CSC Nursing

(A) complications of cv surgery. Cardio- vascular Shock HYPO/HYPERTENSION MYOCARDIAL INFARCTION(S) OPEN CHEST WOUND POST OP DYSRHYTHMIAS PA HTN Right HEART FAIL- URE (population)(patho)(assess- ment)(EKG)(Treatment) CV Tamponade (B) SurgicalTreatment of Non-congenital heart defect repair in adults (e.g., ventricular septal defect [VSD], left ventricular aneurysm repair) 2. Cardiac rhythm disorders (e.g., MAZe procedure/modified MAZe) 3. Congenital heart defect repair in adults 4. Coronary heart disease (population)up to 50% of patients with inferior AMI have RV infarct. (patho) Occluded RCA. SA/AV node is- chemia conduction delays or bradycar- dia (assessment) (EKG) (Treatment) CSC 5. Hypertrophic obstructive cardiomy- opathy (HOCM) 6. Valvular disease a. repair b. replacement C. Other Cardiovascular Problems 1.Off-pump coronary artery bypass (OP- CAb) 2. Patients who have undergone cardiopulmonary bypass 3. Thoracic aorta repair a. open repair b. endograft II. OTHER PATIENT CARE PROBLEMS (24%) A. Pulmonary 1. Acute respiratory distress syndrome (ArDS, to include acute lung injury or ALI) 2.Air-leak syndromes (e.g., pneumoperi- cardium, pneumomediastinum) 3. Aspirations (e.g., aspiration pneumo- nia, hospital-acquired pneumonia) 4. Atelectasis 5. bronchospasm 6. Hemothorax 7.. Pleural effusions 8. Pneumothorax B. Endocrine 1. Hyperglycemia 2. Hypoglycemia C. Hematology/Immunology 1. Anaphylaxis (e.g., protamine reaction) 2. Coagulopathies 2 / 6 CSC 3. Heparin-induced thrombocytopenia (HIT) 4. Heparin rebound 5. Post-operative bleeding 6. Systemic inflammatory response syn- drome (SIrS) D. Neurology 1. Post-operative impaired cognition 2. Stroke (e.g., embolic, hemorrhagic, TIA) E. Gastrointestinal 1. Ischemic bowe F.Renal 1. Acid/base imbalances 2. Acute renal failure (e.g., acute tubular necrosis, azotemia) 3. Life-threatening electrolyte imbal- ances (i.e., potassium, sodium, phosphorus, magnesium, calcium) G. Multisystem 1. Multiple organ dysfunction syndrome (MODS) H. Behavioral 1. Adjustment disorders (e.g., anxiety) 2. Delirium III. INTERVENTIONS (33%) A. Cardiovascular 1. Antidysrhythmics 2. Defibrillation/cardioversion 3. emergent re-opening of the chest 4. epicardial pacing 5. Fluid volume management specific to cardiac surgery 6. Inotropes 7. Intra-aortic balloon pump 3 / 6 CSC 8. rewarming from hypothermia 9. Vasodilators/vasopressors 10. Ventricular assist devices B. Pulmonary 1. Chest tubes/drains (e.g., mediastinal, pleural) 2. noninvasive positive pressure ventilation (e.g., CPAP, biPAP) 3. Post-extubation care 4. Pulmonary vasodilators a. inhaled b. intravenous 5. Ventilator management 6. Ventilator weaning C. Endocrine 1. Hyperglycemia management 2. Hypoglycemia management D. Hematology/Immunology 1. blood and blood products F. Behavioral 1. Non-pharmacologic management of delirium a. diversion strategies b. environmental manipulations 2. Pharmacologic management of deliri- um 3. Pharmacologic pain management G. Postoperative Care 1. DVT prophylaxis 2. early mobility protocols 3. GI prophylaxis (e.g., H2 blockers, proton pump inhibitors) 4. Incision assessment and manage- ment 5. Management of recovery from anes- 4