Heart Surgery

 

Heart Surgery

Heart surgery is required for congenital as well as required cardiac lesions. Specially trained nurse are required for the nursing of patients who have undergone cardiac surgery. These nurses have to observe the patient’s condition minutely, and give him comprehensive care. For that, they have to learn about the patient’s personal history, family history, socioeconomic status etc. They have to learn about the patient’s habits, occupation, restrictions due to cardiac disease, family problems. She should note any changes in the patient’s circulation and ventilation, and give that information to the doctor too, so that the patient can be treated appropriately.

Preoperative care

1.The patient may be afraid of the operation. He is explained the nature of the operation. If the patient is a child the parents are given the explanation.

2. patient is reassured and given confidence that all will be well. It is important for his recovery.

3.All tests required for making a diagnosis should be done and their reports should be ready.

4.The apical-radial pulse is examined every 4 hours and recorded.

5.The blood pressure is recorded.

6.The weight is recorded every day.

7.Diet is given as recommended.

8.The need for a diuretic is assessed by studying the input –output chart.

9.The dose of digitalis is adjusted based on the pulse rate.

 

Preoperative instruction to the patient

1.The importance of personal hygiene and oral hygiene is explained.

2.Advice is given against holding breath.

3.Instructions are given about supporting th wound with a hand during coughing so as to reduce th pain associated with it.

4.He is asked to spit the  sputum in the mug.

5.Deep breathing exercises are taught and he is made to perform them under supervision.

6.The equipment like endotracheal tubes, respirator, intercostal drainage tubes, intravenous and intraarterial cannula and lines, central venous lines are explained to him ,so that he does not get worried by them in the postoperative period.

 

Immediate preoperative care.

1.The area between the chin above and abdomen below, the  back, axillae and arms are shaved.

2.The wrist and ankle areas are shaved too.

3.These parts are cleaned thoroughly with savlon and water.

4.Phenobarbitone 100mg is given orally on the evening before surgery.

5.The patient is kept starving overnight.

6.The morning dose of digoxin is given at 6.00a.m., if the patient is receiving digoxin.

7.Venesection tray and intravenous infusion tray are kept ready.

8.A nasogastric tube is passed so that vomiting and abdominal distention are avoided in the postoperative period.

 9.Vital parameters are noted before the surgery, and the surgeon is informed if there are any changes.

10.A urinary catheter is passed after induction of anaesthesia, e.g. Foley’s catheter.

 

Postoperative care

1 . The patient is kept in intensive cardiac care unit for the first 48 hours, and more if required.

2.The pulse , respiration , and blood pressure are recorded every 5 to 10 minutes during the first 6to8 hours.

3.The doctor is informed, if the pulse become irregular ,because it may be a sign of atrial fibrillation or ventricular ectopic beats.

4.The doctor is informed, if the blood pressure rises or falls. If the blood pressure remains low for a long time, the brain, kidneys, and heart may get damaged.

5.If the patient has been operated on for  mitral stenosis, the posterior tibia pulse is palpated, because it will not be felt in cases of peripheral embolism.

6.Analgesic injections are  given as required, because pain can cause tachycardia, rise in blood pressure, and may cause the anastomosis or graft to come off.

7.The patient is observed for cyanosis, and if present, treated immediately.

8. The doctor is informed if the patient’s temperature rises above  102 F OR falls below 96 F. if it  is low, he is given blankets but not hot water bags.

9.The doctor is informed immediately if any of the following signs of embolism are observed.

                   .Blackish patches on skin.

                   .Heaviness of lower limbs.

                   .Tingling and numbness of lower limbs.

                   .Inability to move the lower limbs.

10.The neck veins may appear to be engorged when the patient comes out of anaesthesia and starts experiencing pain.  But if these do not return to normal after  some time, the doctor is informed about it.

11.The dressing on the wound is observed for haemorrhage.

12.It is confirmed that the intravenous infusion is going normally.

13.The patency of the nasogastric tube is confirmed.

14.Normal functioning of the under water seal drainage is confirmed.

15.The upper airway is kept patent.

16.The patient is encouraged to support the wound with hand while coughing and bring out secretions.

17.Laryngoscope,bronchoscope, and tracheostomy sets are kept ready, especially when endotracheal suction is done.

18.The patient is kept in supine position until the systolic blood pressure reaches 100mm Hg, and then the head end is elevated, after which the blood pressure is checked again after 5 minutes. If it has been lowered, the previous position is given again, for half an hour, and then the procedure is repeated.

19.If the  patient has been operated on for congenital heart disease, aortic valve, his position is changed every 2 hours.

20.If the patient has undergone surgery implant has been done, left lateral position is not changed for 49 hours, because if his position  is changed through even 15,his blood pressure can change. After that his position is changed every 2 hours.

21.In case mammary artery implant has been done ,left lateral position is not given because it can affect expansion of the lungs.

22.Fowler’s position is not given until advised by the doctor because it can cause thrombophlebitis.

23.Oxygen is given at a rate of 15 L/ min until the patient recovers fully from anaesthesia.

24.If the patient appears to be unduly apprehensive, the cause is found out and treated.

25.Liquids are given orally when the following conditions are satisfied. The liquids are not given very hot or cold

                                      .Patient has recovered fully from anaesthesia.

                                      .Peristalsis are normal.

26.Input and output chart is maintained. Excessive intake of fluid may result in fluid may result in fluid accumulation in the body and cardiac failure.

27.patient is weighed every day.

28.He is made to perform deep breathing exercises every day.

29.Leg exercises are done every 2 hours.

30.The following drugs are given as prescribed.

                       .Antibiotics.

                       .Digoxin.

                       .Quinidine.

31.Chest X-ray is obtained using a portable machine on the second postoperative day  for the diagnosis of the following conditions, if any.

                  .Expansion of the lungs.

                  .Pneumothorax.

                   .Haemothorax.

                   .Haemo pneumothorax.

                   .Emphysema.

32.A hemogram is obtained for Hb and WBC count.

33.Urine analysis is done.

34.The following complications are watched for and treated.

 

 

Complications	Features
Respiratory system	.Hypoxia. .Respiratory failure. .Pneumothorax. .Haemothorax. .Atelectasis.
Cardiovascular	.Haemorrhage. .Arterial insufficiency. .Thrombosis. .Embolism.
Renal	.Fluid and electrolyte imbalance. .Renal failure.
Miscellaneous	.Muscle spasms. .Hiccups. .pain. .Mental tension.