This means what you need to know as a warrior is being prepared for Surgery. After the Cardiologist has confirmed the diagnosis and you have seen the thoracic Surgeon, a date would be scheduled for you. Upon your arrival for surgery (1 or 2 days prior), you will see an Anaesthetist whose job is to put people to sleep during surgery and make sure you feel no pain.
The Nurse admits you, get your history which includes family, social, medical history that is the current and previous medication. She prepares you for surgery, physically (operation site prep) and also psychologically (grown kids, adult patient or paed parent). She explains the surgical procedure in lay man’s language and answers your questions. The Nurse states to you or reminds you when the fasting will begin (usually 6-8hours prior to operation time) and starts IV fluids etc. The Nurse also ensures Consent has been taken and wheels you to the Operation Room where she hands over to the Operating room Nurse.
Psychological preparation of a patient for surgery by the Nurse
A nurse could decide to walk you around the ICU to make you see things or a patient who has gone through similar procedure. Just in case you aren’t chanced to see an intensive care unit before surgery, let’s take you through what you will meet.
The Operating Room suite Experience/Intra op
The OR or theatre is a sterile place solely for surgical intervention/ treatment. There are different people that work in the OR for the success of a surgical procedure.
The Nurses ( scrub nurse, circulating nurse, and the team lead): receive patient from the ward, confirm the patient’s name and ID, consent, confirm the operation site /body part and marks if applicable. They also ensure the availability of supplies in the OR, making sure the patient is safe all through the procedure. The Nurses’ work is completed when patient is shifter to the PACU or Cardiac intensive care unit.
The Surgeon (s): These people cut open the chest after ascertaining diagnosis. They open in layers till they get to the heart, then the surgical repair or correction is done whether with a graft, conduit, mechanical valve, repair etc
The Anesthetist: He or she puts you to sleep and ensure no pain, he makes sure the patient hemodynamic status is within normal range. They may transfuse blood and blood products during surgery
Perfusionist: they operate the heart _lungs machine which serves as artificial heart and lungs ensuring supply of blood to the brain during open-heart surgery. He also monitors the hemodynamic status of patient.
Important others like the Surgical technician, nursing assistant, laboratory scientist, medical officer, Cardiologist etc.
IMMEDIATE POST OPERATION
Patient is picked from the OR by the Nurse from the PACU or the CICU team and then transported to the Cardiac/cardiovascular intensive care unit by the staff depending on hospital policy.
Patient returns from the Operating room usually with airway intubated with an endotracheal tube in the mouth or nasotracheal tube in the nose that is connected to a ventilator (life support machine) This breathing assistance continues for hours or days until the patient is strong enough to start taking breaths on their own.
Patient comes out with Arterial line around their wrist or for babies in the groin area which is used for continuous blood pressure monitoring. Central line(s) (similar to an IV cannular) is inserted into major vessel of the body, around the neck or thigh for Children. This is necessary for central venous pressure monitoring, rapid infusion of drugs and fluids, as well as timely blood sample collections.
Chest drains that come from inside the heart or lungs are also seen which helps drain blood from within the chest cavity. It is important that the chest tube stays at least 12 hours following heart surgery and it drains moderately to prevent cardiac tamponade.
On the chest is a sterile clean dressing to cover the operation site, however close to it are chest tubes (small pipes) which is used to drain blood from inside the chest, until when it is no longer active or needed. Pacing wires are also attached close so at to help support the heart should the need arise.
Urinary catheter and bag is passed in a sterile fashion into the patient’s urethra to empty urine, this is necessary to monitor output, response to diuretics and some other meds, monitor kidney function generally.
Of course, there are monitor electrodes like pins clipped to client’s chest, it will be used to monitor the electric activities of the heart. It measures heart rate, respiratory rate, pulse oximetry reading/oxygen saturation, ETCO2, etc.
In terms of medications, the patient usually comes from the theatre with Inotropes which are drugs used to give the heart maximum support in terms of contractive ability, rate and rhythm. They include Adrenaline, Noradrenaline, Milirinone, etc