Ap Lab 8 Answers Ward's

Using homologous graft vein or artery to perform the bypass a blocked segment of one or both coronary arteries. ETIOLOGY

most important causes of myocardial infarction:

1. SEQUENCE. "Deposits of plaques formed by cholesterol and fat are deposited on the inner wall of the coronary arteries." Gradual narrowing of the arteries over the life restricts blood flow to the heart muscle. "Plaque rupture and tamponade may obstruct the duct at a point where the caliber of the artery is less


2. clot formation on the plate (Thrombosis)

primary risk factor

Hypercholesterolemia and hypertension snuff

SIDE Sedentary Stress

TERTIARY family history and other

Patients who do not improve with medical treatment, often have

surgical

II. LEVEL OF CARE applicable to surgical patients of heart failure in the perioperative nursing care level IV.

III. RESPONSIBLE BUSINESS Nurse II Instrumentalist Instrumentalist IEnfermera

IV. DIAGNOSIS PREOPERATIVE NURSING patient with limited mobility, difficulty breathing, crushing chest pain (angina), stress, afraid of death, anxiety about the unfamiliar and surgery. Intraoperative

unconscious patient vital signs are altered, with cardiopulmonary bypass, blood loss and need for intravenous fluid

POSTOPERATIVE

Patient with oxygen tubing with altered vital signs, with hypotension with intravenous fluids, drain bottles and urine collection bag

V. ATENCION DE ENFERMERIA

1. PREOPERATORIO 1.1 DIAGNOSTICO DE ENFERMERIA 1.2 INTERVENCIÓN DE ENFERMERIAPreoperatorio inmediato Instrumentista I:" Apertura de material y equipos " Lavado de manos " Colocación de mandil y guantes estériles " Cuenta de Gasas e instrumental PREPARACIÓN Y VESTIMENTA Vestimenta del equipo quirúrgicoPreparación y distribución del instrumental y equipos por tiempos operatorios. Preparación y distribución del instrumental y equipos por tiempos operatorios INSTRUMENTAL Cardiovascular o Tórax, clamps vasculares, adicional de extracorpórea, organizador, 2 charolas, cateterismo vesical, equipo de limpieza, adicional de coronaria MATERIAL Turnstiles, cava occluder, rubber, internal paddles, pneumatic saw, set of needles, umbilical tape, protective mosquito torunditas Full CLOTHING AND ACCESSORIES, chest, 2 medical aprons, 2 sinks, tubs, round fanny game INSUMOSHojas Knife 22, No. 64 Beaver, No. 11, bone wax, 5cc syringe, 10 cc, 20 cc, Abocath N ° 14, 22, chest drains, elastic bands, etc. SUTURASABSORVIBLES: Synthetic: polyglactin 1, 2 / 0, 3/0NO ABSORB: Organic: Lino 1, 2 / 0, 3 / 0, silk 3/0Sintéticas: Nylon braided 3 / 0, monofilament polypropylene 3 / 0, 4 / 0 , 5 / 0, 6 / 0, 7 / 0, 8 / 0. Polyester braided Coated 2 / 0, surgical steel.

scrub nurse II: PREOPERATIVE "Check request of the Chamber" Welcome to the patient in conjunction with the anesthesiologist, moving to the operating table "Help the anesthesiologist: Oxygenation of the patient" Check the package of surgical supplies Operating room patient reception, transfer the operating table will list external paddles with gel bladder catheterization "It provides the anesthesiologist: AD. PVC, Ad. instrumentation, bucket of supplies, medicines. gloves, etc. "Aid to clothe the surgical team" Receiving the forceps and cuvette aseptización Coordinates the use of blood recovery Make op washing area

intraoperative instruments II: "Accommodate the scrub nurse I, the bedside table, tripod" Connect cautery pencils, suction and internal paddles, rechecking operation. "It accommodates the beam Cialitos according to the surgical time as the auxiliary lamp." Works synchronously with the scrub nurse I because of this depends on the success of the surgery. Make Nursing Records, leaf consumption filling, filling in the operative record book. "Pour the solution of NaCl 9 ° / oo to large bowl wash sponges used during surgery, as necessary "Make gauze count at the beginning of the operation, during and before the closing" To be ready before entering CEC itself requires defibrillator "Prepare internal paddles to get out of CEC and must stay with the defibrillator," Coordinates and requests ICU bed "Watch constantly asepsis, the order" Get and label the bottles postoperative drainage instruments II "will

ready bag with oxygen" Clamp drain bottles in coordination with the anesthesiologist "It helps pass the patient table to the table "Spend the patient monitored with the O2 of the machine and carefully gradually is changing the laptop monitor to the ventilator. "At all times care should be taken with the patient warm, caring ways, taking care accessories anesthesia machine" Take the patient to ICU and gave the patient to the nurse and any special event, HC, RAD, recent analysis , etc "clean operating room monitors and prepares for a next operation." It helps prepare the instruments used

2. Intraoperative 2.1 DIAGNOSIS OF NURSING Patient will undergo cardiopulmonary bypass for acute myocardial infarction 2.2 INTERVENTION ENFERMERIAENFERMERA
INSTRUMENTALISTS IEntrega solution and gauze for surgical fields aseptización Delivery

INSTRUMENTACIÓN QUIRÚRGICA : PASOS 1. Apertura2. Canulación3. Circulación extracorpórea4. Tiempo de Cierre 1. APERTURA Incisión esternotomía media" Instrumentar la preparación de arteria mamaria " Instrumentar la extracción de vena safena y/o arteria radial " Apertura y colocación de puntos de pericardio con lino ó seda 1 2. CANULACION " Instalación de las tubuladuras, probar aspiradores, purgar cardioplejía " Jaretas: Aorta, polilene 2/0 MR 20 y torniquete mediano delgado 2 puntos. " Pasar heparina " Aurícula Derecha: polilene 2/0 MR20, torniquete delgado largo 1 punto " Cardioplejía retrógrada: polipropilene 4/0 MR 20, torniquete largo delgado Implement
cannulation of the aorta, atrium cava cannula retroplejía

3. EXTRACORPOREAL CIRCULATION "total aortic clamping" Pass antegrade cardioplegia needle "Putting the patient's legs on a pillow with sequential coronary instrumental" To implement the placement of bridges AO - SURGICAL CO CECTÉCNICA Output "section of artery or vein segment" section of a small opening to the aorta (proximal) "section of a small opening of the coronary artery (distal)" Clamp tangential. "1 proximal anastomosis off-pump" 2. Distal anastomosis bomb "Clamp intermittent" 1. Distal anastomosis "2. Anastomosis proximal All in bomb" 1. Distal "2. Proximal "Decannulation" Output C: EC "Having pallets ready" Review and Haemostasis 4. CLOSE "count gauze" pacemaker wire placement "Placing chest drains" Closure plans "Sternal surgical wire N ° 5" Fascia nylon 1 "Muscle: polyglactin acid 1" TCS: polyglactin acid 2 / 0 "Skin: polyglactin acid 3 / 0 CC "Placement of dressing" Keep the instruments sterile until it leaves the patient

IMMEDIATE POSTOPERATIVE NURSING INSTRUMENT. I "Remove the Mayo table and the table of instruments careful not to be contaminated" Helps to remove the camps and other "finished telling his instrumental, once removed the patient, covering the table and the instrumental is taken to the workroom" Lava coronary instrumentation and proceeds to prepare jointly with the scrub nurse II

ADVANCES IN CARDIOPULMONARY BYPASS SURGERY BY PASS AO - CO WITHOUT CARDIOPULMONARY BYPASS (CPB SIN) Recent advances in surgical techniques and equipment allow the surgeon to perform bypass surgery AO-CO while the heart continues beating. Avoid placing the patient on cardiopulmonary bypass system used in coronary artery bypass conventional pass py AO - CO

CARDIAC SURGERY MINIMALLY INVASIVE "It's a new term in cardiac surgery" 3 -5 inch incisions. of NGOs (before 12 to 14 inches) "Some cases also sternotomy" Defined as a procedure that incorporates any technique that addresses any sternotomy can be mean "without cardio pulmonary by pass) OCTOPUS 2 The tissue stabilizer system" Octopus 2 "is minimal, only takes a small area of \u200b\u200bstroke. can be used for a vessel or multiple vessels. The rest of the heart continues normal operation
Octopus 2

WHY cardiac surgery is minimally invasive? "Cancellation of the inflammatory system "It reduces postoperative ventilation time support" reduces mortality, "decreases the incidence of" 1. Heart failure "2. Respiratory arrest" 3. Renal failure "4. Reoperation for bleeding" 5. Atrial fibrillation

WHEN IS INDICATED BY PASS AO - CO NOT PUMP? 1. Coronaria2 artery disease. Some cases of calcification of aorta3. Renal4 failure. Pulmonar5 disease. Previo6 unemployment. Diffuse peripheral vascular disease

CABG is contraindicated WHEN NOT TO PUMP? 1. In intramiocárdicos2 deep vessels. In distal pequeño3. Conductos4 poor. Hemodynamically unstable handling or pre condicional5 ischemia. Acute myocardial infarction with cardiogenic shock

ADDITIONAL SYSTEM COMPONENTS 1. Regular vacuum (- 400 mm Hg) 2. Sellado3 suction bottle. A succión4 stabilizer. Device is attached in an articulated retractor

INTRA OPERATIVE NURSING

1. familiarity, what equipment is needed for structuring "Having diversion devices (shunting)" A vascular arteriotomy cannula "Two teams of distal perfusion" Device occlusion: silastic band for coronary occlusion "Pleoget (patch)" There is a clear view with the blower with filter "Having brand wire and generator step "

coronary Instrumentation
2. Facilitate the use of Octopus 2


3. Keep the patient normothermia (heating blanket) and irrigation fluid T ° 68 to 70 GF


4. Ready to take and record the occlusion time and derivation


5. Be prepared for conversion DEC.EC
   
   2003