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Cardiovascular Pulmonary Conditions > CVP Exam II > Flashcards

CVP Exam II Flashcards

1
Q

What are the signs/symptoms of left sided heart failure?

A

shortness of breath, cough, lung crackles, wheezing, tachypnea, restlessness, confusion, orthopnea, tachycardia, fatigue, cyanosis

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2
Q

What are the signs/symptoms of right sided heart failure?

A

fatigue, peripheral edema, ascites, enlarged liver and spleen, distended jugular veins, GI distress (maybe anorexia), weight gain, dependent edema

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3
Q

[systolic/diastolic] heart failure is defined as a pump failure to be able to eject blood.

A

systolic heart failure

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4
Q

[systolic/diastolic] heart failure is reduced volume content due to stiff walls reducing volumes to eject.

A

diastolic heart failure

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5
Q

Class I Heart Failure

A

no limitation of physical activity, normal activity doesn’t cause symptoms (i.e. fatigue, palpitation, or shortness of breath)

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6
Q

Class II Heart Failure

A

slight limitation of physical activity, comfortable at rest, normal activity causes symptoms (i.e. fatigue, palpitation, or shortness of breath)

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7
Q

Class III Heart Failure

A

marked limitation of physical activity, comfortable at rest, less than normal activity causes symptoms (i.e. fatigue, palpitation, or shortness of breath)

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8
Q

Class IV Heart Failure

A

unable to carryout physical activity without discomfort, symptoms (i.e. fatigue, palpitation, or shortness of breath) at rest, with increase in symptoms with any activity.

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9
Q

Those that are older than 65 years old usually receive an LVAD for ______ ______ in order to prolong their life and enhance their QOL.

A

destination therapy

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10
Q

Those that are younger than 65 usually receive a LVAD to prolong their life while they wait for a ____ ____.

A

heart transplant

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11
Q

What are some indications for mechanical circulatory support (MCS)? (4)

A

symptoms, dependence on ionotropes, functional QOL, and medically optimized (i.e. in hospital >60 days and still in cardiogenic shock)

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12
Q

What are some characteristics of LVAD candidates? (i.e. cardiopulmonary, respiratory, musculoskeletal, and NS)

A
  • Cardiopulmonary: Impaired activity tolerances, impaired peripheral artery quality (edema), claudification, impaired heart rate recovery time, reduced cardiac output, increased lactic acid
  • Respiratory: Poor V-Q perfusion, pulmonary congestion, decreased oxygen saturation, increased pulmonary resistance
  • Musculoskeletal: reduction of skeletal muscle mass, affecting insulin resistance, shift of increased anaerobic muscle fibers, (typeI I),change in muscle metabolism
  • Nervous System: Abnormal activation of the SNS which advances heart failure, baro and chemo receptor reflexes are changed,
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13
Q

Reasons why someone wouldn’t be a good candidate for an LVAD or mechanical circulatory device? (7)

A

disability level impacts recovery, cognition + family support limits recovery, anticoagulation prohibited, pulmonary disease, multiorgan failure, BMI>35, and cancer

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14
Q

The mechanical circulatory support device that is designed to assist the left ventricle pump oxygen rich blood from the lungs to the rest of the body is the [LVAD/RVAD].

A

LVAD

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15
Q

The mechanical circulatory support device that is designed to assist the right ventricle pump blood from the right side of the heart to the lungs is the [LVAD/RVAD].

A

RVAD

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16
Q

The mechanical circulatory support device that is designed to support both the right and left sides of the heart is the [BiVAD/TAH].

A

BiVAD

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17
Q

The mechanical circulatory support device that is designed to replace both heart ventricles and four valves is the [BiVAD/TAH].

A

TAH (Total artificial heart)

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18
Q

Mechanical circulatory support devices are approved indications for what 3 things? (according to the FDA and payment perspective)

A

bridge to: transplant, decision, or recovery

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19
Q

The speed of the VAD is set so the MAP equals what?

A

70-90

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20
Q

The VAD has difficulty working against pressures where?

A

in the aorta

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21
Q

What can cause hemodynamic changes in a VAD? (5)

A

pump thrombosis, hypovolemia, orthostatic hypotension, hypertensive crisis, or a suction event

22
Q

T/F VAD precautions are the same as sternal precautions.

A

False

23
Q

What are VAD precautions?

A

week 1-6: don’t lift, push, or pull anything >8lbs (i.e. gallon of milk)

week 7-12: don’t lift, push, or pull anything >20lbs

week 12+: don’t lift, push, or pull anything >50lbs

24
Q

What are possible LVAD complications? (9)

A
  • Arrhythmias
  • Gastrointestinal vascular bleeding
  • Cerebral vascular accident
  • Pump thrombosis
  • Drive line infections
  • Inflow obstruction/suction
  • Severe deconditioning
  • Right ventricular failure
  • Aortic insufficiency
25
Q

What are some outcome measures to use post-op? (6)

A

Comparison of pre-surgical measures (i.e. SPPB, chair-rise, gait, and balance), Borg RPE, dyspnea scale, AMPAC 6 Clicks, 2-Minute Step Test, 6-Minute Walk Test

26
Q

What should you include in documentation after treatment?

A

device parameters (i.e. flow, power)

vitals (i.e. BP, HR, O2)

Alarms that occurred during session

BORG RPE

27
Q

What are some risks/adverse events that may occur after implantation?

A

bleeding, infection, tamponade, ventricular arrhythmias, renal failure, right ventricular failure, neurological complications, hemolysis, thrombus, device failure, higher risk for myopathies, and suicide

28
Q

With a total artificial heart (TAH), what “pump”/machine do they carry? How much can that weigh?

A

Freedom Driver

15.5 lbs (with backpack)

29
Q

With a TAH, you would not have a normal [BP and ECG/BP or ECG]

A

BP and ECG

30
Q

With a TAH, what characteristics do patients have?

A

low hemoglobin (6-8 g/dl), INR between 2.5-3.5, 9.5 L blood pumped/min, pulse set by freedom driver, and they take aspirin and coumadin

31
Q

What does ECMO stand for?

A

extracorporeal membrane oxygenation

32
Q

[LVAD/ECMO] is an external device that oxygenates a hospitalized critically ill patient’s blood, removes CO2, and provides blood flow

A

ECMO

33
Q

When is ECMO utilized?

A

cases of lung or cardiac damage, cystic fibrosis, meconium aspiration, waiting for heart transplant, and waiting for heart to heal

34
Q

[VA ECMO/VV ECMO] is used when cardiac support is needed. The blood is pulled from venous circulation and returned into arterial circulation. Blood is non-pulsatile and mostly bypasses the heart and lungs.

A

VA ECMO

35
Q

[VA ECMO/VV ECMO] is used when there is adequate cardiac function and the support is needed for respiratory reasons.

A

VV ECMO

36
Q

[Pump flow/Sweep flow] is the rate at which the pump is moving the blood in L/min.

A

pump flow

37
Q

[Pump flow/Sweep flow] is the rate at which oxygen is moving through the membrane in L/min.

A

sweep flow

38
Q

[FiO2/SvO2] is the amount of oxygen being delivered to the circuit.

A

FiO2

39
Q

[FiO2/SvO2] is the amount of oxygen left in the blood after one circuit through the body (must be 40% for therapy, but 60% is ideal at rest)

A

SvO2

40
Q

What are the indications for ECMO? (4)

A

heart failure cardiogenic shock, acute coronary syndrome, myocarditis, cardiomypathy, failed cardiopulmonary resuscitation, failed heart surgery, cystic fibrosis

41
Q

Describe the following ECMO configuration.

right internal jugular vein and right axillary artery

A

ECMO in this vein and artery. No ROM of right shoulder but patients can stand and transfer.

42
Q

Describe the following ECMO configuration.

femoral cannulation

A

ECMO placed in femoral artery

43
Q

Describe the following ECMO configuration.

central cannulization

A

ECMO placed below xiphoid in the right atrium and ascending aorta

44
Q

How is a patients increased workload compensated for by a specialist during activity with a patient on ECMO?

A

increase in sweep flow, FiO2, and pump speed

45
Q

What are limiting factors for rehab with patients on ECMO? (2)

A

patient’s O2 consumption (SvO2) and fluid status

46
Q

Venoarterial (VA) ECMO can support up to ____% of the native cardiac output.

A

80%

47
Q

[VV/VA] ECMO has fewer complications than [VV/VA] ECMO.

A

VV has fewer than VA

48
Q

What are some possible complications with ECMO?

A
  • Decannulation
  • Hemorrhagic stroke
  • Bleeding, infection
  • Emboli/thrombosis
  • Lower extremity ischemia
  • Lower extremity compartment syndrome
  • Lower extremity amputation
  • Acute kidney injury
  • Rethoracotomy or surgical exploration of the thoracic cavity
  • Vascular tear
  • Gastrointestinal bleeds
  • ECMO patients are at increased bleeding risk secondary to probable heparin use for anti-coagulation
49
Q

How can you assess patient tolerance for therapy with ECMO and VAD?

A

monitor physical signs and symptoms (i.e. RR, headache, nausea, color)

monitor for mental status changes (i.e. confusion, agitation)

patient’s subjective report (i.e. BORG or RPE scale)

50
Q

Who should manage the ECMO lines and machine when working with patient?

A

ECMO specialist

Cardiovascular Pulmonary Conditions (1 decks)

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