Hemodynamic Basics Flashcards

1
Q

What is the meaning of the term “Hemodynamics”?

What two components is taken into account?

A

The force by which blood circulates through the body

CO and BP

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2
Q

Why is hemodynamics so important?

A

It helps with making sure the patient is accomplishing perfusion

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3
Q

What is preload?

A

Amount of blood filling up the heart when it is relaxing at the end of diastole
- filling pressure

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4
Q

What measurement reflects left ventricular preload ?

A

PCWP or wedge pressure

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5
Q

What measurement goes with right ventricular pressure?

A

CVP

  • central venous pressure
  • fluid status measurement, remember?
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6
Q

List examples that can INCREASED preload and explain why

A

Exercise (slightly)
- your heart is naturally working harder

Hypervolemia
- too much fluid so its filling more

Neuroendocrine excitement
- fight or flight

AV fistula*
- It allows you to bypass arterioles but it will increase the filling in the heart

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7
Q

Name off examples that cause a DECREASE in preload and explain

A

Hypovolemia
- the heart can’t fill up if you are dry

Narrow/stenotic valves
- stops ventricle from filling adequately

A.Fib
- the quiver makes you lose the ability to fill and pump

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8
Q

How would you explain Afterload?

A

The amount of pressure the heart has to overcome in order to perfuse the body

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9
Q

Explain reasons for why there would be an INCREASE in Afterload

A

Increase systemic resistance (Blood pressure)

Aortic Stenosis
- the aorta supplies the body with blood ; if its valves are stenotic, you can’t push blood out which increases resistance

Myocardial Infarction/Cardiomyopathy

Polycythemia
- thicker blood can’t push out as easy to it has to overcome more pressure

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10
Q

Another term for blood pressure?

A

SVR or systemic resistance
- often referred to as the same thing

note: svr also reflects after load

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11
Q

What are some factors that DECREASE Afterload?

A

Decreased volume/dry
- you will have less resistance if your blood is “thinner”

Septic shock
- this is a state of vasodilation so vessel’s open up

End stage Cirrhosis
- Kidney issues are common with this. And if you’re kidneys aren’t working, your heart is affected

Vasodilating meds
- bc they widen the vessels to relax

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12
Q

What happens to the fluid in a septic shock person with decreased afterload? What are the signs?

A

There can be third spacing

  • Decreased BP after compensation doesn’t work
  • Cap refill
  • Edema
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13
Q

Your patient has end state cirrhosis which is causing a decrease in their after load requirements. What might they look like?

A

Jaundice
Decrease in UO
Anemic
Bilirubin scabs

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14
Q

Wha labs would you look at for a cirrhosis patient?

A
Lactate
ASLT
BUN
CR
wbc
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15
Q

Contractility meaning

A

Strength of VENTRICLES contracting

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16
Q

Inotropic meaning

A

Force or energy of the contraction

17
Q

Chronotropic meaning

A

Time and rate related; heart rate

18
Q

Stroke volume meaning

A

Amount o blood ejected by the ventricles

19
Q

Cardiac output meaning

What is the normal trend for this?

A

HR x SV

CO is the same for everyone

20
Q

Cardiac index meaning

A

Similar to CO but more specific to the individual patient due to taking surface area into account

  • more reliable
  • not the same for everyone
21
Q

Main types of invasive monitoring?

A

CVP
Art
Pulmonary artery

22
Q

How can we insure invasive monitoring is accurate?

A

Equipment needs to be zeroed to outside influences

Referencing or the positioning of transducer needs to be at the Phlebostatic axis (4th IC)

23
Q

You raise the HOB of the your patient with an invasive monitoring device. What should you do?

A

Need to reposition the reference point of the transducer so it aligns with phlebostatic axis

24
Q

What do you need for invasive monitoring?

A

Correct catheter

Special tubing system
- IV fluids of NS 
- pressure tubing
stopcocks
-flusher device
- transducer 

Pressure bag set at 300 mmhg
- flusher delivers it at 3mLs/hr

25
Do you pump the pressure bag up or do you spike it? What is the point of the pressure bag?
Spike it first then pump it up - its a lot of pressure in there Keeps you from bleeding out
26
When zeroing the line, what elevation does the HOB need to be at?
60 degrees
27
What do you do when zeroing a line?
Open to air Hit zero function on monitor And confirm
28
List instances where you would want to zero the line?
Do it on the initial set up & do it again after the insertion If you see any changes and need clarification Beginning of shift
29
What can you check on the monitor for a clue you're getting an accurate line reading?
Waveform