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Examination: Right Thoracotomy Approach to Mitral Valve Surgical Procedures
FEBRUARY 1997, VOL 65, NO 2
Examination RlGH" THORACOTOMV APPROACH TO MRRAL VALVE SURGICAL PROCEDURES
4. peripheral and pulmonary edema. a. 1,2, and 3 b. 1,3, and 4 c. 2 , 3 , and 4 d. all of the above
1.The primary task of the mitral valve is to promote blood flow forward from the left atrium to the left ventricle and to prevent the backward leakage of blood from the into the a. right atrium, right ventricle b. left ventricle, left atrium c. right ventricle, right atrium d. left atrium, left ventricle
7 . A closed mitral commissurotomy may be performed by a a. prosthetic valve replacement procedure. b. transposition of the great vessels. c. graft repair of the ascending aorta. d. finger dilation or cardiovalvulotomeinsertion.
2.When the pericardium is opened, the mitral valve is more appropriately thought of as a postenor valve that is located between the left atrium and the left ventricle. a. true b. false
8.Valvuloplasty procedures are surgical reconstructions of all of the following, except a. aortic roots. b. chordae tendineae. c. mitral valve leaflets. d. papillary muscles.
3.Valvular heart disease is the result of two types of valvular disruption, which are a. regurgitation and recycling. b. dehiscence and dissection. c. stenosis and insufficiency. d. rupture and sepsis.
9.Mitral insufficiency usually is the result of 1. mitral valve prolapse. 2. rheumatic fever. 3. bacterial endocarditis. 4. papillary muscle dysfunction or rupture. a. 3 and4 b.2and3 c. 1 and 2 d. all of the above
4.Scarlet fever is the cause of narrowing at the mitral valve's opening in almost all patients. a. true b. false 5.Pathophysiologic changes seen in patients diagnosed with mitral stenosis include 1. decreased cardiac output. 2. increased pulmonary vascular resistance. 3. atrial fibrillation and pulmonary hypertension. 4. increased left atrial pressure. a. 2 and 3 b. 2, 3, and 4 c. 1 and4 d. all of the above 6.Signs and symptoms of mitral stenosis include 1. myocardial infarctions. 2. dyspnea on exertion. 3. fatigue and weakness.
I L S i g n s and symptoms of mitral insufficiency include 1. orthopnea and tachycardia. 2. fatigue and dyspnea on exertion. 3. angina and atrial fibrillation. 4. severe aortic regurgitation. a. 1,3, and 4 b. 1, 2, and 3 c. 2,3, and 4 d. all of the above
11.Annuloplasty procedures are repairs of a. arachnodactyly. b. diffuse aortic dilatation. 366
AORN J O U R N a
FEBRUARY 1997, VOL 65, NO 2
b. 2,3, and 4 c. 1,2, and 3 d. all of the above
c. incompetent valve rings. d. coronary artery graft anastomoses.
1Zhdications for annuloplasty procedures include all of the following, except a. aortic stenosis. b. acute onset of insufficiency from ruptured chordae tendineae. c. progressive cardiac enlargement. d. congestive heart failure. 1 1 T h e median sternotomy approach for repeat open heart surgical procedures is associated with patient complications such as 1. sternal dehiscence and mediastinitis. 2. osteomyelitis. 3. thromboembolisms and aortic stenosis. 4. injuries to the heart, phrenic nerve, and great vessels. a. 1,2, and 3 b. 1,2, and 4 c. 2,3, and 4 d. all of the above 1AAccording to the article, the approach allows surgeons to achieve excellent, rapid exposures of mitral annuli, which facilitates the excision of diseased mitral valves and the insertion of valve prostheses. a. left thoracotomy b. median stemotomy c. posterior spinal d. right thoracotomy 15.Mitral valve repairs, rather than mitral valve replacements, are preferable for all of the following reasons, except a. patients receive new prostheses. b. anticoagulation therapy is avoided. c. patients’ own tissues are retained. d. there is less morbidity and mortality. l&Annuloplasty rings placed around patients’ mitral annuli 1. hold the anterior and posterior leaflets closer together. 2. reduce mitral annuli back to their normal sizes. 3. prevent leakage when patients’ mitral valves are closed. 4. repair ruptured chordae tendieae. a. 1, 3, and4
17.For a right thoracotomy approach to a mitral valve repair, circulating nurses position the patient on his or her a. right side and rotate the body so that the hips are at a 90-degree angle and the thoracic area is at a 45-degree angle to the OR bed. b. back, place the legs in lithotomy stirrups, and place :he OR bed in Trendelenburg’s position. c. left side and rotate the body so that the thoracic area is at a 90-degree angle and the hips are at a 45-degree angle to the OR bed. d. stomach and position the patient’s head and legs at a 45-degree downward angle to the OR bed. 1 b T h e circulating nurses use a padded arm holder to position the patient’s right arm for all of the following reasons, except to a. raise the arm above the patient’s head. b. allow surgeons optimal access to the underlying ribs. c. facilitate widening of the intercostal spaces. d. prevent unnecessary neck stretching. 1 B T h e scrub person anticipates that the surgeon will place traction stitches on the pericardial margins to expose the 1. aorta. 2. right and left atria. 3. right pulmonary artery and vein. 4. superior and inferior vena cava. a. 1 and 3 b. 2and4 c. 2,3, and 4 d. all of the above =One advantage of a right thoracotomy approach is that the left atrium is no longer the lowest point in the surgical field, and the “bilge phenomenon” (ie, surgical debris settles to the lowest point) is diverted from the left atrium to the right pleural space. a. true b. false
21.The perfusionist administers IV to the patient before he or she is placed on cardiopulmonary bypass (CPB) to prevent
369 AORN JOURNAL
FEBRUARY 1997, VOL 65, NO 2
d. meperidine hydrochloride
thrombus formation in the CPB circuit. a. warfarin sodium b. protamine sulfate c. heparin sodium d. cefamandole sulfate =During a mitral valve replacement procedure, the surgeon tries to leave the posterior mitral valve leaflet and its chordal attachments intact to enhance a. the tricuspid annuloplasty. b. atrial contractility. c. ventricular contractility of the heart. d. the workload of the myocardium. =Mechanical valves have shorter life expectancies than biologic tissue valves, but they do not require lifelong anticoagulation therapy. a. true b. false the conclusion of the mitral valve replacement procedure, the anesthesia care provider uses a transesophageal echocardiography transducer probe to assess the patient’s ventricular function and to a. calculate the patient’s cardiac input. b. detect the presence of residual air in the aorta. c. cannulate the ascending aorta at its highest point. d. determine the patient’s core body temperature.
=The CSICU nurses assess the patient for possible postoperative complications associated with mitral valve surgical procedures, which include 1. anticoagulation-relatedhemorrhage. 2. thromboembolism. 3. prosthetic dehiscence or perivalvular leaks. 4. rupture of the left ventricular free wall or atrioventriculargroove. a. 1,3,and4 b. 2,3, and 4 c. 1,2, and3 d. all of the above =.The CSICU nurses do not inflate the balloon of the pulmonary artery catheter to prevent possible a. thrombus formation. b. false readings. c. pulmonary hemorrhage. d. slippage back into the superior vena cava.
=At
=The cardiac surgery intensive care unit (CSICU) nurses administer 4 to 10 mg of every 12 to 24 hours (ie, 0.5 to 1.0 mglhr) through the patient’s epidural catheter to control pain during the immediate postoperative period. a. morphine sulfate b. bupivacaine hydrochloride c. methohexital sodium AORN is accredited os o provider of continuing education in nufsing by the Americon Nurses Credentialing Center‘s Commission on Accreditotion. AORN recognizes this activity 0s continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentioling Center‘s Commission on Accreditation approves or endorses any product included in he octivi@.
=Treatment of mitral valve stenosis and insufficiency depends on the nature and severity of patients’ symptoms. a. true b. false =The most common causes of valvular heart disease include all of the following, except a. bacterial endocarditis. b. scarlet fever. c. congenital defects. d. degenerative tissue changes and ischemia. =According to the article, the right thoracotomy approach is preferable because it decreases patients’ risks of cardiac injuries and bleeding. a. true b. false
AORN maintains the following provider numbers: Aloboma ABNPOO75, Colifornia BRN00667, Florida 2 7FO1 77, Iowa 103. AORN is approved as a provider of continuing nursing education by the Kansas State Board of Nursing. This course offering is approved for three contact hours. The Kansas State Board of Nursing approved provider number is LTO 1 14-0316.
371 AORN JOURNAL
Professional nurses ore invited to submit monuscripts for the Home Sudy Program. Manuscripts or queries should be sent to the Editor, AORN Journal, 2770 S Parker Rd, Suite 300, Denver, CO 80231-5711. As with all manuscripts sent to the Journal, papers submitted for Home Study Programs should not have been previously published or submitted simultoneously to any other publication.
FEBRUARY 1997, VOL 65, NO 2
Answer Sheet RIGHT THORAWTOMY APPROACH TO MCCRAL VALVE SURGICAL PROCEDURES
P
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711
Event # 97038
ID/SS Number
Session # 3849
Program offered February 1997. The deadline for this program is July 3 1, 1997.
~
0
0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 000000000.
(v
g
Session Number
1. Record your AORN identification number in the appropriate section below. 2. Using a pen or pencil, completely darken the space that indicates your answer to each question. Do not circle or check the answer spaces. 3. A score of 70% correct is required for credit. 4. Record the time required to complete the program.
5. Enclose fee: Members $12; Nonmembers $24. AORN (ID) # Name Address City State Zip RN license # State Phone number ( If nonmember, please provide social security number. Fee enclosed or bill the credit card indicated MasterCard 0Visa American Express Card # Expiration date Signature (for credit card authorization)
373 AORN JOURNAL
1
0000000000 0000000000 0000000000 0000000000
Mark only one answer per question. 100000 100000 300000 400000 500000 600000 700000 800000 900000 1000000 1100000 1200000 1300000 1400000 I500000 1600000 1700000 1800000 1900000
2100000 2200000 2300000 2400000 25@0000 2600000 2700000 2800000 2900000 3000000 3100000 3200000 3300000 3400000 3500000
3600000 3700000 3800000 3900000
FEBRUARY 1997, VOL 65,NO 2
Learner Evaluation RlGHT THORACOTOMV APPROACH TO MlTRAL VALVE SURGMCAL PROCEDURES
The following evaluation is used to determine the extent to which this Home Study Program met your leaming needs. Rate the following items on a scale of 1 to 5. OBJpcTlVEs
To what extent were the following objectives of this Home Study Program achieved? ( 1 ) Discuss vaIvular heart disease. (2) Describe surgical approaches to the mitral valve. (3) Discuss perioperative nursing care for patients undergoing mitral valve surgical procedures. (4) Describe perioperative nurses' roles when caring for patients undergoing mitral valve surgical procedures. Ce"T ( 5 ) Did this article increase your knowledge of the subject matter? (6) Was the content clear and organized? (7) Did this article facilitate learning? (8) Were your individual objectives met? (9) Was the content of the article relevant to the objectives? TEsTwLsTto"swulE
(10) Were they reflective of the content? (1 I ) Were they easy to understand? (1 2) Did they address important points?
What other topics would you like to see addressed in a f u m e Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
374 AORN JOURNAL
Examination RlGH" THORACOTOMV APPROACH TO MRRAL VALVE SURGICAL PROCEDURES
4. peripheral and pulmonary edema. a. 1,2, and 3 b. 1,3, and 4 c. 2 , 3 , and 4 d. all of the above
1.The primary task of the mitral valve is to promote blood flow forward from the left atrium to the left ventricle and to prevent the backward leakage of blood from the into the a. right atrium, right ventricle b. left ventricle, left atrium c. right ventricle, right atrium d. left atrium, left ventricle
7 . A closed mitral commissurotomy may be performed by a a. prosthetic valve replacement procedure. b. transposition of the great vessels. c. graft repair of the ascending aorta. d. finger dilation or cardiovalvulotomeinsertion.
2.When the pericardium is opened, the mitral valve is more appropriately thought of as a postenor valve that is located between the left atrium and the left ventricle. a. true b. false
8.Valvuloplasty procedures are surgical reconstructions of all of the following, except a. aortic roots. b. chordae tendineae. c. mitral valve leaflets. d. papillary muscles.
3.Valvular heart disease is the result of two types of valvular disruption, which are a. regurgitation and recycling. b. dehiscence and dissection. c. stenosis and insufficiency. d. rupture and sepsis.
9.Mitral insufficiency usually is the result of 1. mitral valve prolapse. 2. rheumatic fever. 3. bacterial endocarditis. 4. papillary muscle dysfunction or rupture. a. 3 and4 b.2and3 c. 1 and 2 d. all of the above
4.Scarlet fever is the cause of narrowing at the mitral valve's opening in almost all patients. a. true b. false 5.Pathophysiologic changes seen in patients diagnosed with mitral stenosis include 1. decreased cardiac output. 2. increased pulmonary vascular resistance. 3. atrial fibrillation and pulmonary hypertension. 4. increased left atrial pressure. a. 2 and 3 b. 2, 3, and 4 c. 1 and4 d. all of the above 6.Signs and symptoms of mitral stenosis include 1. myocardial infarctions. 2. dyspnea on exertion. 3. fatigue and weakness.
I L S i g n s and symptoms of mitral insufficiency include 1. orthopnea and tachycardia. 2. fatigue and dyspnea on exertion. 3. angina and atrial fibrillation. 4. severe aortic regurgitation. a. 1,3, and 4 b. 1, 2, and 3 c. 2,3, and 4 d. all of the above
11.Annuloplasty procedures are repairs of a. arachnodactyly. b. diffuse aortic dilatation. 366
AORN J O U R N a
FEBRUARY 1997, VOL 65, NO 2
b. 2,3, and 4 c. 1,2, and 3 d. all of the above
c. incompetent valve rings. d. coronary artery graft anastomoses.
1Zhdications for annuloplasty procedures include all of the following, except a. aortic stenosis. b. acute onset of insufficiency from ruptured chordae tendineae. c. progressive cardiac enlargement. d. congestive heart failure. 1 1 T h e median sternotomy approach for repeat open heart surgical procedures is associated with patient complications such as 1. sternal dehiscence and mediastinitis. 2. osteomyelitis. 3. thromboembolisms and aortic stenosis. 4. injuries to the heart, phrenic nerve, and great vessels. a. 1,2, and 3 b. 1,2, and 4 c. 2,3, and 4 d. all of the above 1AAccording to the article, the approach allows surgeons to achieve excellent, rapid exposures of mitral annuli, which facilitates the excision of diseased mitral valves and the insertion of valve prostheses. a. left thoracotomy b. median stemotomy c. posterior spinal d. right thoracotomy 15.Mitral valve repairs, rather than mitral valve replacements, are preferable for all of the following reasons, except a. patients receive new prostheses. b. anticoagulation therapy is avoided. c. patients’ own tissues are retained. d. there is less morbidity and mortality. l&Annuloplasty rings placed around patients’ mitral annuli 1. hold the anterior and posterior leaflets closer together. 2. reduce mitral annuli back to their normal sizes. 3. prevent leakage when patients’ mitral valves are closed. 4. repair ruptured chordae tendieae. a. 1, 3, and4
17.For a right thoracotomy approach to a mitral valve repair, circulating nurses position the patient on his or her a. right side and rotate the body so that the hips are at a 90-degree angle and the thoracic area is at a 45-degree angle to the OR bed. b. back, place the legs in lithotomy stirrups, and place :he OR bed in Trendelenburg’s position. c. left side and rotate the body so that the thoracic area is at a 90-degree angle and the hips are at a 45-degree angle to the OR bed. d. stomach and position the patient’s head and legs at a 45-degree downward angle to the OR bed. 1 b T h e circulating nurses use a padded arm holder to position the patient’s right arm for all of the following reasons, except to a. raise the arm above the patient’s head. b. allow surgeons optimal access to the underlying ribs. c. facilitate widening of the intercostal spaces. d. prevent unnecessary neck stretching. 1 B T h e scrub person anticipates that the surgeon will place traction stitches on the pericardial margins to expose the 1. aorta. 2. right and left atria. 3. right pulmonary artery and vein. 4. superior and inferior vena cava. a. 1 and 3 b. 2and4 c. 2,3, and 4 d. all of the above =One advantage of a right thoracotomy approach is that the left atrium is no longer the lowest point in the surgical field, and the “bilge phenomenon” (ie, surgical debris settles to the lowest point) is diverted from the left atrium to the right pleural space. a. true b. false
21.The perfusionist administers IV to the patient before he or she is placed on cardiopulmonary bypass (CPB) to prevent
369 AORN JOURNAL
FEBRUARY 1997, VOL 65, NO 2
d. meperidine hydrochloride
thrombus formation in the CPB circuit. a. warfarin sodium b. protamine sulfate c. heparin sodium d. cefamandole sulfate =During a mitral valve replacement procedure, the surgeon tries to leave the posterior mitral valve leaflet and its chordal attachments intact to enhance a. the tricuspid annuloplasty. b. atrial contractility. c. ventricular contractility of the heart. d. the workload of the myocardium. =Mechanical valves have shorter life expectancies than biologic tissue valves, but they do not require lifelong anticoagulation therapy. a. true b. false the conclusion of the mitral valve replacement procedure, the anesthesia care provider uses a transesophageal echocardiography transducer probe to assess the patient’s ventricular function and to a. calculate the patient’s cardiac input. b. detect the presence of residual air in the aorta. c. cannulate the ascending aorta at its highest point. d. determine the patient’s core body temperature.
=The CSICU nurses assess the patient for possible postoperative complications associated with mitral valve surgical procedures, which include 1. anticoagulation-relatedhemorrhage. 2. thromboembolism. 3. prosthetic dehiscence or perivalvular leaks. 4. rupture of the left ventricular free wall or atrioventriculargroove. a. 1,3,and4 b. 2,3, and 4 c. 1,2, and3 d. all of the above =.The CSICU nurses do not inflate the balloon of the pulmonary artery catheter to prevent possible a. thrombus formation. b. false readings. c. pulmonary hemorrhage. d. slippage back into the superior vena cava.
=At
=The cardiac surgery intensive care unit (CSICU) nurses administer 4 to 10 mg of every 12 to 24 hours (ie, 0.5 to 1.0 mglhr) through the patient’s epidural catheter to control pain during the immediate postoperative period. a. morphine sulfate b. bupivacaine hydrochloride c. methohexital sodium AORN is accredited os o provider of continuing education in nufsing by the Americon Nurses Credentialing Center‘s Commission on Accreditotion. AORN recognizes this activity 0s continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentioling Center‘s Commission on Accreditation approves or endorses any product included in he octivi@.
=Treatment of mitral valve stenosis and insufficiency depends on the nature and severity of patients’ symptoms. a. true b. false =The most common causes of valvular heart disease include all of the following, except a. bacterial endocarditis. b. scarlet fever. c. congenital defects. d. degenerative tissue changes and ischemia. =According to the article, the right thoracotomy approach is preferable because it decreases patients’ risks of cardiac injuries and bleeding. a. true b. false
AORN maintains the following provider numbers: Aloboma ABNPOO75, Colifornia BRN00667, Florida 2 7FO1 77, Iowa 103. AORN is approved as a provider of continuing nursing education by the Kansas State Board of Nursing. This course offering is approved for three contact hours. The Kansas State Board of Nursing approved provider number is LTO 1 14-0316.
371 AORN JOURNAL
Professional nurses ore invited to submit monuscripts for the Home Sudy Program. Manuscripts or queries should be sent to the Editor, AORN Journal, 2770 S Parker Rd, Suite 300, Denver, CO 80231-5711. As with all manuscripts sent to the Journal, papers submitted for Home Study Programs should not have been previously published or submitted simultoneously to any other publication.
FEBRUARY 1997, VOL 65, NO 2
Answer Sheet RIGHT THORAWTOMY APPROACH TO MCCRAL VALVE SURGICAL PROCEDURES
P
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711
Event # 97038
ID/SS Number
Session # 3849
Program offered February 1997. The deadline for this program is July 3 1, 1997.
~
0
0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 000000000.
(v
g
Session Number
1. Record your AORN identification number in the appropriate section below. 2. Using a pen or pencil, completely darken the space that indicates your answer to each question. Do not circle or check the answer spaces. 3. A score of 70% correct is required for credit. 4. Record the time required to complete the program.
5. Enclose fee: Members $12; Nonmembers $24. AORN (ID) # Name Address City State Zip RN license # State Phone number ( If nonmember, please provide social security number. Fee enclosed or bill the credit card indicated MasterCard 0Visa American Express Card # Expiration date Signature (for credit card authorization)
373 AORN JOURNAL
1
0000000000 0000000000 0000000000 0000000000
Mark only one answer per question. 100000 100000 300000 400000 500000 600000 700000 800000 900000 1000000 1100000 1200000 1300000 1400000 I500000 1600000 1700000 1800000 1900000
2100000 2200000 2300000 2400000 25@0000 2600000 2700000 2800000 2900000 3000000 3100000 3200000 3300000 3400000 3500000
3600000 3700000 3800000 3900000
FEBRUARY 1997, VOL 65,NO 2
Learner Evaluation RlGHT THORACOTOMV APPROACH TO MlTRAL VALVE SURGMCAL PROCEDURES
The following evaluation is used to determine the extent to which this Home Study Program met your leaming needs. Rate the following items on a scale of 1 to 5. OBJpcTlVEs
To what extent were the following objectives of this Home Study Program achieved? ( 1 ) Discuss vaIvular heart disease. (2) Describe surgical approaches to the mitral valve. (3) Discuss perioperative nursing care for patients undergoing mitral valve surgical procedures. (4) Describe perioperative nurses' roles when caring for patients undergoing mitral valve surgical procedures. Ce"T ( 5 ) Did this article increase your knowledge of the subject matter? (6) Was the content clear and organized? (7) Did this article facilitate learning? (8) Were your individual objectives met? (9) Was the content of the article relevant to the objectives? TEsTwLsTto"swulE
(10) Were they reflective of the content? (1 I ) Were they easy to understand? (1 2) Did they address important points?
What other topics would you like to see addressed in a f u m e Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
374 AORN JOURNAL