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CAD and ACSMedical Surgical Nursing

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Which patients are most likely to have a CABG using the gastroepiploic or inferior epigastric artery?
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Those that have had previous CABG surgery
What are the drawbacks to a CABG using the gastroepiploic or inferior epigastric artery?
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#NAME?
________ is a technique used in patients with single vessel disease (like in the left anterior descending artery or right coronary artery). Several small incisions are made between the ribs, a thorascope dissects out the internal mammary artery and puts into place to divert blood flow.
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Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
________ is a procedure that uses full or partial sternotomy to enable access to all coronary vessels and is performed while the heart is still beating.
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Off Pump Coronary Artery Bypass (OPCAB)
This procedure involves a laser that creates channels between the left ventricular cavity and the coronary microcirculation to allow blood flow to ischemic areas of the heart. It is used for patients who are contraindicated for bypass surgeries to treat CAD...
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Transmyocardial Laser Revascularization (TMR)
What are the post-surgical concerns of a transmyocardial laser revascularization (TMR) procedure?
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Dysrhythmias, bleeding, cardiac tamponade, accidental perforation, chordae tendinea damage, low CO
When are optimal results from a Transmyocardial Laser Revascularization (TMR) surgery typically achieved?
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3-6 months post surgery
What are the nursing interventions for a patient experiencing an anginal attack?
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Admin oxygen, assess vitals, begin 12-lead ECG, provide pain relief with nitrates and opioids, listen to the heart, position patient in comfortable position
With respect to MI, S4 is called...
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Atrial gallop
With respect to MI, the development of S3 is called...
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Ventricular gallop
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Development of S3 in a patient with a suspected MI is indicative of _________ damage.
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Left ventricular
Development of a murmur in a patient with a suspected MI indicates damage to...
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The papillary muscles of the mitral valve
Why is it important to reduce a patient's anxiety who is experiencing angina, an MI or heart failure?
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Anxiety increases the need for oxygen, reducing the available supply to the heart
Why should a patient with a diagnosis of angina rest for 1-2 hours after large meals or avoid them altogether?
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Heavy meals cause blood to be shunted to the GI tract to aid in absorption and digestion, reducing the available cardiac supply
What is a concern for a nurse who has successfully managed pain in a patient with ACS?
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Effective pain management can cause a patient to deny the presence of a coronary problem
What are predictors that can alert a nurse of a possibility of a patient developing ventricular fibrillation?
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Premature ventricular contractions or ventricular tachycardia
What ECG changes can indicate silent ischemia?
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ST wave shifts above or below the baseline
T/F Denial is never a positive coping mechanism.
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False, denial can be a positive coping style in early ACS recovery
After CABG surgery, there are many invasive lines for monitoring cardiac status. Describe the function of each of the following: Pulmonary Artery Catheter- Intraarterial Line- Epicardial pacing wires-
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Pulmonary Artery Catheter-measuring CO and other hemodynamics Intraarterial Line-measuring BP Epicardial pacing wires-to apply emergency pacing to the heart
What are the major complication of a CABG caused by the CPB (Cardiopulmonary Bypass)?
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Bleeding, anemia, fluid and electrolyte imbalances, hypothermia
Which type of dysrhythmias are common for up to three days post CABG?
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Atrial dysrhythmias (usually fibrillation)
  
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