PT. REVIEW - Critical Care - Cardiovascular - Mr. Peterson Exam Study Questions and Answers

PT. REVIEW - Critical Care - Cardiovascular - Mr. Peterson Exam Study Questions and Answers Before surgery, the surgical procedure and postoperative care were discussed with Mr. Peterson and his wife. As part of this teaching, the Petersons were taught that coronary artery bypass graft (CABG) surgery was being done to: - Ans:-improve myocardial blood flow RATIONALE: Coronary artery bypass graft (CABG) surgery, the most common type of cardiac surgery performed, improves myocardial perfusion by bypassing narrowed or obstructed coronary vessels. During surgery, a graft from the internal mammary artery (IMA) and/or a saphenous vein or radial artery, is attached to the aorta and anastomosed to the diseased coronary artery (distal to the point of occlusion). Tissue perfusion is reestablished by this procedure. Patients should experience symptomatic relief of chest pain, as well as an improved prognosis if that was a goal. Which of the following statements about cardiopulmonary bypass are true? - Ans:-Venous blood is drained into the cardiopulmonary bypass machine ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/21 Blood is oxygenated, filtered, and temperature-regulated as it circulates through the cardiopulmonary bypass machine Oxygenated blood is returned to the body A dry, easily-visualized operative area is obtained while a patient remains on cardiopulmonary bypass RATIONALE: Cardiopulmonary bypass includes diversion of venous blood from the right atrium and/or vena cavae into the cardiopulmonary bypass machine. Cardiopulmonary bypass diverts blood from the body through the bypass machine where gas exchange, temperature regulation, and filtration occur. Cardiopulmonary bypass includes the return of oxygenated blood to the body via the aorta or femoral artery. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/21 One of the functions of cardiopulmonary bypass is to provide a bloodless, easily-visualized operative area. Body temperature is reduced during open heart surgery with cardiopulmonary bypass. Jane correctly tells you that hypothermia helps to: - Ans:-decrease myocardial oxygen demand diminish intraoperative bleeding RATIONALE: A hypothermic state causes vasoconstriction and decreases the metabolic needs in the area affected. During open-heart surgery, hypothermia reduces myocardial oxygen demand. Hypothermia causes vasoconstriction and therefore diminishes blood loss during surgery. Based on your preliminary assessments, you: - Ans:-record your data RATIONALE: This data should be recorded, but need not be reported, since all data is normal or expected. An SpO2 (O2 saturation by pulse oximetry) of 97% is normal, and is considered good for Mr. Peterson at this time. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/21 Mr. Peterson is on a ventilator set at synchronized intermittent mandatory ventilation (SIMV) of 8 breaths per minute. His respiratory rate is 16. This means that he has eight ventilator-delivered mandatory breaths per minute, and is taking eight spontaneous breaths per minute. This is considered normal at this time. Immediately after surgery, active bleeding, as evidenced by bright red blood in chest tube drainage, is considered normal. Mrs. Peterson's ECG rhythm is interpreted as normal sinus rhythm with an occasional premature ventricular contraction (PVC). Which of the following also apply to Mr. Peterson at this time? - Ans:-Risk for Hypothermia Ineffective Airway Clearance Risk for Infection Impaired Verbal Communication Risk for Injury RATIONALE: During surgery, Mr. Peterson was maintained in a hypothermic state that needs to be reversed postoperatively. He is also predisposed to heat loss because of the frequent and rapid assessments that are required, and for which he needs to be uncovered. His most recen