Questions and Answers
Which value of cardiac index (CI) indicates eligibility for weaning from IABP?
What pulmonary artery occlusion pressure indicates readiness for weaning a patient off IABP?
Which of the following factors is NOT an indication for weaning from IABP?
Which complication of IABP is most commonly observed?
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What immediate action should be taken if there is a balloon rupture during IABP use?
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What is a key advantage of valve reconstruction procedures?
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What is the primary focus when repairing a valve?
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Who is likely to achieve the highest success in valve reconstruction procedures?
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What procedure is typically performed to treat mitral stenosis?
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What is the typical outcome in terms of anticoagulation post valve repair using annuloplasty?
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What physiological response is triggered due to shivering in ICU patients?
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What is one of the key signs of Systemic Inflammatory Response Syndrome (SIRS)?
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How should rewarming be conducted to prevent complications?
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Which of the following is NOT a responsibility of nursing in the postoperative phase?
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What technique is used to help maintain open alveoli and improve oxygenation?
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What may be indicated if breath sounds are diminished upon auscultation?
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Which factor may exacerbate the perception of pain in ICU patients?
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What is one common strategy for preventing pulmonary complications in postoperative patients?
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What is the first intervention if chest tube output continues to be greater than 200 mL/hour?
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Which of the following is a warning sign of cardiac tamponade?
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What is the purpose of rewarming in postoperative care?
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What indicates a need for surgical reexploration in postoperative patients?
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Which medication is commonly used as a first-line treatment for renal complications postoperatively?
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Which condition should be monitored to prevent endocrine complications in postoperative patients?
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How long should a patient be NPO to decrease the risk of gastrointestinal complications postoperatively?
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Which diagnostic tool is definitive for diagnosing cardiac tamponade?
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What is the minimum urine output per hour that should be recorded postoperatively?
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What should be done if a patient's hemoglobin level drops below 8 mg/dL postoperatively?
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Which of the following is NOT a method for maintaining temperature in the postoperative phase?
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What is the recommended action if chest tube drainage exceeds 200 mL per hour?
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When may potassium replacement be required postoperatively?
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What common postoperative cardiovascular complication often arises in patients monitored after surgery?
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Which dietary adjustment is likely to be implemented in the postoperative phase?
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What is crucial to monitor for signs of infection during the postoperative period?
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What immediate postoperative management technique should be prioritized for oxygenation?
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Study Notes
Advantages of Valve Reconstruction
- Eliminates long-term anticoagulation necessity.
- Reduces risks of thromboembolism and endocarditis.
- Lowers reoperation need, improving patient outcomes.
- Increases survival rates significantly.
- Less effective in aortic valve disorders, including insufficiency and restenosis.
- Early intervention enhances success rates before left ventricular function declines.
Cardiac Valve Repair
- Repair procedures typically address valve insufficiency or stenotic valves, primarily targeting insufficiency.
- Valve insufficiency addressed with an annuloplasty ring for stability; termed valve annuloplasty.
- Tears in valve leaflets can be patched using pericardial tissue.
- Ruptured papillary muscles may be reattached to the endocardium.
- Success rates for mitral valve dysfunction repair are about 80%, comparatively lower for aortic valvular issues.
Surgical Treatment for Valvular Disease
- Mitral stenosis treated through commissurotomy, surgically separating fused commissures and debriding calcified tissue.
- For mitral insufficiency, valve leaflets repaired during reconstruction.
- Anticoagulation needed post-repair only with annuloplasty rings, typically limited to three months.
Postoperative Management: Shivering and SIRS
- Shivering commonly occurs within 90-180 minutes post-ICU admission; significant increase in metabolic rate and myocardial workload.
- Management includes increasing room temperature, using heating blankets, and slow rewarming to avoid hemodynamic instability.
- Systemic Inflammatory Response Syndrome (SIRS) often follows CABG surgery due to endothelial damage and increased capillary permeability, presenting symptoms like fever, tachycardia, and elevated WBC.
Preventing Postoperative Complications
- Monitor oxygenation via pulse oximetry and ABGs; PEEP aids alveoli function and oxygenation.
- Promote ambulation and use incentive spirometry to prevent pulmonary complications.
- Frequent auscultation required for breath sounds; diminished sounds may signal atelectasis.
Pain Control and Monitoring Postoperative Bleeding
- Post-surgical pain arises from multiple sources; ICU environment may exacerbate it.
- Watch for chest tube outputs exceeding 200 mL/hour; initiate protocols including Protamine sulfate for heparin reversal.
- Vital signs and blood work need monitoring for effective bleeding control and management.
Cardiac Tamponade and Renal Complications
- Cardiac tamponade results from fluid accumulation around the heart; signs include decreased cardiac output and pulsus paradoxus.
- Renal complications can occur; interventions aim to remove excess fluid while maintaining cardiac function using diuretics like Furosemide.
Endocrine and Gastrointestinal Concerns Postoperation
- Maintain strict glycemic control to prevent adrenal insufficiency, especially in steroid-treated patients.
- Patients are typically NPO for the first 8 hours, with NG tubes to mitigate nausea and vomiting risks.
Criteria for Weaning from IABP
- Monitor for hemodynamic stability, with a cardiac index exceeding 2 L/min.
- Key indicators include adequate urine output, absence of pulmonary edema, and signs of good coronary perfusion.
Complications of IABP
- Potential issues include neuropathy, arterial insufficiency, and balloon rupture.
- Immediate actions required for complications involve removing the catheter and ensuring patient safety.
Collaborative Management in ICU
- Restore body temperature carefully; avoid severe hypothermia to manage myocardial function during recovery.
- Conduct regular assessments of neurologic and cardiovascular status, including ECG monitoring.
- Encourage early ambulation and mobility to promote recovery.
Multidisciplinary Goals in Postoperative Care
- Ensure optimal oxygenation and hemodynamic stability.
- Balance fluid and electrolytes, maintain nutrition, and prevent complications.
- Promote self-management for therapeutic regimens, supporting optimal activity levels.
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Description
This quiz explores the various advantages of cardiac valve repair over long-term anticoagulation treatments. It addresses the reduction of thromboembolism risk, the decrease in reoperation needs, and the increase in survival rates associated with early reconstruction procedures. Additionally, it highlights the limitations in cases of aortic valve disorders.
