Page 166 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 151

Assist patient with getting OOB when medically cleared or according to
protocols to prevent atelectasis and pneumonia.
Splint the incision when turning to prevent pulling on the sternotomy.
Administer vasoactive drips to maintain MAP greater than 80 mm Hg.

Administer pain medications to allow the patient to turn, cough, and deep
breathe without undue pain.

Attach temporary pacemaker to the epicardial leads so they can be used im-
mediately if the patient experiences bradycardias or heart blocks. Label leads
clearly to prevent accidental attachment when pacer is needed. When ma-
nipulating wires, the nurse should wear gloves to prevent microshocks that
can lead to ventricular fibrillation.
Give psychological support to significant others because when they visit the
patient, the lines and equipment and physiological changes from edema can
be overwhelming.

Interventions (Late)
Monitor for postpericardiotomy syndrome, which is a type of pericarditis
(fever, malaise, dyspnea, chest pain, pleural and pericardial effusions, friction Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
rub), as this is a common occurrence 4 days postoperatively.
Observe for cardiac tamponade as this can occur from fluid/inflammatory
buildup (electrical alternans, increased neck veins, muffled heart sounds,
hypotension).
Assess for wound infection associated with sternal infection (fever, increased
WBCs, exudate and inflammation at the sternal incision).
Teach the patient regarding medications, mobility, rest, and pain relief to
help give patient control over his or her situation.
Encourage patient to attend community support groups to help identify suc-
cessful strategies and receive emotional support.

Heart Transplantation

What Went Wrong?
A heart transplant involves the removal of all or part of a patient’s heart, replac-
ing it with a donor’s heart. A median sternotomy and CP bypass are completed
as with CABG. An orthotopic technique is the most common and is performed
when the recipient’s right and left atria, pulmonary artery, and aorta are
removed. The recipient’s septum and posterior and lateral walls of the atria are