Danielle Pelini

Open-Heart Observation

Today I had the opportunity to observe an open-heart surgery. More specifically,

an aortic valve replacement and removal of an aortic aneurysm. During this procedure,

this patients failing aortic valve was replaced with an artificial heart valve.

Once the surgical team was all set up and ready to go, the doctor entered the room

to start the surgery. He did this procedure through a median sternotomy, which is an

incision made by cutting through the sternum. The patient was put on a cardiopulmonary

bypass machine, also called a heart-lung machine. This machine takes over the task of

breathing for the patient and pumping their blood around while the surgeon replaces the

heart valve. It acts as the heart and lungs while the patient actual heart and lungs are

stopped for the procedure.

Once the patient was on bypass, a cut was made into the aorta and a cross clamp

was applied. The surgeon then removed the aneurysm and the patient’s diseased aortic

valve to put an artificial valve in its place. He had to sew it together well enough to make

sure that no blood could escape, and this really was the majority of the procedure.

Once the valve was in place and the aorta was closed, the patient was taken off

the cardiopulmonary bypass machine. Chest tubes were then inserted to drain remove

fluids from the chest. There was one placed in front of his heart and one behind. Once

those were set, the doctor used surgical wire to pull the sternum back together, and then

one of the nurses sewed him back up. A bandage was applied to cover the stitches, keep

the site dry and prevent infection. He was then transferred to the ICU to be monitored

during recovery.
 An ethical concern related to the post-operative care of an open-heart surgery

would have to include the care regarding pain. With these types of surgeries, we cannot

always see or understand exactly what is going on with the patient. We have to assess our

patients to the best of our abilities, but also listen to the complaints that they have so that

we can treat these patients accordingly. Another concern would be the information that

the health care team is providing to patients and families. We want to provide them with

the appropriate information so that they can make decisions regarding their own health

care, balancing principles of autonomy and beneficence.

The nursing management priorities for patients requiring an aortic valve

replacement includes assessing and comparing patient baselines during and after the

procedure. Vital signs are constantly being monitored and compared. The patient is

receiving medications and experiencing high stress during the procedure. The nurses

should be assessing the patient using the technology provided but not so much that they

ignore the physical signs that are presented to them.

It was crazy being able to watch this surgery happen. The whole team understood

that this was a high-risk procedure. It all seemed relaxed and routine at first, but as soon

as the doctor stepped foot into the room, it got serious, quiet and really professional. It

was a life-changing procedure for the patient, and everyone wanted to do what they could

for him. Nothing else mattered except for that procedure for the five hours it occurred. It

was a great experience for me as a student, and I hope to someday find myself

contributing to such a great team like the one I was able to observe working together so

well today!