Intraoperative Nursing Management - Invasive Coronary Artery Procedures

INTRAOPERATIVE NURSING MANAGEMENT

The perioperative nurse performs an assessment and prepares the patient for the operating room and recovery experience. Any changes in the patient’s status and the need for changes in therapy are identified. Procedures are explained before they are performed, such as the application of electrodes and use of continuous mon-itoring, indwelling catheters, and an SpO₂ probe. Intravenous lines are inserted to administer fluids, medications, and blood products. The patient will receive general anesthesia, be intubated, and placed on mechanical ventilation. In addition to assisting with the surgical procedures, perioperative nurses are responsible for the comfort and safety of the patient. Some of the areas of interven-tion include positioning, skin care, wound care, and emotional support of the patient and family.

Before the chest incision is closed, chest tubes are positioned to evacuate air and drainage from the mediastinum and the tho-rax. Epicardial pacemaker electrodes are implanted on the surface of the right atrium and the right ventricle. These epicardial elec-trodes can be used to pace the heart and to monitor it for dys-rhythmias through the atrial leads.

Possible intraoperative complications include dysrhythmias, hemorrhage, MI, CVA (stroke, brain attack), embolization, and organ failure from shock, embolus, or adverse drug reactions. As-tute intraoperative patient assessment is critical in preventing these complications and for detecting symptoms and initiating prompt therapy.