Cardiac Surgery CSC

You are caring for a patient with an in￾tra-aortic balloon pump and note blood in the tubing.Your initial action should be: A. Stop the balloon pump and notify the physician. B. Administer 100% oxygen to help dis- place the helium and notify the physician C. Leave the IABP running and notify the physician. D.Purge the IABP manually to clear the blood from the tubing. When caring for a patient immediately post CABG the nurse recognizes that the most likely cause of hypotension in the immediate post-operative period is A. Decreased circulating volume requir￾ing no intervention unless persistent > 12 hours. B. LV failure requiring an inotrope as first line treatment for any hypotension. C. Decreased circulating volume repre- senting the need for increased fluid ad- ministration. D. LV failure requiring an assist device. A. Blood in the IABP tubing indicates a balloon rupture which can cause gas em- bolus. However, helium is thought to be easily absorbed in the presence of bal￾loon rupture and oxygen is not generally indicated. The appropriate action is to disconnect the balloon from the console or turn it on standby so the movement of helium is stopped and notify the physi- cian. The nurse will need to prepare for IABP removal and replacement if need- ed. C. Hypotension in the immediate postop- erative period is usually caused by low circulating volume and responds to treat- ment with fluids. Volume is the first line treatment for hypotension. If there is no immediate response to volume adminis￾tration, 500 mg of IV calcium chloride is often given. Existing vasopressors, such as norepinephrine, can also be adjust- ed. It is important for hypotension to be promptly treated. Persistent hypotension can result in hypoperfusion and end or- gan damage. LV failure is not the most common cause of hypotension in the immediate post-op- erative period and therefore inotropic agents are not first line agents used in the treatment of hypotension. Hypoten- sion that does not respond to fluid admin￾istration may require an inotrope. C. Clopidogrel inhibits the P2Y12 recep￾tor on the platelet for the lifetime of the platelet (10 days). Inhibited platelets can- not participate in clotting, so the risk of bleeding increases with antiplatelet drugs. Most clinical trials have identified Cardiac Surgery CSC 2 / 99 Preoperative clopidogrel should be held for how many days in the elective surgery patient: A.It does not need to be held. B. 1-2 days. C. 5-7 days. D. 30 days. The term OPCAB refers to: A. combination open heart surgery and percutaneous procedure. B. CABG surgery without the use of car- diopulmonary bypass (CPB). C.the use of thoracotomy instead of ster- notomy. D. patients who are fast tracked to be discharged in less than 5 days. Which of the following patients is at high- est risk for neurological complications after CABG? A. A 63-year- old patient with a BMI of 30 undergoing OPCAB B. A 85-year-old patient with an athero- sclerotic aorta undergoing CPB C. A previously healthy 50-year-old woman undergoing CPB D.A 67-year-old man having a MIDCAB to the LAD with no known history of hy- pertension an increased risk in bleeding, transfu- sion, and re-exploration when clopido- grel is taken within 5 days of surgery, and no increase in bleeding or transfusions when clopidogrel is stopped for > 5 days prior to surgery. Therefore, clopidogrel should be stopped for 5 to 7 days prior to elective surgery. Emergent surgery can be done regardless of when the last dose of clopidogrel was taken, but will be asso- ciated with increased bleeding and need for platelet transfusions. B. OPCAB refers to off-pump coronary artery bypass. Surgery is done without CPB but it still involves a median ster- notomy. MIDCAB (minimally invasive direct coro- nary artery bypass) is performed on a beating heart without CPB and without the use of a median sternotomy. MIDCAB is commonly done through an anterior thoracotomy incision and is used to by- pass the mid to distal LAD with a left internal mammary artery (LIMA) graft. A ministernotomy can also be used to gain access during MIDCAB. B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-clamping, diabetes, hypertension, female sex, and history of stroke place patients at high risk for neurological complications following cardiac surgery. Other factors contributing to neurologi- cal complications include alcohol abuse, heart failure, arrhythmias, and hyper- glycemia.