Test 1 Week 1-4 Flashcards
1
Q
How is the renal system a buffer system
A
kidneys excrete or retain bicarbonate, blood pH decreases - then kidney retain HCO3, if pH rises, kidneys will excrete HCO3 through urine
System can take hours or days to compensate
2
Q
How is the respiratory system a buffer
A
CO2 is a by-product of metabolism, CO2 is carried from blood into lungs - excess CO2 binds with H20 - to create carbonic acid
the level of H2CO3 triggers lungs to either increase or decrease rate of respriatrion - compensation begins in 1-3 minutes
3
Q
how long is a large box and small box on ECG paper
A
1 large box has 25 small boxes
large box is .20 seconds
small box 0.04 seconds
4
Q
how long is normal PR interval
what does it measure
A
0.12-0.20 seconds (3-5 small boxes)
Time from SA node to AV node, delay represents a block in atrial conduction
5
Q
How long should QRS interval be what does it represent
A
0.06 - 0.12 (1.5 to 3 small boxes)
time from AV node to bundle of His and purkinjie fibres
Delay - block in ventricualr conduction
narrow - pulse originated in atria, wide pulse originated in ventricles
6
Q
How to manage/avoid the complication of unexplained extubation
Signs, prevention, what to do
A
**Signs **
* patient vocalization, low-pressure alarm, diminished/absent breath sounds, respiratory distress, gastric distension
**Prevent **
* adequate securment of ET tube
* support ET tube during reposition/procedure
* soft wrist restraints
* sedation/analegsia
**Managment **
* stay with patient, call for help, manully ventialte patient with 100% O2, psychological support
7
Q
How to treat sinus bradycardia if symptomatic
A
- pulse oximetry
- give O2 if needed
- IV access
- 12-lead ECG
- Atropine - blocks vagus nerve- more sympathetic activity - SA note rate will increase - can use until temp pacemaker availble (if unstable or needed)
8
Q
How to treat sinus tachycardia
what symptoms are seen
A
treat undelrying cause
* fluid replacment, reflief of pain, removal of offending mechanisms, reducing fever or anxiety
dizziness, dyspnea, hypotension
9
Q
If someone comes in unconcious, with respiratory problems, with no knoweldge of why - what will you give
A
D50 (hypoglycemia), B12 (alcoholic), & nalaxone
10
Q
Important steps for after ET intubation
A
- inflate cuff and confirm placement, will manually ventalting pt with 100% O2
- CO2 detected (usually 30-40)
- ascultate lung bases and bilaterally (bc right lobe is less of an angle so tube might go into right lung so might not hear breath sounds in L lung - need 2 cm above fork)
- bilateral chest movment
- Chest x-ray will confirm placment
- measure - mark and document distance form edge of the lip to end of tube and monitor
11
Q
Oral care needed for patients with ET intubation
A
- brush teeth BID
- every 2-4hours and PRN suction oral/pharyngeal cavity
- reposition and retake ET tube every 24 hours
*chlorhexidine mouth swabs to prevetn infection - gums, mouth should be moistned with slaine or water swabs
12
Q
Respiratory Distress VS Failure
A
Distress - increased WOB in the presence of normal state & oxygenation abilities - increase resp rate and effort. - trying to maintain homeostasis
Failure - inability of the respiratory system to fulfil gas exchange needs of the patient - hypoxemia - abnormal PO2 and PCO2
13
Q
Types of mechnical ventilation - what is volume, pressure, time
A
volume - delivers precise volume of air for each cycle regardless of pressure
Pressure - generates flow until pressure is reached - need to monitor closely - if pt breathd out of synchrony with machine, pressure limit may be reached quickly- dont get enough air
Time - generates flow for preset amt of time
14
Q
what are 4 types of disorder of impulse formation
A
**Enhanced Automaticity ** - cardiac cells depolarize sponatenously OR pacemaker site other then SA increases its firing rate beyond normal
**Abornal electrical impulses **during repolarization requires a stimulus
**Conduction blocks ** partial (slowed, intermittent) and complete (no impulses are conducted)
Reentry impulse returns to stimualte tissue that was previosuly depolarized - closed loop (wolf parkinson white syndrome)
15
Q
what are causes of hypoxemic respiraotry failure
A
- ventilation - perfusion mismatch (COPD/asthma)
- shunting (anatomical or intrapulmonary)
- diffusion limitation (decrease gas exchange)
- alveolar hypoventialtion
often it is combination of things
16
Q
What are complications of ET suction
A
Complications
* hypoxemia (preoxygenate)
* bonrchospasm
* ICP
* Dysrrhythmias (may be result of hypoxemia).
* hyper/hypotension
* mucosal damage, bleeding
* pain infection
17
Q
what are important guidelines for suctioing ET tubes
How to avoid complication
A
- suctioning should not be regular
- assess pt b4, during and after
- if performing CST - hyperoxygenate
- limit suction pressure to 120mm Hg
- provide adequate hydration - saline - manage thick secretions
*
18
Q
What are interventions for B-breathing
A
- Position (high fowlers chest can expand more, ^ gas exchange, if fatigue semi-fowlers & tripod (COPD))
- Coached breathing ( pursed lip breathing causes PEEP )
- Oxygen - NP (2L (21%) 6L(40%)) - face mask (5-10L to get out CO2), Venturi mask 24-50% O2 Non-rebreather & partial rebreather
- Bronchodilators (ventolin)
- Bipap - help keep lung open
- Intubation
- ventilation - ambu bag
PEEP -limit air that comes in, max exhalation - keep alveloi open longer
19
Q
what are interventions in respiratory failure ( include drugs )
A
- oxygen
- mobilization of secretions
- effective coughing/positing
- hydration/humidification
- chest physiotherpay
- airway suctioning
- positive-pressure venitaltion (BiPAP)
- DRUGS - bronchodilators, corticosteriods, dieuretic, antibiotics, opiod, sedative, muscle relaxant
20
Q
What are interventions to maintain A- Airway
A
- Open airway (head tilt chin lift & jaw thurst if spinal injury)
- Suction - yankauer
- Oropharygeal tube (no gag reflex)
- nasopharyngeal airway (if trauma to mouth, or still conscious)
- HOB FLAT no pillows
21
Q
What are nursing considerations/assessments with mechanical ventilation
A
- assess cardiopulmonary status q2h-q4h (VS, breaht sounds, SpO2, ETCO2, I/O)
- assess for complications (decrease CO, pneumothorax, O2 toxicity, ulcerations VAP, atelactasis)
- HOB elevated 30 degree - turn pt every 1-2 hours to help lung expansion/remove secretions
- active/passive ROM, call bell
- sedative/neuromuscular blocking agents as required
- be ready to give manual respiration (ambu bag)
22
Q
what are nursing implications for ventialtor associated pneumonia
A
- elevate head of bed - 45 degrees when possible, otherwise 30 (enteral nutrtion, protein to fight infection)
- avoid routine chanigng of circuit tubing
- daily evaluation for extubation
- use ET tubes with subglottic secretion drainage
- oral care and use of chlorhexidine BID
- intiation of safe enteral nutrion 24-48 h of ICU admission
- hand hygiene
- VTE prophylaxis
23
Q
What are patterns/types of positive pressure ventilattion
CV, AC, SIMV, PEEP
A
CV - controlled ventilation, prederminted rate/volume independent of pts resps
AC - assist-control - client may initaite cycle with inspriation
SIMV - synchronised intermittent mandaotry respiration - deleiver preset tidal volume, pressure, rate alllows for spontaneous breaths between - synchronize with client - weaning
PEEP - pt unable to intiate spontaneous breaths - maintain positive pressure in alveloi at end of expiration, facilitate O2 diffusion (WILL increase intrathoracic pressure - decreased return- decrease BP - will give fluid, intropes)
24
Q
What are possible complications of ET intubation
A
- bronchospasm/laryngospasm
- aspiration during procedure
- tooth damage
- injury to lips, mouth, pharynx, vocal cords
- hypoxemia
- tracheal stenosis, erosion, necrosis (often with cuff too inflated- pressure)
25
What are predisposing factors to respiratory failure
* ARDS - acute respiratory distress syndrome
* direct lung injury (aspiration, infection, near-drowning, toxins)
* indirect airway injury (sepsis, shock, bypass)
* asthma, COPD
* CF
* opiod overdose
* brainstem infarction, head injury
* obesity, scoliosis, rib fracture
* ALS
26
What are S/S of sinus bradycardia
pale, cool skin, hypotension, weakness, angina, dizziness, syncope, confusion disorientation, SOB
27
what are the 3 things to specify when interpreting a rhythm
specify site of origin
specify mehcanism (brady, tachy)
specify ventricular rate
28
What are the important aspects of nursing managment in terms of ET intubation
* maintaing proper cuff inflation (20-25mm HG)
* monitoring oxygen (signs of hypoxemia & change in mental status)
* monitoring ventilation (PaCO2)
* maintaing tube patency (suction when needed - not routinely - closed suction )
29
What are the methods of determining rate off of ECG strip
| 6 second, large, small
Six-Second - count number of QRS complexes within 6 seconds (30 big box) - multiply by 10 (good for irregular rhythm)
Large Box method - count number of large boxes between two waveforms (r-r or p-p) and divide into 300 (ex if you have 4 boxes between 75bpm)
Small box method - count number of small boxes between two waveforms and dvidie into 1500 (ex 18 small boxes 83 bpm)
30
What are the risk factors for aspriation with ET tube, what can we do to prevent that
Risk factors
* imporper cuff inflation, patient positiong, tracheoesophgeal fistula
* the ET tube cuff cannot totally prevent trickle of oral/gastric secretions into the trachea
prevention
* patient always be 30 degree - often have NG tube as well
* suction oral cavity frequently
31
What are the S/S of decreased CO
* SOB
* Altered LOC
* Syncope/presyncope
* weakness
* chest pain
* hypotension
32
What are the steps needed before ET intubation
| and positioning for oral/nasal
* Pre-oxygenate with 100% O2 for 3-5 minutes
* limit each intubation attempt to less then 30 seconds
* ORAL - place patient supine with head extended and neck flexed
* Nasal - spray nasal passage with local anesthetic and vasoconstriction (maybe)
33
what are the three lethal rhythms
pulseless Vtach, Vfib, asystole
34
What are these rhythms, what causes, what do you do about it, what are complications
A - Unifocal PVC
B - multiform PVC
PVC - is a contraction originating in an ectopic foscs in ventricles - preamture QRS that is wide/distored. 0.12 sec or greater
Rhythm regular with preamture beats, rate usually normal, p waves usuall absent, PR none, QRS longer with bizarre T in opposite direction
CAUSE - acid-base, Acute conroary syndrom, digitialis toxicity, elecotrlyte imabalnce, exercise, HF, hypoxia, medications, stimulants
Treatment based on cause - infrequent PVC not typically treated - Assess ABC- S/S decrease CO - can give amniodarone or lidocaine
35
what are vagal manoeuvers
carotid sinus massage
application of a cold sitmulus to the face
valsalva manoeuvre
bear down
36
What can cause sinus tachycarida
**Fear, anxeity, fever,pain **
MI, caffeine, hypovolemia, cannabis, exercise, HF, hypoxia, medications, nicotine, PE, shock
Things that increase sympathetic stimulation
37
What can you find out from ECG, what can't you no
Information
* conduction disturbances, electrical effects of medications and electrolytes,
* the mass of cardiac muscle
* presence of ischemic damage
* right or left ventricle hypertrophy
Does Not
* does not tell you cardiac output
* nothing about the mechancial, contractilitty of the myocardium
38
What causes atrial tachycardia
Acute illness, digitalis toxicity, electorlyte imbalance, heart disease, infection PE, stimulant use (caffeine, cocaine, albuterol)
39
What causes sinus bradycardia
* sleep, athletes
* can see in association with acute MI
* vagal stimulation (cough, strain, vomit, carotid sinus pressure, cold water exposure)
40
What do you assess as part of D-disability
* LOC
* neuro exam
* **AVPU** - Alert, respond to verbal, resond to painful, unresponsive
* VS - cushings triad (increase systolic, widneing pusle pressure, bradycarida - increased ICP(mannitol get rid of fluid )
* GCS (3-15) - eyeopneing, verbal, motor - less then 8 will be intubated
* CT scan - HTN
* hypoglycemia - drug overdose
41
What do you assess when looking at A- Airway
* is airway patent
* Secretions
* mucous & vomit
* Swelling (pressure on airway)
* tongue (LOC - tongue can block airway)
42
What do you assess when looking at B- breathing
* Respiraotry rate, depth (shallow, deep), rhythm (ex. kussmaul, DKA acid)
* accessory muslce use
* Quick listen ( wheezing (air), crackles (fluid), air entry (pneumothroac, COPD etc) - percussion (fluid = dull, air=hyper resonance)
* SpO2 (95% +)
43
what does a peak t wave indicate
hyperkalemia
44
What does ABCD stand for
A- airway
B- breathing
C- circualtion
D- disability
| if patient has circulation and airway problem - deal with airway first
45
What equipment is needed for ET intubation procedure
Equipment
* self-inflating bag valve mask attached to oxygen
* suction and IV access
46
What interventions are part of C-circulation
* positioning
* fluids (maybe)
* Drugs - epi (increase HR) norpinephrine (BV, constrict) , inotropic (increase Ca, heart contract harder) /anti inotropic, antiarrythmias
* address underlying cause
* ECG
47
What is artifact and what causes it
distortion of an ECG tracing
Causes
* loose electrodes, brocken ECG wires
* muscle tremor, patient movement
* external chest compressions
* 60-cycle interference
48
What is continuous subglottic suctionning
A dorsal lumen above the cuff allows for suctioning of secretions from the subglottic area
- with some tubes there is a tube to inflate cuff and one for suction, and one that delivers oxygen
49
what is hypercapnic respiratory failure (S/S)
excessive CO2
* results from an imbalance between ventialtory supply and ventilatory demand
* ventilatory supply is max ventilation pt can withstand and ventialitry demand is amt of venitlation needed to keep PaCO2 normal
S/S
* dyspnea, decrease resp, shallow, disorientation, bounding pulse, dysrhymias, weakness,
* pursed-lip breathing
50
What is metabolic acidosis, S/S, conditions, compensation
* decreased HCO3 and decreased pH
* overproduction of acids and/or failure to eliminate them
S/S - headahce, confusion, restleness-lethargy, stupor-coma, dyrrhthmias, KUSSMAUL RESP (deep, rapid) warm flushed, N/V
Conditions : ketoacidosis (diabtes, alcoholic, starvation), lactic acidosis (hypoxia, shock, sepsis, seizures), toxic ingestion (alcohol) renal failure - loss of bicarb in diarrhea
Compensation - increase in respiratory rate to get rid of CO2
51
What is metabolic alkalosis, S/S, conditions, compensation
* increased HCO3, increased pH
* caused by anything that decreases H+ ions or increases bicarb
* S/S - dizziness, lethargy, disorientation, seizures, coma, weakness, muscle twitching, cramps, tetany, N/V, respiraotry depression
* Conditions - prolonged vomiting, prolonged NG suction, excessive intake of Bicarb (anacids), loss of K+, diuretics, imbalance in serum calcium
52
what is normal P wave - what does it mean when it is long or short
Normal P-wave is smooth/rounded, 0.12 seconds in duration
Long PR interval - impulse delay passed through av
Short - impulse orignates close to AV node or in AV bundle
53
what is normla pH, PaO2, SaO2, PaCO2, HCO3
pH - 7.35 - 7.45
PaO2 - 80-100 mmHg
SaO2 - 95% and above
PaCO2 35-45
HCO3 22-26 mmol/L
54
what is P-P interval used for
used to detemrine atrial rate and regularity
55
what is paroxysmal atrial tachycardia
atrial tachycardia that starts or ends suddenly - sandwhiched between normal sinus rhythm
56
What is part of your assessment for C-Circulation
* skin colour, temperature, turgor (hydration)
* capilary refill (less then 2 seconds)
* Pulse - (radial pulse systolic >90, brachial >60, carotid >40)
* blood pressure - (systlic what heart has to overcome, diastolic is peripheral venous resistance )
57
What is positive pressure ventilation
Exert positive pressure on inspiration therby increasing tidal volume - inspiratory cycle adjusted for volume, pressure or time
58
what is r-r used for
used to determine ventricular rate and regularity
More important then P-P as it contributes more to CO
59
what is rapid-sequence intubation (RSI)
it is the rapid, concurrent admistration of both a sedative and a paralytic agent during an emergency airway mangment to decrease the risks for aspiration and injury
* not for pts in caridac arrest or known to have difficult airway
60
What is respiratory alkalosis, S/S, conditions, compensatory method
* decreased PaCO2 and increased pH
* S/S ligh-headed, numbness, tingling, confusion, blurred vision, dyrrythmias, palpitations, dry mouth, diaphoreis, spasms of arms and legs
* Conditions - pain, anxiety, sepsis, fever, hypoxemia,pregnancy, restrictive lung disease, HF< PE, hepatic failure, thyrotoxicosis
* - anything that causes hyperventilation
* compensatory - kidneys will excrete HCO3 to increase H+
61
What is respiratory acidosis - lab values, S/S, causes, compensatory
* anything that causes respiratory depression, hypoventialtion - accumulates CO2 - causes acidosis
* increase PaCO2 and decreased pH
* S/S - dyspnea, respiraotry distress, shallow respirations, headache, restlesness, confusion, tachycardia, dysrhythmias
* CAUSES - airway obstruction, severe pneumonia, chest trauma, pneumothorax, acute drug intoxication (narcotic, sedatives), neuromuscular blockade, CNS injury
* Compensaotey system - kidneys and buffer systems - kidneys will retain HCO3 to reduce H+ but occurs in hours/days
62
What is S1, S2, S3, S4 and murmur
S1 & S2- normal heart sounds, it is the sound of the valves closing
S3 - indicative of heart failure, fluid overload, transient
S4 - rush of blood agisnt a non compliant ventricle
Murmur is problem with valves- prolapse, blood is not going through as it should
63
What is seen in normal sinus rhythm in ECG
| p,QRS, T etc
R-R/P-P regular
Ventricular rate 60-100 bpm
P wave upright, look the same, precedes each QRS complex
PR interval 0.12-0.20 seconds constant (3-5 small box)
QRS - 0.12 seconds or less
64
what is synchronized cardioversion
delivers an electrical shock to the heart timed to occur during QRS complex during R wave so it does not cause worse rhythm
## Footnote
need more enerrgy to break atrial flutter then you do atrial fibrilation
65
what is the atrial kick
the atrial kick adds volume to cardiac output, with a fast atrial rate this can be lost
66
What is the P wave, PR interval, QRS, ST segment and T wave
67
what is the rhyhm, what causes it, what can you do
**asystole**
absence of ventricular electrical activity
5H/5T reversible causes -Hypoxia, Hypovolemia, Hydrogen ions (acidosis), Hyper/Hypo-kalemia, Hypothermia; Tension pneumothorax, Tamponade-cardiac, Toxins, Thrombosis-coronary (MI), Thrombosis-pulmonary(PE).
treatment - CPR, ACLS
- IV, IO, epineprhine, advanced airway, capnograph
68
What is the rhyhm, what causes it, what do you do
**Third Degree AV Block **
WORST - affects CO the most - comp;ete block of impulses between the atria and ventricles - a cell in the ventricles becomes pacemaker for ventricles
QRS wider
CAUSES - MI, myocarditis, heard disease, Drug (amnio, BB, CC, digoxin) fibrosis, **increased parasymapthic tone **
If symptomatic bc slow heart rate
- pulse oximetry, O2, IV, 12-lead, Atropine, Epi, dopamine, isoproterenol IV, temp/permaent pacing - Frequent reassessment
69
What is the rhyhm, what causes it, what do you do about it
**Ventricular Fibrilation**
NO CO - CPR/DEFIB ASAP
the ventricle is quivering and no effecitve contraction - no CO.
Occurs with acute MI, myocaridal ischemia, CAD, cardiomyopathy. dysrhythmias, electrlyte imbalance, electrocution, hypertrophy, increase SNS, severe HF, vagal stimulation, medications
Puslessness - defibrialte - CPR - epinephrine amniodarone
70
What is the rhythm, what causes it, what do you
**second degree AV block Type II**
delay occurs in his&purkinjie system - less common then type I and more serious.
Ventricular rate irregular, atiral regular, ventricular rate often slow, P waves normal, missing QRS complexes, PR normal and constant
CAUSE - left CAD, MI, mycocaridits, aortic valve disease, cardiomyopathy, fibrosis, heart disease
IF PT symptomatic bc slow HR
- pulse oxumetry, O2, IV access, 12-lead ECG, IV atropine (pacemaking may be necessary) reassess
71
what is the significance of alkalosis >7.45
interferes with normla tissue oxygenation
interfers with normal neurological funcitonning
interferes with normla muscular functionning
72
what is the signifiance of aciodsis <7.35
decreased force of caridac contractions
decrease in vascular response to catecholamines
dimished response to effects and actions of certain medications
73
What is this rhythm
**Sinus arrhythmia- When SA node fires irregularly**
**Respiraotry** - associated with the changes in intrathroacic pressure with breathing
**Nonrespiraotry - **not realted to breathing, seen with heart disease, after MI, increased ICP, medications
Usually 60-100bpm - IF bpm is less then 60 or above 100 then sinus brady-arrhythmia /tachy-arrythmia
**Rhythm/interval - NOT norma**l - rate, p wave, PR, QRS normal
74
What is this rhythm & What are you going to do about it
**Atrial Tachycardia **
* rapid atrial rate overdies the SA node and becomes pacemaker
* rhythm regular, **rate 100-250bpm** p and t waves may blend together, p wave not normal shape, QRS normal length
Assess S/S - decrease CO
If Stable
- pusle oxumetry, oxygen, VS, IV access, caridac monitor, 12-lead ECG, vagal manoeuvers, adenosine
Unstable
- pulse oximtry, O2, IV access, sedation - synchroized cardioversion
May give BB/ calcium, channel based on heart
75
what is this rhythm, what causes it, what do you do about it
Ventricular tachycardia - ventricle takes control as the pacemaker - multiple PVC at rate higher then 100 bpm
- nonsustained - short run lasting less then 30 seconds, and sustained lasts for more then 30 seconds
Rhythm regular, ventricular ratre 101-250 bpm, p wave not seen, no PR, cant really see QRS/t wave
CAUSE - acid/base imbalance, ACS, cardiomyopathy, cocaine, digitlais toxciity, elecotrlyte imbalance, mitral valve prolapse, trauma
PULSE OR NO PULSE
Pulse & Stable - O2, IV, ventricular antiarrhythmics (lidocaine, amniodarone)
Pulse & Unstable - O2, IV, sedation, synchronized cardioversion
NO PULSE - defibirilate immediately CPR
76
What is tracheotomy
| surgical procedure that ..
surgical procedure that is perfomed when the need for an artifical airway is expected to be long term
* has larger bore ET so reduces work of breathing bc less airway resistant - easy to remve secretions, need bite block for oral airway (bc pts bite down)
77
what measurment is used to measure quality of ventilation
PaCO2
| PaO2 - is used for quality of oxygenation
78
What portion of the respriatory system does ariway focus on
airway - upper airway to to the larynx
79
what rhyhm is this, what causes it, what do you do
**First Degree AV Block ** delayed impulse conduction
rate regular, usually normal bpm, p wave normal, PR prolonged, QRS normal
CAUSES - MI, heart infection, cardiomyopathy, degenrative fibrosis, drug, Hyperkalemia, vagal tone, ischemia, heart disease
Usually no symptoms - if acute MI monitor pt closely
80
What rhythm is this
Sinus bradycardia
Interval normal, **Rate is less then 60 ** P wave normal, PR normal, QRS normal
81
what rhythm is this
Sinus tachycardia
Intervals regular, **101-180 bpm, usually not higher then 150 as that gets into atrial tachycarida** P waves normal, QRS normla, PR normal
82
What rhythm is this, what causes it, what do you do about it
Atrial Flutter - an irritable site within the atria fires reguallry an rapid rate - sawtooth flutter - closed loop - not every beat is converted to ventricles
Rhythm regular or irregular, Rate less then 180 bpm, no identifiable p waves, QRS may or may not be burrie
CAUSES : paroxysmal rhythm, caridac surgery, cardiomyopathy, MI, digitlais or quindine toxicity, hypethyroidism, heard disease, regurgitation, infection of heart, PE - NOTE no stress/pain = pathological causes only
IF rapid ventricular rate - control rate
IF rapid rate with S/S - syncrhonized cardioversion, (prophyalxis, warfarin potentially)
83
What rhythm is this, what causes it, what do you do about it
Atrial Fibrilation - disorganization of atrial electrical activity cause by multiple ectopic foci - loose effective atrial contraction
Rhythm - irregular, atria rate 400-600bpm, ventrical varries, no P waves, QRS normal
CAUSES - MI, heart infection, age, caridac surgery, cardiomyopathy, lung dieases, chest trauma, HF, heard disease, PE, wolf-white -- STROKE RISK bc turbulence
TREAT - if rapid ventrucalr rate. control - BB, Calcium channel, digoxin, amiodarone
- if rapid ventricular and S/S - synchronized cardioversion
IF more then 48 hours - give anticoagulants
84
What rhythm is this, what causes what do you do about it
**Second Degree AV block Type I**
Progressive increase in length of PR until drop in QRS,
Atrial rate regular, ventricular rate irregular, p wave normal, PR inconsistent, QRS complexes periodically dropped
CAUSES - block in RCA, athletes bc of vagl tone, during sleep, aortic valve disease, medications (BB, CC, digxin ) heart disease
PT usually asymptomatic - fix underlying cause (structural)
If symptomatic bc low HR
- pulse oxumetry, O2, TV, 12-lead ECG, IV atropine (maybe), monitor
85
What rhythm is this, what do you do about it what causes it
**AV Nodal Reentrant Tachycardia (AVNRT) **
Most common type of SVT, closed loop - signal keeps firing, narrow QRS so orignated above AV.
Rhythm usually regular, rate 150-250bpm, p waves often hidden in QRS
Causes : hypoxia, stress, anxiety, caffeine, smoking, sleep deprivation, medications, COPD, heart disease, HR, digitialis toxicity
ASSESS S/S
Stable - PO2, O2, VS, IV, caridac monitor, 12-lead ECG, vagal manoeuver, adensoine
Unstable - PO2, O2, IV, sedation - synchronized cardioversion
86
What to do if pt has sinus arrhythmia
usually nothing
If symptomatic - IV atropine if slow rate and affecting hemodyanmic stability
87
What to do when mechanical ventilation system - high pressure alarm and low pressure alarm are present
High pressure
- tidal volume cant be delivered to set limit
- may be secretions (suction), client bitting tube (oral airway), coughing, anxiety (sedatives)
Low Pressure
- tidal volume is not delveired due to a leak or breath in the system
- check all connections, check tube cuff
88
what types of aciodsis/alkalosis can you have in terms of compensation
89
When is a patient ready to be weaned off mechanical ventilation
1. reversal of undelrying cause of respiraotry failure
2. adequate oxygenation
3. hemodynamic stability (no hypotension, absence of myocardial ischemia
4. patient ability to intiate inspiratoryeffort
## Footnote
spontaneous breath trials - recommened for when weaning possible, min 30 min max 120 min
90
When is it indicated to use mechancial ventilation
* anything that impedes a perons ability to ventilate themselves
* acute respiratry failure - ARDS, pneumonia, AECOPD, pulmonary embolism
* Resp center depression ; CVA, trauma, head injury
* Neuromuscualr disturbance - guilian barre, MS, ALS
* apnea- or impending inability to breath
91
when would you use nasotracheal intubation
* indiacted when head and neck manipulation is risky - spinal injury
* no visiblity of layrnx
* contriandiated in pts with facial fracture
* post-op cranial surger
*
92
why is oral intubation preferred
* prefered method of intubation - pt needs to be sedated or unconsious
* larger diameter tubes can be used so decreases WOB - makes removing secretions and perfomring fibre optic brochonscopy easier
* can use laryngoscope or bronchoscope to guide
