Maricopa Community Colleges  NCE247   19986-20086 
Official Course Description: MCCCD Approval: 07/22/08
NCE247 19986-20086 LEC 1 Credit(s) 1 Period(s)
NURSING MANAGEMENT OF THE OPEN HEART SURGICAL PATIENT
Management of the open heart surgical patient including hemodynamic monitoring, post anesthesia care, x-ray evaluation, drug therapy, ventilation management, chest drainage, post-operative complications and care plans.
Prerequisites: Registered Nurse (RN).
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MCCCD Official Course Competencies:
 
NCE247   19986-20086 NURSING MANAGEMENT OF THE OPEN HEART SURGICAL PATIENT
1. State three elements of the pre-operative teaching plan for the open heart surgical patient. (I)
2. Describe the room set-up and state what measures must be taken to prepare the Intensive Care Unit (ICU)to receive an open heart surgical patient. ( II)
3. Identify the team members who assist with the recovery of the open heart surgical patient and describe their responsibilities. (III)
4. Identify three key alterations in cardiovascular hemodynamics related to coronary artery bypass graft and valve replacement. (IV)
5. Describe the appropriate pharmacological treatment of changes in cardiovascular hemodynamics resulting from cardiac surgical procedures. (V)
6. Develop a nursing care plan directed at recovering the open heart surgical patient from anesthesia. (VI)
7. Identify the anatomic location of invasive lines, endotracheal tube, and mediastinal/chest tubes seen on a chest radiograph. (VII)
8. List the medications/nursing care measures taken to provide adequate rest, sleep and pain management for the open heart surgical patient. (VIII)
9. List five key criteria used to determine the open heart surgical patient's readiness to wean from mechanical ventilation. (IX)
10. Identify early signs and symptoms of five common complications of cardiac surgery and develop an appropriate nursing care plan to prevent/treat each of these complications. (X)
11. Demonstrate the skills necessary to maintaining chest tube patency and drainage system integrity. (XI)
12. Develop a nursing care plan for the open heart surgical patient which promotes independence and prepares the patient to transfer out of the intensive care unit. (XII)
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MCCCD Official Course Outline:
 
NCE247   19986-20086 NURSING MANAGEMENT OF THE OPEN HEART SURGICAL PATIENT
    I. Open Heart Pre-operative Teaching Plan
        A. Pre-operative admission
        B. Patient history
        C. Post operative complications
        D. Teaching plan
      II. Intensive Care Unit (ICU) Pre-arrival Preparation
          A. Room preparation
          B. Standing orders
          C. Nursing report
        III. Post Operative Care
            A. Anesthesia report
            B. Priorities in patient care
              1. airway management
              2. vital signs/patient assessment
              3. equipment
            C. Team Responsibilities
          IV. Cardiovascular Hemodynamic
              A. Hemodynamic parameters
              B. Changes in vascular disease
                1. stenosis
                2. insufficiency
              C. Hemodynamic changes with valve replacement
                1. aortic stenosis
                2. mitral stenosis
                3. mitral/aortic insufficiency
            V. Pharmacological Management
                A. Vasopressors
                B. Vasodilators
                C. Inotropes
              VI. Nursing Management of the Anesthesia Patient
                  A. Stages of anesthesia
                  B. Protective device protocol
                  C. Diprivan
                  D. Assessment
                VII. Chest Radiographic Landmarks
                    A. Normal landmarks
                    B. Location of tubes
                    C. Markers of complications
                      1. cardiac tamponade
                      2. pulmonary embolism
                      3. pneumothorax
                  VIII. Patient Management
                      A. Environmental factors
                      B. Management of pain and sedation
                      C. Post extubation management of pain
                      D. Ensuring proper rest and sleep
                    IX. Ventilator Issues
                        A. Assessment for weaning
                        B. Management of weaning
                        C. Extubation protocol
                        D. Post extubation management
                          1. wound splinting
                          2. oxygen therapy
                          3. signs and symptoms of complications
                      X. Management of Post-operative Complications
                          A. Cardiac tamponade
                          B. Hemodynamic markers
                          C. Volume administration
                          D. Cardiac rhythm disturbances
                          E. Cardiovascular accident
                          F. Bleeding/hypovolemia
                          G. Chest tube management
                        XI. Chest Drainage Systems
                            A. Milking/striping
                            B. Equipment review
                          XII. Care Plan for Discharge
                              A. Activity progression
                              B. Nutrition
                              C. Wound care
                              D. Removal of invasive lines
                              E. Drug Therapy
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