Laney Lytle

Open Heart surgery journal

1. Briefly describe the type of surgery observed in the OR.

The surgery being done was a mitral valve repair and a bypass graft. The
graft came from a vein in the patients leg and was about 4 inches long. The graft
was put distal to the blockage and then connected to the aorta. This helped blood
flow get past the blockage. The patient had cardiac endocarditis which lead to
mitral valve regurgitation which was the reason for the repair.

2. Describe the purpose of the cardiopulmonary bypass machine.

The cardiopulmonary bypass circulates the blood instead of the heart. It
bypasses the heart while the surgeon is working to make it easier for him to see.
When the blood comes out of the body it goes into a chamber where it becomes
oxygenated and is sent back in the body. The doctor showed me the difference in
the color of the oxygenated blood going into the heart and the deoxygenated
blood coming out of the body. The doctor explained to me that when a patient is
on bypass the goal is to keep it under 90 minutes, even though this isn’t always
possible. The patient today was on bypass for about an hour, so he was in the
safe limits. The longer they are on the more risks are present.

3. Identify one potential ethical concern related to open-heart surgery or post-

operative care.
An ethical concern for open heart surgery is inform consent. This is not
just important for the patients understanding but for the health care provider. The
consent is grounded on the idea of respect for the patients autonomy, the patient
making his or her own decisions about how the surgery will go and what, if
anything, will be put in the body. For example, for the mitral valve replacement
the doctor could have used a rubber band type hold or a mechanical hold, which
would be metal. In this case the doctor discussed this option with the patient and
they decided with the rubber band like fix.

4. Discuss nursing management priorities for patients requiring coronary

artery bypass surgery (p 456, Wagner)
Before undergoing surgery the nurse must assess the patient for individual
needs because this surgery comes with anxiety. The nurse needs to make
sure the patient has no questions and is informed about everything that
will be happening. This also goes for the patients family that is there with
them. They need to be informed about how they will feel and look after
surgery, such as having a tube down their throat. During surgery the nurse
in the OR is responsible to help prep the patient and then document
 everything in the room, such as the time of the first cut. After surgery the
pulmonary assessment is important. It is important to always have a pulse
ox on the patient. Vitals need to be constantly monitored and a constant
eye on the patient is needed because changes in these patients can
happen so quickly.

5. How was your experience overall? Would you recommend this experience
for future students?
My experience in the OR was an unforgettable experience. At first I was
put in the corner out of the way. During the beginning there was a lot of
organized chaos. There was certain things that needed done before the surgery
could take place. The patient needed to be bathed in the iodine solution, a
catheter needed put in and the patient needed toe be secured to the table for
safety. The medication were started and the patient was intubated. At this time
they prepared him for the surgery by draping him. The surgeon came in and they
observed the heart to make sure the plan hadn’t changed from the last time he
looked at his heart. Then, he made his first cut. The nurses began explaining
everything that was happening, but I was still in the corner unable to see. Once
the patient was open the pulmonologist came over and brought me over to the
bypass machine. At this time they turned on the cameras so I could get a closer
view. The pulmonologist explained everything in great detail as I watched the
patient be put on bypass. Then, the craziest thing, they stopped his heart before
the doctor began to do the repairs. Again, everything was being explained to me
and I felt very welcomed in the OR. I would 100% recommend this for all
students.