Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCRN > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Normal cardiac output, or volume of blood ejected by the heart in 1 minute is how much?

A

4-8L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which is more accurate CI or CO and why?

A

CI because it adds the body surface area of the individual into the equation. So size doesn’t matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the normal Cardiac Index?

A

2.5-4.3L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the concern when a patient becomes tachycardic? Who is this especially dangerous for?

A
  • The heart is unable to fill due to rapid rate so it decreases cardiac output
  • The coronary arteries are unable to perfuse

If someone has CAD and tachycardia they will develop ischemia rapidly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the normal stroke volume and what does that tell you?

A

Stroke Volume- the volume of blood ejected with each heart beat

  • normal 60-100 ml/beat
    Or

SVI (with BSA)
35-60mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is preload?

A

The volume of blood in the ventricles at the end of diastole
Or

Pressure generated by the volume of blood in the ventricles at the end of diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are two ways to determine preload?

A

RV: CVP RA Pressure

LV: PAOP LA pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the normal CVP?

A

0-5

Optimal varies 10

*if a patient is hypotensive they want the optimal level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the normal PAOP?

A

6-12

Optimal 14-18

  • if the patient is critically ill and hypotensive they want the CVP/PAOP higher
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What medications reduce preload?

What would then increase preload

A

Vasodilators
Diuretics

Think Lasix and Nitroglycerin

Vasoconstriction and volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is afterload?

A

The pressure the ventricle must generate to open the semilunar valve and eject its contents

*the higher the afterload the greater the work
Increase myocardial oxygen demands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to you assess afterload?

A

Left ventricle: SVR

Right ventricle: PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is SVR? What is the normal SVR?

A

It reflects the overall resistance against systolic ejection.

The greatest resistance lies in the small arteries and arterioles

Normal SVR 800-1200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some things that decrease SVR? Think meds and disease?

A

Diuretics
Vasodilators (nitropruside/nicardipine)
Sepsis
End stage shock d/t loss of vasomotor tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What increases SVR

A 
Vasopressors
Volume infusions
Peripheral vasoconstriction
LV failure
Increased blood viscosity
Hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What meds reduce afterload?

A 
Nitroglycerin
Nicardipine
Hydralazine
Isosorbide
CCB
Nitropruside
ACEI/ARB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What medications increase afterload?

A 
Epinephrine
Phenylephrine
Levophed
Dopamine
Vasopressin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the range for PVR?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What medications treat increased PVR?

A

Nitroglycerin
Hypoxia correction
Prostaglandins
Prostacyclin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can cause increased PVR?

A 
Hypoxia
Pulmonary edema
Pulmonary embolism
ARDS
Sepsis 
Valvular heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is contractility

A

The ability of the heart to modulate its contractile performance independent of preload and afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a normal PAOP?

A

6-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Normal PAP?

A

15-25/6-12

Systolic/diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can cause a high PAP?

A

Pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What can cause a low PAP?

A

Hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the MAP? What is a normal MAP?

A

It is used to determine perfusion of vital organs

70-105

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the first to suffer from a decreases MAP?

A

The gut and then the kidneys

28
Q

Inotropic therapy can do what to your map (dobutamine/milronone)

A

Decrease it.

29
Q

What are the determinants of SV?

A. HR, CO, systolic BP
B. Preload, afterload, contractility
C. Cardiac Index, diastolic BP, HR
D. MAP, CO, HR

A

B

30
Q

Afterload is defined as…

A. Decreased resistance
B. Vasodilation
C. Increased resistance
D. Mean arterial pressure

A

C- due to vasoconstriction of the vascular bed

31
Q

What two important things occur during diastole?

A

Ventricular filling and coronary artery perfusion

32
Q

Name 2 inotropes

A

Dobutamine and milronone

33
Q

Which inotropes is a phosphodiasterase inhibitor?

A

Milronone

34
Q

Which inotropes is receptor dependent?

A

Dobutamine

35
Q

Where are beta 1 and beta 2 cells?

A

Beta 1 heart, beta 2 lungs

36
Q

Name catecholamines. How do they work?

A

Epinephrine and norepinephrine

They work by stimulating beta 1 receptor sites, making CAMP which allows calcium into the cell

37
Q

Dopamine is unique in that it has 2 effects which vary by dosing. What are these effects

A

2-10mcg/kg/min = increased contractility (beta effects)

> 10mcg/kg/min = vasoconstriction (alpha effects)

38
Q

What medications can you never use through a peripheral line?

A

Vasopressors!

Levophed phenylepherine, and dopamine

39
Q

What are indications for dopamine use?

A

Shock states:
Cardiogenic or septic
Post cardiac surgery

40
Q

Is dopamine first Line for shock? Why or why not

A

No Levophed is. This is due to higher incidence of tachyarrythmias using dopamine

41
Q

What are SE from dopamine?

A

Tachyarrythmias and vasoconstriction

42
Q

How does dobutamine work?

A

Increases contractility and HR with slight vasodilation

43
Q

What should never run with dobutamine?

A

Alkaline solutions like sodium bicarbonate.

*sodium bicarbonate should run alone in its own line

44
Q

What are indications for dobutamine?

A

CHF

Shock states

45
Q

Name some positive inotropes. What do they do?

A

They increase contraction

Digoxin, phosphodiasterase inhibitors, catecholamines, Amiodorone, prostaglandins

46
Q

What are negative inotropes? What do they do?

A

Weaken contraction, slow heart

BB, CCB, quinine, procainamide

47
Q

What are some indications for use of epinephrine?

A 
Low output states
Cardiac arrest
Shock states
Asthma
Anaphylaxis
48
Q

SE of epinephrine?

A

Severe hypertension
Tachyarrythmias
Restlessness and fear

49
Q

Indications for Levophed?

A

Hypotension
Cardiac and septic shock
GI lavage

50
Q

When using Levophed for a gastric lavage, what should you be sure to do?

A

Draw it in and back out. Never leave down an NGT

51
Q

What makes phenyl ephedrine different than other catecholamines?

A

It’s purely an alpha stimulator

It won’t increase HR like the other meds in its class, can actually cause bradycardia

It’s effects are primarily vascular by increasing SBP, DBP, and PAP

52
Q

Milronone is a phosphodiasterase inhibitor indicated for what conditions?

A

Low CO
Acute CHF
Cardiomyopathy

53
Q

Nitroglycerin works how?

A 
Systemic and pulmonary vasodilation
Decreases preload
Decreases afterload
Dilates the for coronary arteries
Makes it harder for heart to fibrilate
54
Q

Why is a 12 hour free time important with nitrates?

A

To decrease nitrate tolerance!

55
Q

When giving nitropruside what must you watch for?

A

Cyanide poisoning

Confusion
Hyperreflexia
Seizures

*sodium thiosulfate is the antidote

56
Q

Nesiritide is BNP. What does this do and what is it used for?

A

Vasodilates
Diuresis

HF patients

57
Q

Nesiritide is incompatible with many medications and should be administered on its own. What are some MAJOR medications it interacts with?

A

Lasix, insulin, heparin

58
Q

What are the 2 classes of CCB?

A

Nondihydropyridines (diltiazem, cardizem, verapamil) - stronger for arrhythmias

dihydropyridines (nicardipine)- stronger vasodilators

59
Q

Name pressor agents…

A

Levo, phenylepherine, vasopressin dopamine, epinephrine

60
Q

What is the major effect of inotropes?

A

Increase contractility by facilitating the transport of calcium into the cell

61
Q

What is the concern of giving nitropruside for greater than 72 hours?

A

Cyanide toxicity

62
Q

This is a state caused by inadequate tissue perfusion in which cells are deprived of oxygen and anaerobic metabolism causes a production of lactic acid and an acidotic state

A

Shock

63
Q

What happens to preload, afterload, and contractility during hypovolemix shock?

A

Preload- decreases
Afterload increases (vasoconstriction)
CO- decreases

64
Q

What happens to preload, afterload, and SVR during carcinogenic shock?

A

Preload increases, afterload increases, and increase in SVR

65
Q

How to manage cardiogenic shock

A

Pharm: inotropes to increase contractility and vasodilators to decrease SVR

IABP
VAD
ECMO
Transplant

66
Q

Explain how IABPs work.

A

The IABP is inserted just below the subclavian artery. The balloon fills from the bottom to the top, pushing blood back up through the aortic arch and back towards the coronary arteries.

This improves both coronary and cerebral perfusion.

It deflates right before the aortic valve opens, greatly reducing afterload by sucking blood from the left ventricle

67
Q

A patient in cardiogenic shock has a hemodynamic profile of:

BP 90/56 HR 110. CO/CI: 1.4/0.8
PA: 36/20 PAOP: 18 SVR: 3000 RAP (CVP): 10

What is the BIGGEST concern?

What would the next intervention be?

A

The SVR is very high

The CO/CI is very low

The SVR has increased the workload of the heart so much that the ventricle is unable to contract effectively, causing the low CO/CI

Decrease SVR by adding nitropruside to vasodilate and reduce afterload

CCRN (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions