Page 314 - ACCCN's Critical Care Nursing

Cardiac Surgery and

Transplantation 12

Judy Currey
Michael Graan

Learning objectives Key words

After reading this chapter, you should be able to: cardiac surgery
● outline cardiac surgical procedures including coronary cardiopulmonary bypass
artery bypass graft surgery and valve repair and valve replacement, repair
replacement arrhythmia
● describe the indications, advantages and disadvantages of intra-aortic balloon pump
using cardiopulmonary bypass heart transplant
● outline methods of myocardial preservation during cardiac denervation
surgery ischaemic reperfusion injury
● outline immediate postoperative management of cardiac
surgical patients including haemodynamic, rhythm
monitoring, ventilatory support, postoperative bleeding
including pericardial tamponade, postoperative pain, fluid
and electrolyte and emotional and family support
● outline the principles of counterpulsation in intra-aortic cardiac surgery for coronary artery disease or valvular
disease will be discussed, including the use of cardiopul-
balloon pumping monary bypass. In addition, the use and management of
● outline the benefits and timing of balloon inflation and intra-aortic balloon pumping in cardiac surgical and
deflation, conventional and real timing, management and medical patients will be outlined. The management of
assessment of timing and timing errors patients following heart transplantation will be identified
● describe the nursing management of IABP complications, including the immediate postoperative complications
including limb perfusion, bleeding and immobility-related and their prevention and management.
complications
● discuss methods of weaning IABP and management of IABP CARDIAC SURGERY
removal
● discuss the immediate postoperative care of heart Cardiac surgery includes repair of structural abnormali-
transplant recipients ties, repair or replacement of stenotic or regurgitant
● describe the clinical manifestations of postoperative valves, and bypass of lesions within the coronary arteries
complications in heart transplant recipients that are reducing blood flow to the myocardial tissue.
● identify signs and symptoms of rejection in heart transplant
recipients STRUCTURAL ABNORMALITIES
● evaluate the effectiveness of nursing interventions in the Some structural abnormalities result from myocardial
postoperative management of heart transplant recipients. infarction, and have been described in Chapter 10. Other
structural abnormalities result in valvular disease (mitral,
aortic, tricuspid, pulmonic) and ventricular defects.

INTRODUCTION Valvular Disease
The incidence and types of valvular disease have changed
1
Many critically ill patients experience compromised over the past 50 years. Valvular disorders, such as mitral
cardiac function, as either a primary or secondary condi- stenosis and aortic regurgitation, often arise from infec-
tion. This chapter follows on from those situations exam- tious diseases like rheumatic fever and syphilis, which are
ined in Chapter 10, and reviews patients with conditions much less common today. Conversely, there has been a
that tend to be cared for in specialised critical care units. rise in the rate of aortic stenosis, which is due to degen-
In this chapter, the management of a patient who requires erative disease common in ageing. In contrast to these 291