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Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street with a gorgeous young woman on his arm. A couple of days later, the doctor spoke to Morris and said, 'You're really doing great, aren't you?' Morris replied, 'Just doing what you said, Doc: 'Get a hot mamma and be cheerful.'' The doctor said, 'I didn't say that.. I said, 'You've got a heart murmur; be

Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

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Page 1: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Intro to Valvular DiseaseMorris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street with a gorgeous young woman on his arm. A couple of days later, the doctor spoke to Morris and said, 'You're really doing great, aren't you?' Morris replied, 'Just doing what you said, Doc: 'Get a hot mamma and be cheerful.'' The doctor said, 'I didn't say that.. I said, 'You've got a heart murmur; be careful.'

Page 2: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Valvular Heart DiseaseHeart contains

Two atrioventricular valves Mitral Tricuspid

Two semilunar valvesAorticPulmonic

**review areas to listen**

Page 3: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Tricuspid

Page 4: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Valvular Heart DiseaseTypes of valvular heart disease depend on

Valve or valves affectedTwo types of functional alterations

StenosisRegurgitation

Valvular disorders occur in children and adolescents primarily from congenital conditions and in adults from degenerative heart disease

Stenosis and Insufficiency

Page 5: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Valvular Heart Disease

Flashcards about Ch 19 NETI KQ- on your own

Page 6: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Risk FactorsRheumatic Heart Disease MICongenital Heart DefectsAgingCHF

Page 7: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

PathophysiologyStenosis- narrowed valve, increases afterloadRegurgitation or insufficiency- increases preload. The heart has to pump same blood**Blood volume and pressures are reduced in front of the affected valve and increased behind the affected valve.This results in heart failureAll valvular diseases have a characteristic murmur murmurs

Page 8: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral StenosisDec. flow into LVLA hypertrophyPulmonary pressures increasePulmonary hypertensionDec. CO* early symptom is DOELater get symptoms of R heart failureA fib is common- anticoagulantsUsually secondary to rheumatic fever

Page 9: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Treatment

Page 10: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Valve Replacment

Page 11: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Regurgitation

Mitral insufficiency

Page 12: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Regurgitation (Insufficiency)

Regurg of blood into LA during systoleLA dilation and hypertrophyPulmonary congestionRV failureLV dilation and hypertrophy-to accommodate inc. preload and dec CO

Page 13: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Valve ProlapseA type of mitral insufficiencyUsually asymptomatic- click murmurMay get atypical chest pain related to fatigueTachydysrhythmias may developRisk for endocarditis may be increased

Page 14: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Valve ProlapseUsually benign, but serious complications can occur

Mitral valve regurgitation Infective endocarditis Sudden death Cerebral ischemia

Page 15: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Valve Prolapse

Dysrhythmias Paroxysmal supraventricular tachycardiaVentricular tachycardia

Palpitations LightheadednessDizziness

Page 16: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Mitral Valve ProlapseMay or may not be present with chest pain

If pain occurs, episodes tend to occur in clusters, especially during stressPain may be accompanied by dyspnea, palpitations, and syncope Does not respond to antianginal treatment

Page 17: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic StenosisIncrease in afterloadReduced COLV hypertrophyIncomplete emptying of LAPulmonary congestionRV strain

Page 18: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street
Page 19: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Symptoms

Syncope

Angina

Dyspnea

This triad reflects left ventricular failure

Page 20: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic StenosisMay be asymptomatic for many years due to compensationDOE, angina, and exertional syncope are classic symptomsLater get signs of R heart failureUntreated-poor prognosis- 10-20%sudden cardiac death

Page 21: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic Valve Stenosis

Poor prognosis when experiencing symptoms and valve obstruction is not relievedNitroglycerin is contraindicated because it reduces preload

Page 22: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic Regurgitation

Page 23: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic RegurgitationGet increased preoad- 60% of SV can be regurgitatedCharacteristic water hammer pulseRegurgitation of blood into the LVLV dilation and hypertrophyDec. CO

Echocardiography

Page 24: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic Valve RegurgitationClinical manifestations

Sudden manifestations of cardiovascular collapseLeft ventricle exposed to aortic pressure during diastoleWeakness

Page 25: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Aortic Valve RegurgitationSevere dyspnea Chest painHypotension Constitutes a medical emergency

Page 26: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Water Hammer pulse

Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle ).

Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse. YouTube - Corrigan's sign

Austin Flint

Page 27: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Tricuspid and Pulmonic Valve Disorders

Result in R side heart failure

Page 28: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Diagnostic TestsEcho- assess valve motion and chamber sizeCXREKGCardiac cath- get pressures

Page 29: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

MedicationsLike Heart Failure

ACE inhibitorsDigoxinDiureticsVasodilatorsBeta blockersAnticoagulants*Prophylactic antibioticsAntiarrhythmics

Page 30: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Medical/ Surgical TreatmentPercutaneous balloon valvuloplastySurgical therapy for valve repair or replacement:

**Valve repair is typically the surgical procedure of choice

Open commissurotomy- open stenotic valvesAnnuloplasty- can be used for both

Valve replacement may be required for certain patients Heart valve surgery

Mechanical-need anticoagulantBiologic-only last about 15 yearsRoss ProcedureMedlinePlus: Interactive Health Tutorials- on own

Page 31: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street
Page 32: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street
Page 33: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Ross Procedure

Page 34: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

This is an excised porcine bioprosthesis. The main advantage of a bioprosthesis is the lack of need for continued anticoagulation. The drawback of this type of prosthetic heart valve is the limited lifespan, on average from 5 to 10 years (but sometimes shorter) because of wear and calcification.

Page 35: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

This is a mechanical valve prosthesis of the more modern tilting disk variety (for the mitral valve). Such mechanical prostheses will last indefinitely from a structural standpoint, but the patient requires continuing anticoagulation because of the exposed non-biologic surfaces.

Page 36: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Medical Animation. Aortic valve replacement

Page 37: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Nursing DiagnosesActivity intoleranceExcess fluid volumeDecreased cardiac outputIneffective therapeutic regimen management

Page 38: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

What is new?Percutaneous Transcatheter Heart Valve Implantation-Metallic clip -for the treatment of mitral regurgitationLonger-lasting replacement valvesStem cell research and the use of endothelial cells

Page 39: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

CardiomyopathyCondition is which a ventricle has become enlarged, thickened or stiffened. As a result heart’s ability as a pump is reduced

Page 40: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Cardiomyopathy-CausesPrimary-idiopathicSecondary

Ischemia- from CADinfectious diseaseexposure to toxins -alcohol, cocaineMetabolic disordersNutritional deficienciesPregnancy

Page 41: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

3 Types of Cardiomyopathy

DilatedHypertrophicRestrictive

Page 42: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

PathophysiologyDilated

Most common- heart failure in 25-40%Cocaine and alcohol abuseChemotherapy, pregnancyHypertensionGenetic* Heart chamber dilate and contraction is impaired and get dec. EF%*Dysrhythmias are common- SVT Afib and VTPrognosis poor-need transplant

Page 43: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

This very large heart has a circular shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile. This is an example of a cardiomyopathy.

Page 44: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Pathophysiology Hypertrophic-HCM

**GeneticAlso known as IHSS or HOCMGet hypertrophy of the ventricular mass and impairs ventricular filling and COSymptoms develop during or after physical activitySudden cardiac death may be first symptomSymptoms are dyspnea, angina and syncope

Page 45: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

HOCM Patho1. Massive ventricular hypertrophy2. Rapid, forceful contraction of the LV3. Impaired relaxation or diastole4. Obstruction to aortic outflowPrimary defect is diastolic filling**HCM most common cause of SCD in young adulthood

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Fig. 37-14

Page 46: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street
Page 47: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street
Page 48: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

There is marked left ventricular hypertrophy, with asymmetric bulging of a very large interventricular septum into the left ventricular chamber. This is hypertrophic cardiomyopathy. About half of these cases are genetic. Both children and adults can be affected, and sudden death can occur.

Page 49: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street
Page 50: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

HCM- Symptoms (SAD)DyspneaFatigue- dec. COAngina, SyncopeS4 and systolic murmur

Page 51: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Hypertrophic DiagnosticsEcho- TEE

Heart Cath

Page 52: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Treatment of HOCM

cardiomyopathy - Live Search Video

PTSMA- alcohol induced percutaneous trans luminal septal myocardial ablation

- inject alcohol into small branch of LAD which causes ischemia and MI of septal wall. (Grey’s Anatomy episode relief of heart failure)

Page 53: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

InterventionsGoal- improve vent filling and relieve LV outflow obstruction

Beta blockers- metoprololCalcium channel blockersDig- only for A-fib if present Anti-arrhythmics- amiodorone or sotalolICD- to dec. risk of sudden deathAV pacing

Page 54: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Surgical TreatmentVentriculomyotomy and myomectomy- incising the septum muscle and removing some of the hypertrophied muscle

Page 55: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Nursing

Relieve symptomsPrevent complicationsProvide pysch and emotional supportTeaching-

Avoid strenuous exercise and dehydrationAvoid anything increasing the SVR (afterload) makes obstruction worseIf chest pain- rest and elevation of feet for venous returnAvoid vasodilators like nitroglycerine- decrease venous return to the heart

Page 56: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

PathophysiologyRestrictive

Least commonRigid ventricular walls that impair fillingContraction and EF normalSigns of CHFPrognosis-poor

Page 57: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

PathophysiologyRestrictive

Least commonRigid ventricular walls that impair fillingContraction and EF normalSigns of CHFPrognosis-poor

Page 58: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Diagnostics for CMP

Echo-wall motion and EF

EKGCXRHemodynamicsPerfusion scanCardiac cathMyocardial biopsy

Page 59: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

TreatmentMedications

Same as for heart failure except for hypertrophic

SurgeryVad-bridge to transplant or destination therapyHeart TransplantMyoplastyICD- antiarrhythmics are negative inotropesDual chamber pacemakerHypertrophic- excision of ventricular septum-myotomy, inject denatured alcohol in coronary artery that feeds the top portion of septum.

Page 60: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Nursing DiagnosesDecreased Cardiac OutputFatigueIneffective Breathing PatternFearIneffective Role PerformanceAnticipatory grieving

Page 61: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Case study 15Ms. C. 81y/o admitted to CCU with SOB. She has a hx of mitral valve regurgitation with left ventricular enlargement. She received 100mg lasix IV in ER and her dyspnea improved. She has O2 at 3L/min. She has crackles bibasilar and monitor is SR rate 94-96 with occ. PVC’s. The only med ordered is MSO4 2-4mg IV as needed for chest pain or dyspnea.

As you go to assess her you find her in bed at 60 degree angle. She is pale, has circumoral cyanosis and respirations are rapid and labored.

Page 62: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Question 1

What action should you take first?

1. Listen to breath sounds

2. Ask when the dyspnea started

3. Increase her O2 to 6L minute

4. Raise the HOB to 75-85 degrees

Page 63: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Cont.Upon assessment, you find crackles and she is coughing pink frothy sputum. Her O2 sat is 85% with O2 increased to 6L/min. She has 3-4+ pitting edema in her feet and mid- calf. She has JVD with HOB elevated to 75 degree angle.

Page 64: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

Case Study 15- #2Which one of these complications are you most concerned about, based on your assessment?1. Pulmonary edema2. Cor pulmonale3. Myocardial infarction4. Pulmonary embolus

Page 65: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#3Which action will you take next?1. Call the physician about client’s condition.2. Place client on a non-rebreather mask with FiO2 at 95%.3. Assist client to cough and deep breathe.4. Administer ordered morphine sulfate 2mg IV.

Page 66: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#4What additional assessment data are most important to obtain at this time?1. Skin color and capillary refill2. Orientation and pupil reaction to light3. Heart sounds and PMI4. Blood pressure and apical pulse

Page 67: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#5Client’s B/P is 98/52 and AP is 116 and irregular in ST rate 110-120 with frequent multifocal PVC’s. You call the physician and receive these orders. Which one should be done first?1. Obtain serum dig level2. Give furosemide 100mg. IV3. Check blood potassium level4. Insert #16 french foley catheter

Page 68: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#6Which order could be assigned to an LVN?1. Obtain serum digoxin level2. Give furosemide 100mg. IV3. Check blood potassium level4. Insert #16 french foley catheter

Page 69: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#7While you are waiting for the the potassium level, you give morphine sulfate 2mg IV to the the client. A new graduate asks why you are giving her the morphine. What is the best response?1. It will help prevent any chest pain from occurring.2. It will decrease her respiratory rate.3. It will make her more comfortable if she has to be intubated.4. It will decrease venous return to her heart.

Page 70: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#8Her K is 3.1. the physician orders KCL 20meq. IV before giving the furosemide. How will you administer it.1. Utilize a syringe pump to infuse the KCL over 10 minutes.2. Dilute the KCL in 100 ml of D5W and infuse over 1 hour.3. Use a 5ml syringe and push the KCL over at least 1 minute.4. Add the KCL to 1 liter of D5W and administer over 8 hours.

Page 71: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#9After you have infused the KCL, you give the lasix. Which of these nursing actions will be most useful in evaluating whether the lasix is having the desired effect?1. Obtain the client’s daily weight2. Measure the hourly urine output3. Monitor blood pressure4. Assess the lung sounds

Page 72: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#10The physician orders a natrecor 100mcg IV bolus and an infusion of 0.5 mcg/ min. Which assessment data is most important to monitor during the infusion?1. Lung sounds2. Heart rate3. Blood pressure4. Peripheral edema

Page 73: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#11Which nurse should be assigned care for this client?1. A float RN who has worked on CCU step down for 9 years and has floated before to CCU2. An RN from a staffing agency who has 5 years CCU experience and is orienting to your CCU today3. A CCU RN who is already assigned to care for a newly admitted client with chest trauma4. The new graduate RN who needs more experience in caring for client with left ventricular failure.

Page 74: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

A few days later, she is transferred to the step-down unit. Her weight has decreased 4 kg. She denies SOB at rest, has crackles only in the bases. She is receiving O2 at 1L/min. She has a grade III/IV murmur and her pulse is very irregular. The monitor shows atrial fibrillation, rate 80-100. She denies dizziness, but states her vision feels “fuzzy.” She has 2+ ankle edema. VS are B/P 108/62, 86, 24, O2 sat 95%. Medications:Lasix 40mg twice daily KCL 10mEq dailyAspirin 81mg daily Captopril 6.25mg tidDigoxin 0.25mg daily’

Page 75: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#12Which information would be most important to report to the physician?1. Crackles and oxygen saturation2. Atrial fibrillation and fuzzy vision3. Apical murmur and pulse rate4. Peripheral edema and weight

Page 76: Intro to Valvular Disease Morris, an 82 year-old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street

#13All meds are scheduled for 9 AM. Which would you hold until you discuss it with the physician?Furosemide 40mg po bidEcotrin 81mg po dailyKCL 10meq three times a dayCaptopril 6.25mg po three times a dayLanoxin .125mg po every other day


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VALVULAR CARDIAC SURGERY. Outline Heart and Heart Valve A & P Valvular Pathology Valvular Diagnostics Open Heart Patient Preparation Supplies, Instrumentation,

VALVULAR CARDIAC SURGERY. Outline Heart and Heart Valve A & P Valvular Pathology Valvular Diagnostics Open Heart Patient Preparation Supplies, Instrumentation,

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Valvular (1)

Valvular (1)

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Valvular heart lesions

Valvular heart lesions

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