
2. Pump failure
S/S: High CVP, PAD, PAW; low BP and CO; increased resistance (high SVR and PVR), tachycardia
If RV MI: CVP will rise while PAD and PAW stay normal
If LV MI: PAW and PAD will rise initially, then failure will back up through lungs to right side of heart and the CVP will increase
tx:
RV MI: fluid loading
LV MI: diuretic, inotropes, NTG, nipride, IABP, transplant
3. Vasodilation
S/S low CVP, PAD and PAW; low BP, High CO, decreased PVR and SVR, tachycardia
TX: volume load and antibiotics, vasopressors |
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Term
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Definition
| can increase afterload (high SVR) due to peripheral vasoconstriction |
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Term
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Definition
Caused by meds, possible nuero deficits
May need increase in O2 due to agitation |
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Term
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Definition
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Term
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Definition
Results from hypoperfusion, uncontrolled DM, blood distal to occlusion is very acidic
TX: sodium bicarb, hyperventilation |
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Term
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Definition
From:
improper de airing of the heart
emboli
calcium plaque from valves
low flow states during surgery
Report to MD
Hypothermia contributes to slow awakenign after anesthesia
If pt is receiving thrombolytic agents or platelet inhibitors during preop period, the risk for intracranial bleed increases |
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Term
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Definition
Can result from
Inadequate O2 supply
inadequate circulation of oxygenated blood (pulm embolis, low cardiact output)
Icreased metabolic demand of O2 (fever, shivering, pain, suctioning, agittion, increased activity)
Give supplemental O2 before and after suctioning |
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Term
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Definition
| DX: compare Pre op and post op EKG, onset of Vtach or VFib, elevation CKMB |
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Term
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Definition
Exhibited by elevated pulmonary artery pressure values
If too high, stress placed on right ventricle, impeding the forward flow of blood
Tx:
meds and nitric oxide |
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Term
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Definition
Results from
Toxic agent
hypoperfusion
prolonged cross clamp time |
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Term
| Respiratory acidosis/alkalosis |
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Definition
| Most commonly from improper vent settings |
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Term
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Definition
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Term
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Definition
Classic S/S
High CO, low SVR, low BP
Increased risk of infection:
DM
internal mammary grafting
chronic lung disease |
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Term
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Definition
consumes vast amounts of oxygen
usually effectively treated with demerol |
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Term
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Definition
Low BP can be accompanied by low or high SVE
TX varies:
fluid therapy
vasodilators/constrictors
Body temperature
IABP |
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Term
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Definition
Post op anesthesia reaction to sufentanyl; extreme muscle rigidity, feels like a stone
TX: single dose of skeletal muscle paralysis agent (pancuronium bromide, norcuronium bromide, per MD order) |
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