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NRSG 200: Med Surg 3 > [Exam 2/Final] Chapter 25: Assessment of Cardiovascular Function > Flashcards

[Exam 2/Final] Chapter 25: Assessment of Cardiovascular Function Flashcards

1
Q

What is the S1 sound?

A

First sound when you hear lub. Tricuspid and Mital valves closing.

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2
Q

Normal Heart Sounds: What is the S2 sound?

A

The dub, the closing of the aortic and pulmonary valves.

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3
Q

Normal Heart Sounds: What is a S3 sound?

A

Abnormal early diastolic sound during period of rapid ventricular filling

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4
Q

Normal Heart Sounds: What happens if Mitral valve malfunctioning and blood not flowing as easily from left atrium to left ventricle?

A

Will hear an extra sound.

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5
Q

Normal Heart Sounds: What can cause extra heart sounds?

A

Left ventricle being enlarged, hypertension, coronary artery disease, aortic stenosis.

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6
Q

Normal Heart Sounds: What does it mean when you hear lub dub dub?

A

blood flowing into the left ventricle is met with resistance, and is why you hear this sound.

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7
Q

Normal Heart Sounds: What does it mean if you hear “lub” lub dub

A

Blood is flowing back into the right ventricle.

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8
Q

Normal Heart Sounds: What is a S4 sound?

A

Abnormal late diastolic sound during atrial systole

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9
Q

Normal Heart Sounds: Where is the tricuspid valve?

A

Between Right atrium and ventricle

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10
Q

Normal Heart Sounds: where is the mitral valve?

A

Between the left atrium and ventricle

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11
Q

Key Terms: What is SV?

A

Amount of blood ejected from the ventricles per heartbeat. Typicaly will send out 60-130 mL

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12
Q

Key Terms: What is Cardiac Output?

A

Total amount of blood ejected per ventricle in L per minute.

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13
Q

Key Terms: what is the normal cardiac output?

A

4-6 L per minute.

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14
Q

Key Terms: What is the formula for CO

A

HR x SV

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15
Q

Key Terms: Why may a heart rate go up for CO?

A

To try to get more cardiac output so the body compensates this way.

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16
Q

Key Terms: What is preload

A

Ventricular filling volume at the highest. Degree of stretch of ventricular muscle fibers, the degree of stretch that the heart can take.

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17
Q

Key Terms: What is afterload?

A

Resistance to the injection of blood from the ventricles. Resistance ventricles must overcome, the pressure it must overcome to get it ejected into rest of heart.

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18
Q

Key Terms: What is contractility?

A

How forceful the contraction the myocardium can make, the heart muscle. The squeez

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19
Q

Key Terms: What is ejection fraction

A

How much blood is being ejected out from left ventricle. Normally 55-65%. Its the end diastolic blood volume.

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20
Q

Key Terms: What is patient experiencing when EF < 40%

A

Likely has HF and not functioning as well.

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21
Q

Factors Influencing Cardiac Output: What factors influence HR?

A

Autonomic Innervation,
Hormones,
Fitness Levels,
Age

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22
Q

Factors Influencing Cardiac Output: What factors influence SV>

A 
Heart Size
Fitness Level
Gender
Contractility
Duration of Contraction
Preload
Afterload
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23
Q

Preload and Afterload: What is preload?

A

Pressure from volume of blodo in ventricles at end of diastole

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24
Q

Preload and Afterload: Preload is increased under what circumstances?

A

Hypervolemia
Regurgitation of Cardiac Valves
Heart Failure

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25
Q

Preload and Afterload: What is Afterload?

A

Resistance left ventricles must overcome to circulate blood

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26
Q

Preload and Afterload: Afterload increased when?

A

Hypertension and Vasoconstriction

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27
Q

Preload and Afterload: An increase in afterload causes what change in body?

A

Increase in cardiac workload

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28
Q

Hemodynamic Monitoring: What is this

A

Close monitoring of all of the patients pressures?

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29
Q

Hemodynamic Monitoring: How is non-invasive monitoring performed?

A

By checking vital signs.

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30
Q

Hemodynamic Monitoring - CVP: What is called?

A

Central Venous Pressure

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31
Q

Hemodynamic Monitoring: What is a Pulmonary Artery Pressure (Swan Ganz Catheter)?

A

Also called PA Catheter

They will get isnerted through IJ or subclavian and have different monitoring decives. Includes CVP

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32
Q

Hemodynamic Monitoring - CVP: What is this

A

Catheter sits inside tip of right atrium. Tells us about right atrial pressure,

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33
Q

Hemodynamic Monitoring - CVP: Why would monitoring right atrial pressure be useful?

A

Gives us an idea about the patient’s fluid status

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34
Q

Hemodynamic Monitoring - CVP: What is another name for a PA Catheter?

A

Swans Ganz Catheter

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35
Q

Hemodynamic Monitoring: What is contained within PA Catheter (Swns Ganz Catheter)

A

CVP

Pulmonary artery Line

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36
Q

Hemodynamic Monitoring: What is the color of the CVP line?

A

BLue Line

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37
Q

Hemodynamic Monitoring - Swan Ganz Catheter: What path does PA Line follow?

A

Goes through right atrium, right ventricle, and up and then sits in the pulmonary artery.

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38
Q

Hemodynamic Monitoring - Swan Ganz Catheter: What does the PA Line tell us?

A

Gives us a PA pressure and tells us about how that left ventricle is functioning. Because left ventricle can push back pressure within lungs.

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39
Q

Hemodynamic Monitoring - Intra-Arterial Pressure: What is this?

A

Catheter can be ran into radial pulse, femoral pulse, brachial pulse and get us a continous blood pressure reading.

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40
Q

Hemodynamic Monitoring: What are the three examples of Invasive Modalities?

A

CVP, Pulmonary Artery Pressure (Swan Ganz Catheter), Intra-Arterial Pressure

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41
Q

Hemodynamic Monitoring -Complications: What complications can result

A

Infection, Pneumothorax, or Air Embolism

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42
Q

Phlebostatic Axis: What is this?

A

When we hook up the patient for invasive monitoring, there needs to be spot on body where we have reference point for atrium, reference point for line.

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43
Q

Phlebostatic Axis: What position will this always be

A

Mid Axillary Line in the fourth intercostal space

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44
Q

Phlebostatic Axis: So where do the transducers need to be?

A

At the same level of the phlebostatic axis.

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45
Q

Swan Ganz Catheter: What is located at the end of the catheter that sits in PA Artery?

A

Balloon, that will be inflated when in place

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46
Q

PA Catheter and Pressure Monitoring System: CVP and PA will always be hooked up to what?

A

Pressure bag. Primed with normal saline and maintains pressure of the line.

47
Q

PA Catheter and Pressure Monitoring System: When pressure bag hooked up to monitor, what does it tell you

A

Gives you various readings. Tells CVP, and PA pressure.

48
Q

PA Catheter and Pressure Monitoring System: When would Pulmonary Artery catheters be isnerted?

A

When there is severe heart failure, after cardiac surgery,

49
Q

PA Catheter and Pressure Monitoring System: What is the normal PA Pressure?

A

15-25 / 8-15

50
Q

PA Catheter and Pressure Monitoring System: What is a Wedge?

A

A number that will give a better view of whats going on in left ventricle.

51
Q

PA Catheter and Pressure Monitoring System: How do you get a wedge pressure?

A

You have to inflate the balloon and wedge it into the section of the pulmonary artery to get a pressure.

52
Q

PA Catheter and Pressure Monitoring System: What do you want the wedge pressure to be?

A

Around 8-12

53
Q

PA Catheter and Pressure Monitoring System: What is the arterial blood pressure normally?

A

This is our normal blood pressure. Will be around 120/80

54
Q

Minimally Invasive Monitoring Device: What is Pulse Pressure Analysis?

A

These can be used with ART line to estimate SV, continous CO, and includes what patients age, weight is.

55
Q

Minimally Invasive Monitoring Device: What is Esophageal Doppler Probes

A

Doppler goes through esophagus and probe placed above heart. Lets us know of cardiac output

56
Q

Minimally Invasive Monitoring Device: What is the Fick Principle

A

Based on patients CO2, and will use this on vented patients . Uses patients CO2 and O2 to determine CO

57
Q

Central Venous Pressure (CVP): What does thsi measure?

A

Pressure of the right atrium

58
Q

Central Venous Pressure (CVP): These can be included with what?

A

Pulmonary artery catheter, the yellow catheter, the swan ganz catheter.

Triple Lumen central line , which will be brown port usually.

59
Q

Central Venous Pressure (CVP): Sites for insertion will usually be what

A

IJ or Subclavian, or femoral as well

60
Q

Central Venous Pressure (CVP): Normal pressure?

A

2-6

61
Q

Central Venous Pressure (CVP): By monitoring this, this tells us a lot about what?

A

The patients fluid status

62
Q

Central Venous Pressure (CVP): What doees it mean if CVP is higher than 6?

A

Patients have fluid overload, right sided heart failure , could have pulmonary hypertension.

63
Q

Central Venous Pressure (CVP): How could high fluid volume be treated?

A

With diuretics

64
Q

Central Venous Pressure (CVP): What does it mean if they have low CVP?

A

They are hypovolemic, dehydrated. They need some fluid.

65
Q

Arterial Line: What is this?

A

Continuous invasive blood pressure measurement that is placed in a artery (radial, femoral, or brachial)

66
Q

Arterial Line: When would this be helpful?

A

If the patient was extremely unstable , on medications to keep blood pressure up.

67
Q

Arterial Line: We want our MAP to be at

A

> 65

68
Q

Arterial Line: What does a MAP tell us?

A

How the patients heart is functioning and what their pressure is . Indicates perfusion, how well heart is getting blood out to rest of body

69
Q

Arterial Line: What does it mean if MAP is < 50

A

There could be compromise.

70
Q

Arterial Line: When would MAP be elevated?

A

Elevated when hypertensive with cuff pressures, when hypervolemic, have vasoconstriction, have atherosclerosis.

71
Q

Arterial Line: When would MAP be low?

A

If they are septic, dehydrated, have blood loss.

72
Q

Arterial Line: How would a low MAP be treated?

A

Give them medication to get their blood pressure up, if dehydrated give fluids .

May need a pressor to get their blood pressure up

73
Q

Pulmonary Artery Catheter: Where does this sit?

A

In the Pulmonary Artery

74
Q

Pulmonary Artery Catheter: What information does this provide?

A

PA Pressure and PA Wedge Pressure (PAOP, PWP)

75
Q

Pulmonary Artery Catheter: What does this show ?

A

The LV Function

76
Q

Pulmonary Artery Catheter: Normal PA Pressure?

A

15-25 / 8-15

77
Q

Pulmonary Artery Catheter: Normal PAOP *Wedge) pressure?

A

8-12

78
Q

Pulmonary Artery Catheter: What is done at the end of the catheter?

A

Balloon is inflated, to show wedge pressure.

79
Q

Pulmonary Artery Catheter: This provides what two things?

A

PA Pressure and Wedge Pressure

80
Q

Pulmonary Artery Catheter: Wedge pressure is similar to what?

A

8-12 Wedge is simillar to 8-15 Diastolic PA pressure.

81
Q

Pulmonary Artery Catheter: Elevated PA pressures occur when?

A

When theres a increase in volume, pulmonary hypertension, and left sided heart failure.

82
Q

Pulmonary Artery Catheter: An increase in PA number means what in left side of heart?

A

Decrease function of the left side of the heart.

83
Q

Pulmonary Artery Catheter: How can elevated PA pressure be treated?

A

Dobutamine, an ionotrope that helps with squeeze of heart and helps with contractility

84
Q

Pulmonary Artery Catheter: What is done if PA pressure elevated because of fluid overload?

A

Diuretics.

85
Q

Pulmonary Artery Catheter: What if PA Pressure is low, what does it mean?

A

May not have enough volume, or could be in shock causing vasodilation.

86
Q

Pulmonary Artery Catheter: How can a low pressure be treated?

A

Treat with some fluids, maybe some pressors depending on whats going on if they are in shock. Because we have to tighten down the vessels so heart can push heart out bc of vasodilation.

87
Q

Pulmonary Artery Catheter: This catheter can also be used for what?

A

Give us measurements of what CO is. Can be continuous CO or fluid can be injected totravel throughout body to tell us what CO is.

88
Q

Hemodynamic Monitoring Comparison - CVP: Placement of this?

A

Central Venous Catheter through IJ or SCV OR Pulmonary Artery Catherr

Right Atrium is where it goes

89
Q

Hemodynamic Monitoring Comparison - CVP: Normal values?

A

2-6

90
Q

Hemodynamic Monitoring Comparison - CVP: High value causes?

A

Hypervolemia, RHF, Cardiac Tamponade

91
Q

Hemodynamic Monitoring Comparison - CVP: Low value causes?

A

Hypovolemia (Dehydrated, N/V/D, Blood Loss)

Decrreased Preload

92
Q

Hemodynamic Monitoring Comparison - CVP: High value treatment?

A

Diuretics

93
Q

Hemodynamic Monitoring Comparison - CVP: Low value treatment?

A

Fluids / Blood

Tx of Cause

94
Q

Hemodynamic Monitoring Comparison - CVP: Complications from this?

A

Infection (CDI, Occlusive), Air Embolism

Pneumothorax risk with Insertion

95
Q

Hemodynamic Monitoring Comparison - Arterial Line: Where can this be placed?

A

Radial (most common), Femoral, and Brachial

96
Q

Hemodynamic Monitoring Comparison - Arterial Line: Normal Value?

A

120/80

Map > 70

97
Q

Hemodynamic Monitoring Comparison - Arterial Line: High value causes?

A

Vasoconstriction / Atherosclerosis

FVE

98
Q

Hemodynamic Monitoring Comparison - Arterial Line: High value treatment?

A

Diuretics, Medications, BB, Vasodilators

99
Q

Hemodynamic Monitoring Comparison - Arterial Line: Low value causes?

A

FVD, Sepsis/Shock

100
Q

Hemodynamic Monitoring Comparison - Arterial Line: Low Value Treatment?

A

Fluid, Dobutamine (Contractility)

Norepinephrine and Dopamine normally to vasoconstrict

101
Q

Hemodynamic Monitoring Comparison - Arterial Line: Complications of this”?

A

Infection, Decreased Perfusion Hand/Leg

102
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery: Normal Placement?

A

Pulmonary Artery

103
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery (PA/PAOP): Normal Values?

A

PA - 15-25 / 8-15

PAOP/PWP/PCWP: 8-12

104
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery (PA/PAOP):High Value causes?

A

FVE, LHF, Pulmoary Hypertension, Mechanical Ventilation (Increased PEEP)

105
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery (PA/PAOP):High value treatment?

A

Dobutamine, Diuretic

106
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery (PA/PAOP):Low Value ccauses?

A

Vasodilation (Shock)

FVD

107
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery (PA/PAOP):Low Value Treatments?

A

Fluids, Pressors

108
Q

Hemodynamic Monitoring Comparison - Pulmonary Artery (PA/PAOP): Complications from this?

A

Infection (CDI, Occlusive), Air Embolism

Pneumothorax risk with insertion,

Perforated Pulmonary Artery

109
Q

Hemodynamic Monitoring Comparison - NANDA and Intervention: Of Placement?

A

RF Injury
RF Infection
RF Impaired Tissue Perfusion (ART)

110
Q

Hemodynamic Monitoring Comparison - NANDA and Intervention: For High Value Causes?

A

FVE - Diuretics

Decreased Output

111
Q

Hemodynamic Monitoring Comparison - NANDA and Intervention: For High Value Treatment?

A

RF Fluid and Electrolyte Imbalance

112
Q

Hemodynamic Monitoring Comparison - NANDA and Intervention: For Low value causes?

A

FVD - Fluids

113
Q

Hemodynamic Monitoring Comparison - NANDA and Intervention: For Low volume treatment?

A

FVD - Fluids

114
Q

Hemodynamic Monitoring Comparison - NANDA and Intervention: For Complpications?

A

Pneumo - Infective Breathing

Pattern/Impaired Gas Exchange

NRSG 200: Med Surg 3 (46 decks)

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