A small compilation of nurse anesthesia care plans
These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.
Aortic Insuficiency
Problem: During Diastole (backflow)
LV Preload
Normal to increased
Venous dilation may decrease CO
Heart Rate
Increase 80-100 NSR. Avoid long diastolic times with bradycardia (increases regurgitation)
Contractility
Maintain
SVR
Decrease. Increased afterload = increased regurgitate flow
PVR
Maintain
Etiology
Acute AI
Bacterial Endocarditis
Trauma
Aortic Dissection - antegrade/retrograde
Chronic AI
Congenital - bicuspid
Dilation of aortic root
Marfan's Syndrome - 30-35y
Ankylosing spondylitis
Ascending Aortic aneurysm
Syphilitic/rheumatic
Symptoms
Acute
CHF, pulmonary edema
Volume overload LV, no hypertrophy
Compensatory
Tachycardia, increased contractility, increased SVR (further regurgitation), decreased SV
Increased LVEDV
Pulmonary edema and cardiogenic shock
Emergency surgical repair
Chronic
Dyspnea, fatigue, palpitations, angina (late)
Mild
Asymptomatic with compensation, eccentric hypertrophy (dilated, volume overload LV)
Moderate
LV dilation and hypertrophy, increased LVEDP, and LV dysfunction
Dyspnea and CHF
Subendocardial ischemia - sudden death
Severe
Terminal heart failure
Cardiac Remodeling
Eccentric hypertrophy and dilatation
Increase LVEDV
LV dysfunction is moderate to severe
Functional Mitral regurgitation (may need MV surgery)
Pulmonary HTN / RHF
Preoperative Considerations
Dyspnea, PND, Orthopnea
Angina, decreased DBP = decreased CPP, increased wall tension, and increased LVH
Decrescendo-blowing diastolic murmur along LSB
Widened pulse pressure, lack of a dicrotic notch, diastolic pressure < 50mmhg
EKG: LVH, LBBB, A fib
TEE
Color flow to evaluate
Dilated LV
Functional MR if severe
PCWP
Underestimate the LVEDP
Large v Wave
Overestimate LVEDP if functional MR
Surgical Technique
Myocardial protection difficult
Hypertrophied ventricle – cardioplegia ante grade via coronary Ostia / or retrograde via LV vent (via pulmonary veins as aorta open)
Cardiopulmonary bypass temperature 25-28 degrees C
Post Bypass Procedure
Maintain adequate preload
NSR
Treat dysrhythmias
Treat left ventricular failure with inotropes
Aortic Root Replacement
Renal and cerebral protection
Coronary arteries may be detached from the root and reimplanted