- Narrowing of the aortic valve(obstruction blood from the LV to the the aorta) - usually due to degeneration - calcification ( aging, smoking , DM, hypercholesterolemia , HTN, Elevated LDL)
AT RISK FOR AA
- LV hypertrophy, pulmonary congestion , HF
- MUMUR( rough, loud, harsh, raspy) S4
-narrowed pulse pressure
- decreased CO- to the brain( dizziness and syncope)
use caution with exercise stress test-- ( - overworks the LV---risk for v tach, or fibrillation
= Definitive treatment - surgical replacement
· Clients will need medical management (milrinone, dobutamine, dopamine, beta blockers, diuretics, sildenafil)
· Inotropes (milrionone as an example) are used to increase __Cardiac Output_____________
· If pharm treatment fails, - LVAD or heart transplant
Signs & Symptoms: DOE, fatigue, PND, chest pain, palpitations, dizziness, nausea, and syncope with exertion, cough , orthopnea
-If untreated, will result in rupture and death
o S&S: feel HB in abdomen, pain radiating to back, "tearing", "ripping", widening mediastinum on chest x-ray, different BP in left/right, widening pulse pressure
o Management: CV intervention (consider sending out), strict bed rest, lower BP and HR as low as they tolerate,
"Stable" = warm/dry skin, alert, BP in normal range, calm, has a pulse, breathing normally
"Unstable"= feeling faint, shortness of breath, tachypnea, chest pain, pale, diaphoretic, unresponsive, NO PULSE
The SA node is still in control, but created an impulse at a slower than normal rate due to various needs
Rate less than 60 bpm, regular with 1 QRS for each P wave.
sleep, athletic training, hypothyroidism, vagal stimulation, meds like: nifedipine, amiodarone, metoprolol) or from heart disease like MI, CAD, hypoxia and severe heart failure
Atropine would be our treatment if they were not tolerating this (but still had a pulse). If atropine does not help (after 3mg total), pacemaker may be needed
Atrial rate is very high, ventricular rate is also very high, usually narrow and "regular" 1 QRS for each P sometimes 2P to 1 QRS
The SA node sends a signal to the AV node, which sends to the ventricles, but is also sends it back to the SA node which starts the process again, resulting in a very high atrial rate
120+, cannot differentiate p waves, narrow.
Caffeine, stress, hypoxia,
-Adenosine, cardioversion, calcium channel blocker (verapamil, diltiazem) or antiarrhythmics like procainamide, flecainide, sotalol or amiodarone
o Stable: Vagal maneuver, ice water to the face, IV meds to slow the HR
o Unstable: synchronized cardioversion, Adenosine
wide and tall QRS, no P waves seen, over 100
;MI, aneurysm, CAD, rheumatic heart diseases, mitral valve prolapse, hypokalemia, hyperkalemia, and pulmonary embolism
palpitations, weakness, lightheadedness
Amiodarone, synchronized cardioversion (be prepared to move to unstable treatment!)
Defibrillation, CPR, ACLS
No coordinated cardiac activity--- no audible heart beat, no pulse, no respirations. Death is imminent without intervention.
myocardia ischemia or infarction.
ventricular tachycardia, electrolyte imbalances, digoxin or quinide toxicity, or hypothermia
Clinical manifestations loss of consciousness, pulselessness, loss of blood pressure, cessation of respirations, possible seizures and sudden death.
Defibrillation ASAP, ACLS/CPR
epinephrine or vasopressin,lidocaine, amiodarone
wavy P waves, irregular.
Causes atherosclerosis, heart failure, congenital heart disease, chronic obstructive pulmonary disease, hypothyroidism and thyrotoxicosis
clinical manifestation palpitations, dyspnea, and pulmonary edema.
o Stable: Monitor, give anticoags and schedule for ablation or cardioversion.
Remember that we should check for clots before conversion if we have time (with a TEE).
Can also take PO(Amiodarone, Cardizem, BB, anticoag*) meds for rhythm management and ventricular control.
o Unstable: _Synchronized Cardioversion + meds to maintain a normal rhythm
o VIP: Main goal in afib with RVR is to Controlling the ventricle response will prevent long term damage to the mitral valves and prevent ventricular hypertrophy
o Pt will need anticoagulation!
o Ablation- hot or cold probe to obliterate the pathway that is causing the arrythmia
Ablation- cath lab procedure, Uses an sound waves to cause thermal injury/ cell destruction to hopefully stop that conduction pathway
Inhalation of foreign material into the lungs
o Swallow test for neuro, no gag reflex, Post op patients
o S&S: Tachycardia, fever, tachypnea, SOB, cough, cyanosis, crackles
o Treat: NPO, respiratory support- ETT, ABX
When do they need a vent: surgical, respiratory failure, ARDS, obstruction, paralyzed client , general anesthesia
Deterioration- respiratory failure, compromised airway, drug overdose, neuromuscular disorders, inhalation injury, COPD exac, SHOCK
o Don't turn off alarms!
Troubleshoot, ask for help and bag the patient if you are unable to determine cause of alarm
o Verify placement of your tube and maintain normal cuff pressure to prevent injury
o Weaning: return to normal vitals, better ABGs, more alert
· Data to monitor during mechanical ventilation
o ETT: Requires ventilator, placed by MD/APP only, in-line suction
Indications: long term oxygen needs, bypass upper airway obstruction, long term vent
emergent or planned placement, suction is sterile, equipment at bedside should be obturator, ambu bag, suction supplies and extra cannula.
Complications: accidental dislodgment, bleeding, air embolism, aspiration, subQ emphysema, nerve damage, tracheal penetration, infection, dysphagia, tracheoesophageal fistula, tracheal ischemia and necrosis.
o Sterile suction
o Nasal Cannula- up to __6___ L
o Venti-Mask:- great for COPD because it delivers PRECISE amounts of oxygen that we need and not excess (which might suppress their hypoxic drive)
o Non-rebreather- mask, 100% oxygen
o High Flow O2- humidified nasal cannula but at higher percentages/flow/pressure
o NPPV- Cpap/Bipap
S&S of Oxygen toxicity include
presents like acute respiratory failure and pulmonary edema
substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates evident on chest x-rays.