Excellence in Care:
Current Surgical Cardiac Procedures
Pam Bayles-Prevost RN, BSN
INDEPENDENT STUDY
Health Professions Institute
for Continuing Education
Austin Community College
The Austin Community College
Health Professions Institute, Continuing Education
5930 Middle Fiskville Road, Austin, TX 78752
INDEPENDENT STUDY: HPRX 3006: Current Surgical Cardiac Procedures
Description and Purpose: Pam Bayles RN, BSN appears with Alyssa Monacelli RN, BSN, instructor and
coordinator with the Health Professions Institute of Austin Community College (ACC), to discuss
cardiac protocols; how they are used in a clinical setting and how they relate to cardiac conditions. Ms.
Bayles has 25 years experience working in critical care in the NICU, PICU, and adult ICU settings. She
currently teaches through the ACC Health Professions Institute and works clinically with the Heart
Hospital of Austin.
The purpose of this activity is to enrich the participant’s contribution to quality healthcare and the
pursuit of professional career goals by providing current and updated information on surgical procedures
for the treatment and management of cardiac conditions.
This offering is a self-paced learning activity developed to meet the individual needs of nurses, social
workers, and emergency medical services personnel requiring continuing education for relicensure.
Goals and Objectives: Upon completion of this activity, the student will be able to:
1.
2.
3.
4.
Discuss the differences between a CABG, EVH, and OPCAB.
Identify two (2) surgical procedures used to repair abdominal aneurysms.
List two (2) valve-sparing surgical procedures.
Describe complications associated with balloon valvuloplasty.
Requirements for Successful Completion: The packet you have received contains a pre-test, DVD,
post-test and a program evaluation. To successfully complete this activity and earn continuing
education the participant must:
1. Complete the pre-test
2. View the DVD
3. Complete the post-test (score an 80 or more)
4. And, complete the evaluation
NOTE: Following the viewing of the DVD and completing the accompanying documents, questions
may be addressed by contacting Elizabeth Huss @ 512-223-7271 or [email protected]
Submit all of the documents (pre/post-test, evaluation) along with your completed Registration Form
(check or credit card), and payment to:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Within two business weeks from receipt of your material at ACC, your certificate of completion will
be available (to be mailed, fax, or picked up at the above address … your choice).
Upon successful completion participants will be awarded a certificate of successful completion worth
2.0 contact hours.
Austin Community College is an approved provider of continuing nursing education by the Texas
Nurses Association, an accredited approver by the American Nurses Credentialing Center’s
Commission on Accreditation.
Contact hours for programs applicable to social work are approved for CEU’s by the Texas State Board
of Social Worker Examiners. This program is worth 2.0 contact hours or 0.2 continuing education
units (CEU’s).
Continuing education for Emergency Medical Personnel is approved by the Texas Department of
State Health Services. This program is worth 2.0 TDH (P) contact hours.
Conflicts of Interest: A conflict of interest occurs when an individual has an opportunity to affect or
impact educational content with which he or she may have a commercial interest or a potentially
biasing relationship of a financial, professional or personal nature. All planners and faculty/content
specialist(s) must disclose the presence or absence of a conflict of interest relative to this activity. All
potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing
nursing education activity. All activity planning committee members and faculty/content specialists
have submitted Conflict of Interest Disclosure forms.
The planning committee members and faculty/content specialists of this CNE activity have disclosed
no relevant professional, personal or financial relationships related to the planning or
implementation of this CNE activity.
Sponsorship or Commercial Support: This CNE activity received no sponsorships or commercial
support.
Non-Endorsement of Products: Approved provider status of Austin Community College refers only to
the continuing nursing education activity and does not imply a real or implied endorsement by Austin
Community College, the American Nurses Credentialing Center (ANCC) or the Texas Nurses
Association (TNA) of any commercial product, service, or company referred to or displayed in
conjunction with this activity, nor any company subsidizing costs related to this activity.
Off-label Product Use: This CNE activity does not include any information about off-label use of any
product for a purpose other than that for which it is approved by the U.S. Food and Drug
Administration (FDA).
Reporting of Perceived Bias: Bias is defined by the American Nurses Credentialing Center’s
Commission on Accreditation (ANCC COA) as preferential influence that causes a distortion of opinion
or of facts. Commercial bias may occur when a CNE activity promotes one or more product(s) (drugs,
devices, services, software, hardware, etc.) This definition is not all inclusive and participants may
use their own interpretation in deciding if a presentation is biased.
The ANCC COA is interested in the opinions and perceptions of participants at approved CNE
activities, especially in the presence of actual or perceived bias in continuing education. Therefore,
ANCC invites participants to access their “ANCC Accreditation Feedback Line” to report any noted bias
or conflict of interest in the educational activity. The toll free number is 1(866) 262-9730.
Expiration: This continuing nursing education activity will expire on March 1, 2014
Printed Name:
Date:
Instructions: Complete this pre-test PRIOR to watching the video. Choose the best answer by circling
the letter corresponding to your choice. Submit this pre-test, your post-test, completed evaluation,
completed registration, and payment to:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Pre-Test: Current Surgical Cardiac Procedures
1. Trends in cardiovascular procedures include all of the following EXCEPT:
a. New procedures are involving increased length of hospital stays.
b. New procedures are less invasive.
c. There has been a plateau in the number of open heart surgeries and cardiac caths.
d. The plateau in open heart surgeries and cardiac caths is driven by the availability of new
technology.
2. Client criteria for Endovascular Aneurysm Repair (EVAR) include the following:
a. Young age, optimum weight, normal renal function
b. Obesity, co-morbidities, elderly, renal disease
c. Obesity, renal disease, 55 years and older, normal weight
d. Young or elderly, obesity, renal disease, co-morbidities
3. The following relate to repair of the thoracic abdominal aortic aneurysm procedure (commonly
referred to as “T triple A”):
a. The repair is lengthy; spanning a large portion of the abdominal aorta.
b. Serious complications include lower extremity weakness and/or paralysis.
c. Post-op care includes monitoring neurological status in lower extremities at least Q 1 hour.
d. All of the above.
4. Minimally invasive heart surgery:
a. Is associated with increased procedural costs.
b. Increases morbidity among clients.
c. Is performed on a beating heart.
d. Requires use of the heart-lung machine.
5. Minimally invasive heart surgery is frequently referred to as:
a. Minimally invasive direct coronary artery bypass
b. Off-pump CABG
c. A only
d. Both A and B
Pre-Test
Pg. 2
6. Suitable candidates for minimally invasive heart surgery include:
a. Diabetes, high risk for stroke, renal disease, peripheral vascular disease, lupus nephritis
b. Elderly, renal disease, high risk for stroke, decreased pulmonary function, peripheral
vascular disease
c. Co-morbidities, renal disease, cancer, high risk for stroke, increased pulmonary function
d. Obesity, renal disease, co-morbidities, peripheral neuropathies, high risk for stroke
7. Complications associated with minimally invasive heart surgery include the following:
a. Restenosis,
b. Pericarditis
c. Bleeding
d. All of the above
8. The difference between the OPCAB and CABG with EVH is:
a. With the OPCAB procedure, the internal mammary arteries are typically used for the graft;
the heart-lung machine is not needed (the procedure is performed on a beating heart).
b. The grafts for the CABG with EVH are endoscopically harvested from the saphenous vein
and the heart-lung machine is used because the procedure is not performed on a beating
heart.
c. Both A and B
d. Neither A nor B
9. Pre-operative care for clients undergoing cardiac procedures:
a. Includes teaching regarding what to expect post-operatively.
b. Requires that teaching be conducted directly with the client; face to face.
c. Includes a visit to the surgical suite prior to the procedure.
d. Involves medicating clients with anti-depressants prior to the procedure.
10. Post-operative care for clients undergoing cardiac procedures includes all of the following
EXCEPT:
a. Promoting the well-role
b. Pain management
c. Signing consent forms for the procedure
d. Instruction in use of pillow (to support sternal incision) for coughing and deep breathing
11. All of the following are complications associated with Balloon Valvuloplasty:
a. Bleeding, regurgitation, embolus, cardiac perforation
b. Stroke, diplopia, bleeding, regurgitation
c. Cardiac tamponade, bleeding, DIC, pseudoaneurysm
d. Pseudoaneurysm, bleeding, amblyopia, regurgitation
Pre-Test
Pg. 3
12. Facts about transcatheter aortic valve replacement (AVR) are:
a. There are two (2) approaches (antegrade and retrograde); access is via a left thoracotomy.
b. Access is femoral; the only approach is antegrade and involves puncturing the cardiac
septum.
c. The replacement does not require removal of the native valve; must be conducted in a
surgical suite.
d. Performed with local, spinal anesthesia with sedation or general anesthesia; can be
completed in cath lab or the OR.
13. All of the following are effects of being “on pump” EXCEPT:
a. Clients typically lose weight immediately following an open heart procedure.
b. Metabolic status is frequently decreased (electrolytes, serum albumin).
c. Oxygen demand is decreased.
d. Changes in hemodynamic and metabolic status cause 3rd spacing.
14. Two valve sparing surgeries are:
a. Bentall procedure involving replacement of the root and proximal ascending aorta with a
tube graft.
b. Ross procedure involving replacement of the aortic valve with the pulmonary valve which is
then replaced with a cadaver valve.
c. Bentall procedure involving replacement of the root and proximal ascending aorta with a
pulmonary valve.
d. Ross procedure involving replacement of the aortic valve with a tube graft.
e. Both C and D
f. Both A and B
15. Differences between the antegrade and retrograde transcatheter AVR include:
a. The antegrade procedure involves access through the femoral artery.
b. The retrograde procedure involves access through the femoral artery.
c. The antegrade procedure involves puncturing the cardiac septum.
d. A only
e. Both B and C
f. Both A and C
Excellence in Care: Current Surgical Cardiac Procedures
Program Outline
Written:
I. Pre-Test
DVD Presentation:
II. Trends in Cardiovascular Procedures
A. Less invasive procedures
B. Procedures involving shortened hospital stays
C. Catheterizations and Open Heart Surgery plateau
1) Due to less invasive procedures
2) Technology driven
III. Surgical Repair of Abdominal Aneurysm
A. Endovascular Aneurysm Repair (EVAR)
1) Client Criteria
2) Goal
3) Complications
B. Thoracic Abdominal Aortic Aneurysm
1) Description
2) Complications
3) Post-procedure care
IV. Minimally Invasive Heart Surgery
A. Description
B. Client Criteria
C. MIDCAP (Minimally Invasive Direct Coronary Artery Bypass)
1) Complications
2) Post-procedure care
D. OPCAB (Off-Pump CABG)
1) Complications
2) Post-procedure care
V. Valve Replacement Procedures
A. Transcatheter Valve Replacement
1) Antegrade, transeptal procedure
2) Retrograde procedure
B. Transapical Approach
C. Balloon Aortic Valvuloplasty
VI. Other Cardiac Surgical Procedures
A. Maze Procedure- for atrial fibrillation, client criteria
B. Cox-Maze II Procedure
C. Valve Sparing Procedures
1) Bentall procedure- indication, description
2) Ross procedure- indication, description
3) Post-procedure care
D. CABG with EVH (Endoscopic Vein Harvest)
VIII. Summary
Written:
VI. Post-Test
VII. Evaluation
Evaluation
Title of Education Activity: Excellence in Care: Current Surgical Cardiac Procedures
Location: DVD Video Format
Date: Participants check out and complete on own time
Purpose of this activity: The purpose of this activity is to enrich the participant’s contribution to
quality healthcare and the pursuit of professional career goals by providing current and updated
information on cardiac protocols for use in management of cardiac conditions.
Directions/Instructions: Please complete this evaluation questionnaire. Your anonymous
responses will be used to revise this activity and to plan future educational activities. Circle the
number that best fits your evaluation of this activity.
1 = Not at all
2 = Somewhat
3 = Almost completely
4 = Completely
1. Rate your achievement of these objectives:
1. Discuss the differences between a CABG, EVH, and OPCAB.
1
2
3
4
2. Identify two (2) surgical procedures to repair abdominal
aneurysms.
1
2
3
4
3. List two (2) valve-sparing surgical procedures.
1
2
3
4
4. Describe the complications associated with balloon valvuloplasty. 1
2
3
4
2. Rate the effectiveness of the teaching/learning resources?
1
2
3
4
1
1
1
2
2
2
3
3
3
4
4
4
1
1
1
2
2
2
3
3
3
4
4
4
1
2
3
4
3. Please evaluate the guest speaker- Pamela Bayles RN, BSN
a. Knowledge and currency of topic
b. Ability to make points clear
c. Ability to apply content to practice
4. Please evaluate the moderator- Alyssa Monacelli RN, BSN
a. Guides the discussion
b. Asks pertinent questions
c. Fosters clarification of presented information
5. Were the objectives relevant to the overall purpose?
(see above)
6. How long (in minutes) did it take you to complete the entire activity (including taking the pretest, watching the video, taking the post-test, and completing this evaluation tool)? ________
Minutes
7. List two (2) ways you will integrate what you learned in this activity into your practice and/or
employment environment.
8. The following were disclosed prior to the beginning of this activity either in writing or
verbally?
a. Requirements for successful completion
Yes
No
b. Conflicts of Interest
Yes
No
c. Commercial Support
Yes
No
d. Non-endorsement of Products
Yes
No
e. Off-label Use
Yes
No
9.Did you, as a participant, notice any bias that was not previously
presentation?
disclosed in this
Yes
No
If “Yes”, please describe who was biased and how.
10. Comments: If you answered (1) to any of the above, please comment.
11. Please list any suggestions or topics for future programming.
Printed Name:
Date:
Address (where you would like to receive your certificate of completion):
City:
State:
Zip code:
Instructions: Choose the best answer for each question listed below and circle the corresponding letter. A
passing score of 80% (answer 12 or more correctly) or more is required to earn continuing nursing education
(CNE). After you have completed this post-test, submit it along with your completed evaluation, pre-test,
registration form and payment to the address below:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Post-Test: Current Surgical Cardiac Procedures
1. Trends in cardiovascular procedures include all of the following EXCEPT:
a. New procedures are involving increased length of hospital stays.
b. New procedures are less invasive.
c. There has been a plateau in the number of open heart surgeries and cardiac caths.
d. The plateau in open heart surgeries and cardiac caths is driven by the availability of new
technology.
2. Client criteria for Endovascular Aneurysm Repair (EVAR) include the following:
a. Young age, optimum weight, normal renal function
b. Obesity, co-morbidities, elderly, renal disease
c. Obesity, renal disease, 55 years and older, normal weight
d. Young or elderly, obesity, renal disease, co-morbidities
3. The following relate to repair of the thoracic abdominal aortic aneurysm procedure (commonly
referred to as “T triple A”):
a. The repair is lengthy; spanning a large portion of the abdominal aorta.
b. Serious complications include lower extremity weakness and/or paralysis.
c. Post-op care includes monitoring neurological status in lower extremities at least Q 1 hour.
d. All of the above.
4. Minimally invasive heart surgery:
a. Is associated with increased procedural costs.
b. Increases morbidity among clients.
c. Is performed on a beating heart.
d. Requires use of the heart-lung machine.
Post-Test Pg. 2
5. Minimally invasive heart surgery is frequently referred to as:
a. Minimally invasive direct coronary artery bypass
b. Off-pump CABG
c. A only
d. Both A and B
6. Suitable candidates for minimally invasive heart surgery include:
a. Diabetes, high risk for stroke, renal disease, peripheral vascular disease, lupus nephritis
b. Elderly, renal disease, high risk for stroke, decreased pulmonary function, peripheral
vascular disease
c. Co-morbidities, renal disease, cancer, high risk for stroke, increased pulmonary function
d. Obesity, renal disease, co-morbidities, peripheral neuropathies, high risk for stroke
7. Complications associated with minimally invasive heart surgery include the following:
a. Restenosis,
b. Pericarditis
c. Bleeding
d. All of the above
8. The difference between the OPCAB and CABG with EVH is:
a. With the OPCAB procedure, the internal mammary arteries are typically used for the graft;
the heart-lung machine is not needed (the procedure is performed on a beating heart).
b. The grafts for the CABG with EVH are endoscopically harvested from the saphenous vein
and the heart-lung machine is used because the procedure is not performed on a beating
heart.
c. Both A and B
d. Neither A nor B
9. Pre-operative care for clients undergoing cardiac procedures:
a. Includes teaching regarding what to expect post-operatively.
b. Requires that teaching be conducted directly with the client; face to face.
c. Includes a visit to the surgical suite prior to the procedure.
d. Medicating clients with anti-depressants prior to the procedure.
10. Post-operative care for clients undergoing cardiac procedures includes all of the following
EXCEPT:
a. Promoting the well-role
b. Pain management
c. Signing consent forms for the procedure
d. Instruction in use of pillow (to support sternal incision) for coughing and deep breathing
Post-Test Pg. 3
11. All of the following are complications associated with Balloon Valvuloplasty:
a. Bleeding, regurgitation, embolus, cardiac perforation
b. Stroke, diplopia, bleeding, regurgitation
c. Cardiac tamponade, bleeding, DIC, pseudoaneurysm
d. Pseudoaneurysm, bleeding, amblyopia, regurgitation
12. Facts about transcatheter aortic valve replacement (AVR) are:
a. There are two (2) approaches (antegrade and retrograde); access is via a left thoracotomy.
b. Access is femoral; the only approach is antegrade and involves puncturing the cardiac
septum.
c. The replacement does not require removal of the native valve; must be conducted in a
surgical suite.
d. Performed with local, spinal anesthesia with sedation or general anesthesia; can be
completed in cath lab or the OR.
13. All of the following are effects of being “on pump” EXCEPT:
a. Clients typically lose weight immediately following an open heart procedure.
b. Metabolic status is frequently decreased (electrolytes, serum albumin).
c. Oxygen demand is decreased.
d. Changes in hemodynamic and metabolic status cause 3rd spacing.
14. Two valve sparing surgeries are:
a. Bentall procedure involving replacement of the root and proximal ascending aorta with a
tube graft.
b. Ross procedure involving replacement of the aortic valve with the pulmonary valve which is
then replaced with a cadaver valve.
c. Bentall procedure involving replacement of the root and proximal ascending aorta with a
pulmonary valve.
d. Ross procedure involving replacement of the aortic valve with a tube graft.
e. Both C and D
f. Both A and B
15. Differences between the antegrade and retrograde transcatheter AVR include:
a. The antegrade procedure involves access through the femoral artery.
b. The retrograde procedure involves access through the femoral artery.
c. The antegrade procedure involves puncturing the cardiac septum.
d. A only
e. Both B and C
f. Both A and C