Phase 1 monitoring post CABAG - ANS Q15 vitals
SVR, PVR, PAP, CI, CO, pain, RASS
Drains
LOC
Outputs
The temperature has to be above 96 degrees F
Aldrete Score - ANS postanesthesia recovery score
complete once when they get to the floor and again after extubation
must be ...
Phase 1 monitoring post CABAG - ANS Q15 vitals
SVR, PVR, PAP, CI, CO, pain, RASS
Drains
LOC
Outputs
The temperature has to be above 96 degrees F
Aldrete Score - ANS postanesthesia recovery score
complete once when they get to the floor and again after extubation
must be a score of 9 to stop Q15 vitals (phase 1)
Demerol - ANS Narcotic, comes from pharmacy, used for shivering while weaning propofol
Increased SVR with all other stable VS can mean the pt is shivering.
epicardial pacing wires - ANS first line for bradycardia of post-op pt's
must stay on for the first 24 hours
RSBI (Rapid Shallow Breathing Index) - ANS must be 105 or less for 30 min
ABG must be WNL
must be able to follow commands (esp lifting their head)
ambu bag at bedside, suction at bedside
urine output notification to provider - ANS less than 30 mL / the first two hours after surgery
drain notification to provider - ANS greater than 100 mL / hr between blake and chest tube
ensure patency of the drains
re-sternotomy - ANS common causes: cardiac tamponade, hypovolemia, tension
pneumothorax
can be performed up to postoperative day 10
avoid EPI!!
if there is an IABP (change to pressure trigger)
small surgical tray- ICU
large surgical tray- CTS
found in left cabinet in the med room
, cardiac arrest post CABAG
v-tach
v-fib - ANS DC shock x 3
amiodarone 300mg
prepare for sternotomy
begin CPR and shock every 2 min
internal paddles - shocking only 20 joules (found separately from sterile package)
Cardiac arrest post CABAG
severe bradycardia, asystole - ANS PACE
consider external pacing
sternotomy
start CPR no shock
Cardiac arrest post CABAG
PEA - ANS turn off pacing to determine underlying rhythm, exclude v-fib
go from there as you determine what the rhythm is
Cardiac arrest post CABAG - respiratory considerations - ANS turn 02 to 100% and turn off
PEEP
assess for pneumo and hemothorax
check ET tube placement
switch to bag
Catecholamines - ANS hormones secreted by the adrenal medulla that affect the
sympathetic nervous system in stress response... increase will constrict vessels, decrease will
dilate
beta receptors - ANS 1- increase HR and contractility, positive inotropic agent
2- affects the lungs, dilates smooth muscles
Norepinephrine #Levooo - ANS Always look at VS first, make sure the patient does not
need fluid to treat hypovolemia
Indication: hypotension unresponsive to fluid, maintain organ perfusion
therapeutic effects: increased HR, BP, SVR, and coronary blood flow
side effects: tachy, dysrhythmias, hypertension, ischemia, dyspnea
titration: .02mcgs
Beta-1 stimulant only
central line
EPI - ANS beta 1 and 2
indication: hypotension, decreased CO requiring inotropic support, anaphlyaxis
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