[snickers]

We have begun admitting post-op endarterectomy pts. to our unit, and we have no standards of care for this .
Just wondering,(other than neuro vitals) what the protocol is from other places,?

Thanx.

sj.

[Zee_RN]

Ok, just thinking out loud here...our care plan on CEAs are being updated now too..we've been using the same one that is used for neuro patients.

Neuro vitals, BP monitoring and the possible use of Nipride/Neosynephrine; all our CEA's come to the unit with arterial lines. Carotids coming to our unit are usually seen as "easy" patients but they can be touchy if their BP is hard to control. Vascular surgeon usually writes to maintain MAP between 70-100, 80-90, something along those lines, at his preference. BP is our biggest concern, along with of course neuro assessment. Gotta watch out for bleeding too. Pain control.

Personally, I'd rather NOT have a carotid patient...somehow I always seem to get the cranky, hypertensive, nauseated, 94 people in the family waiting room, just-get-me-outta-here-I-hate-this-place kinda patient . Give me a big ole AAA repair anytime.

[susanmary]

My suggestions, in addition to the previous poster, are to monitor neck for numbness, tingling, swelling. Is patient able to swallow? Trach midline? Monitor airway. Monitor incision. Frequent neuro checks, vital signs -- watch BP & be sure patient receives excellent pain relief.

I do not work in Step-Down or ICU -- work on a vascular surgical unit. CEAS come to my unit, from PACU early evening & are usually discharged home the following morning. 1:6 max day/evening ratio.

[snickers]

Susanmary....
Thanx for the information, it gives me a much broader perspective on what I should be watching for etc. etc.and a protocol to set in place for myself.
Thanx again.

sj.

[snickers]

Thanx for the input.
.Susanmary...so if there is numbess, tingling, inability to swallow, is it reasonable to assume that there has been nerve damage intraoperatively?...Specifically, cranial nerves
X1(glossopharyngeal) and X( Vagus). So , is that something you would report to physician right away, or could it wait until morning?

thanx again.

sj.

[susanmary]

Originally posted by snickers:
Thanx for the input.
.Susanmary...so if there is numbess, tingling, inability to swallow, is it reasonable to assume that there has been nerve damage intraoperatively?...Specifically, cranial nerves
X1(glossopharyngeal) and X( Vagus). So , is that something you would report to physician right away, or could it wait until morning?

thanx again.

sj.

I report any changes from baseline. Listen CLOSELY to the PACU report -- might get a "heads up" on what to look for. Could be transient neuro changes; still you need to watch for TIAs/CVA. Have seen numbness/tingling resolve specifically with carotids where the doc had to go very high (blockage was high, had to clamp high.) Post-op I carefully document my assessment, report changes in VS, neuro, urine output, etc. -- I contact the doc & chart the date/time/who I spoke with & what was reported. Always cover yourself -- if you feel something is significant enough to report -- then do it. Ahhh, you're making me think of cranial nerves on my day off. Monitor II/vision-pupils reactive to light accomodate; VII/facial droop; IX/swallowing; X; XII/tongue midline. I always check to see if bilateral handgrasps equal/strong. Monitor any numbness/weakness on one side of the body, etc.,etc. I wish I could help you more, but my neurons are disconnecting -- need to go pick up kiddos!