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NSG 478 > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

1
Q

Systole

A

Contraction
* Ventricles eject blood into the aorta and pulmonary artery

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2
Q

Diastole

A

Ventricular relaxation and filling
* When blood return blood to the heart in preparation for the next ventricular contraction

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3
Q

Four properties of the myocardial cell

A
  1. Automaticity (Chronotropic)
  2. Conductivity (Dromotropic)
  3. Contractility (Inotropic)
  4. Excitability (Bathmotropic)
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4
Q

Chronotropy

A
  • Chrono=time
  • The rate of contractions
  • Positive chronotropic drugs increase HR
  • Negative chronotropic drugs decrease HR
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5
Q

Chronotropic effects of Beta blockers

A

Negative chronotropic

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6
Q

effects of Calcium channel blockers

A

Negative chronotropic
Negative inotropic
* Calcium increases the strength of contractions, so by blocking calcium you decrease the strength of those contractions

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7
Q

All beta blockers end in what

A

lol

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8
Q

All calcium channel blockers end in

A

Pine/ zem

(Amlodipine/ Cardizem)

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9
Q

Amiodarone chronotropic effects

A

Negative chronotropic effects
(Also turns you blue)

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10
Q

Inotropes

A

Affect the contractility of the heart
* Positive increase the contractility, used to pump more blood with fewer heart. beats
* Negative decrease the contractility: and to decrease the HR

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11
Q

Why do we give positive inotropes

A
  • CHF
  • Cardiomyopathy
  • Recent MI
  • Cardiogenic shock
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12
Q

Why do we give negative inotropes

A
  • Weaken the contractions of the heart and slows the HR
  • HTN
  • Chronic heart failure
  • Arrhythmias
  • Chest pain

Also used in MI patients to decrease the burden on the heart

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13
Q

Dromotropy

A

Affects the conduction speed at the AV node, increasing/decreasing rate which electrical impulses move through the heart
* Positive increases conduction velocity
* Negative decreases velocity (Vagal stimulation)

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14
Q

Contractility

A

Force which the heart is able to contract
* Essential property of all muscles this is what allows the heart to act as a pump

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15
Q

Frank starling laws

A

Essentially the heart is a rubber band, the more you’re able to stretch the muscle (More full), the more powerful the contraction
* Increasing preload increases contractility

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16
Q

Digoxin, effects on the heart

A
  • Lowers HR (Negative chronotropic effects)
  • Increases contractility (Positive inotropic effects)
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17
Q

Cardiac Output (CO)

A

Amount of blood pumped by the heart in one minute (L/min)

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18
Q

Preload

A
  • Stretch of the ventricle, due to be filled with blood at the end of diastole
  • LVEDP
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19
Q

diseases with increased preload

A
  • HF
  • Valve diseases
  • Increasing O2 demand
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20
Q

Meds that decrease preload

A
  • Ace inhibitor
  • Arbs
  • Diuretics
  • Nitrates
  • calcium channel blockers (CCB)
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21
Q

LVEDP

A

Left ventricle end diastolic pressure
Stretch of the ventricle at the end of diastole, known as preload

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22
Q

Afterload

A
  • The pressure which the heart must work against to be able to eject its blood during systole
  • Increased afterload makes the heart work harder decreasing CO
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23
Q

Conditions that increase afterload

A

Aortic stenosis and elevated BP

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24
Q

Stroke volume

A
  • Volume of blood pumped by LV during one contraction
  • Normal is 50-100
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25
Q

Venous return

A
  • Blood needs to come back to the heart in order to pump it
  • Volume of blood from the veins that returns to the atria each min
  • Venous has a huge impact on cardiac
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26
Q

Systemic vascular resistance

A

Total peripheral resistance, and the force which is exerted onto the blood by the vasculature of the body

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27
Q

Pulmonary vascular resistance

A

Resistance against blood flow from the pulmonary artery to left atrium

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28
Q

Cardiac output

A

SV * HR

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29
Q

Goal of hemodynamic monitoring

A

* Maintain adequate tissue perfusion

  • identify the presence and nature of shock
  • Guide response to resuscitation
  • Eval volume state
  • measure cardiac contractility
  • and systemic vascular resistance

You need sufficient CO to keep BP and supply O2 rich blood to the brain and organs

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30
Q

Goal of hemodynamic monitoring

A

* Maintain adequate tissue perfusion

  • identify the presence and nature of shock
  • Guide response to resuscitation
  • Eval volume state
  • measure cardiac contractility
  • and systemic vascular resistance

You need sufficient CO to keep BP and supply O2 rich blood to the brain and organs

31
Q

Hemodynamic monitoring: Swan-ganz

A
  • Indwelling line which gives info about
    1. Blood volume
    2. Perfusion
    3. Fluid status
    4. How well the heart is pumping
32
Q

Swan-ganz/ pulmonary artery cath: Proximal lumen

A

Measures
* right atrial pressure, (CVP)
* IVF’s
* And can collect venous blood samples

33
Q

Swan-ganz/ pulmonary artery cath: Distal lumen

A

Measures
* Pulmonary artery pressure (PAP)
* Pulmonary artery systolic/diastolic
* Mean Pulmonary artery pressure
* Pulmonary artery wedge pressure

34
Q

Swan-ganz/ pulmonary artery cath: Balloon inflation port

A
  • Used intermittently for pawp measurements
  • When not in use it must be deflated and locked
35
Q

Swan-ganz/ pulmonary artery cath: Thermistor

A
  • Measures temp difference between right atrium and pulmonary artery to determine CO
36
Q

An increase in the Pulmonary artery pressure can be an early indicator of

A

Can show us before the patient is symptomatic
* Left ventricular failure
* Pulmonary edema
* Fluid overload

Early indication means it needs to be treated early

37
Q

Indications for a pulmonary art cath

A
  • Critical illness
  • Shock
  • Hemodynamic instability
  • Heart failure
  • Unstable post op patient
  • ARDS
  • Acute kidney injury
  • Severe burn injury
  • Trauma
38
Q

Normal Central Venous pressure (CVP)

A
  • 2-6 mm HG
  • (Located by the right atrium)
  • Can be used to measure preload on the right side of the heart
39
Q

Normal Pulmonary Artery Systolic (PAS)

A

15-28 mmHg

40
Q

Normal pulmonary artery diastolic (PAD)

A

5-16 mmHg

41
Q

Normal pulmonary artery wedge pressure

A

Measured in the pulmonary artery
* 6-15 mmHg
* Can be used to measure the preload for the left side of the heart

42
Q

Normal Cardiac output

A

3-6 L/min

43
Q

Normal mixed venous (SVO2)

A

60-80%

44
Q

Pre procedure nursing actions: Cardiac cath insertion

Probably dont need to know

A
  • Informed consent
  • Assemble the pressure monitoring system, purge air and maintain sterility
  • Place pt trendelenburg or supin
  • Administer sedation or analgesia as ordered
  • Level transducer with phlebostatic axis
  • Can see arrhythmias during insertion
45
Q

Phlebostatic Axis

A

Anatomical point that corresponds to the RA and most accurately reflects a patient’s hemodynamic status

Pt lies supine with an art line entering their left forearm which is measured at the 4th intercostal space, mid axillary line where the RA exist

46
Q

Post op Cardiac cath

A
  • Get a chest X ray to confirm cath placement
  • Monitor vitals, Resp and cardio status
  • Maintain line placement and integrity (Secure it)
  • Secure it

Observe and doc waveforms, report changes as this can indicate cath migration or displacement
Doc cath placements every shift and after movements
Obtain readings from the cath

47
Q

Post op cardiac cath: Taking a reading

A
  1. Place pt supin position prior to getting readings of hemodynamic values (HOB can be elevated 15 degrees)
  2. Level the transducer at the phlebostatic axis before reading and with all position changes
  3. Zero system to atmospheric pressure
  4. Compare hemodynamic findings to physical assessment
  5. Monitor trends in values obtained over time
48
Q

Complications of a cardiac cath: infection/sepsis

A
  • Change dressings per protocol and doc
  • Use surgical aseptic technique (Masks Sterile gloves, sterile field)
  • Monitor for S+S of infection (Fever, increased WBC)
  • Collect specimens or cultures as ordered
  • Admin antibiotics as orders
  • Admin IV fluids for vascular support (Sepsis)
  • Admin vasopressors secondary to sepsis as needed
49
Q

Complications of cardiac cath: Embolism

A
  • Use 0.9% NS for flushing system. Flush can include heparin or whatever your facilities protocol is
  • Avoid introduction of air into flushing system to prevent air embolism
  • Recognize the risk of pneumothorax with line insertion
  • Recognize the risk of arrhythmias with insertion or movement of the line

Plaque or a clot can be dislodged from the procedure

50
Q

Hemodynamic instability

A
  • Systolic BP equal to or less than 90
  • Sustained low BP and dropping
  • Not orthostatic hypotension
  • Need a baseline for the patient,, what is their usual BP
51
Q

Goal Mean arterial pressure (MAP)

A

> 60 mmHg

52
Q

Mean Arterial pressure (MAP)

A

(SBP + (DBP*2))/3

53
Q

Normal MAP

A

70-105 mmHg
Greater than 60 is the goal

54
Q

Manifestations of altered hemodynamics: Elevated preload

A
  • Crackles in the lungs
  • Jugular vein distention
  • Hepatomegaly
  • Peripheral edema
  • Taut skin turgor

Wedge measures the Left heart
CVP measures the right heart

55
Q

Manifestations of altered hemodynamics: Decreased preload

A

Poor skin turgor
Dry mucous membranes

Basically dehydrated or in shock

Wedge measures the Left heart
CVP measures the right heart

56
Q

Manifestations of altered hemodynamics: Increased Afterload

A

More resistance means less blood flow out
* Cool extremities
* Weak pulses

Left heart is measured by the systemic vascular resistance
Right heart is measured by the pulmonary vascular resistance

57
Q

Manifestations of altered hemodynamics: Decreased Afterload

A

Less resistance means more blood flow out
* Warm extremities
* Bounding pulses

Left heart is measured by the systemic vascular resistance
Right heart is measured by the pulmonary vascular resistance

58
Q

Caution with vasopressors

A

Can cause too much vasoconstriction, which can lead to infarction/ blood clots in the bowel

59
Q

What do vasopressors do

A

Increase SVR and increase BP
* Class of drugs that increase MAP via vasoconstriction

60
Q

Is a vasopressor an inotrope

A

No they differ from inotropes, however many drugs both have inotropic and vasopressor effects

61
Q

Five vasopressor drugs

A
  • Phenylephrine
  • Norepinephrine
  • Epinephrine
  • Dopamine
  • Vasopressin
62
Q

Positive Inotrope examples

A

Epi
NE
DA
Dobutamine
Milrinone
Digoxin

63
Q

Negative inotropes examples

A

Flecainide (Antiarrhythmic agent)
Verapamil (Calcium channel blocker)
Cardizem (Calcium channel blocker)
Clonidine (Antihypertensive given to psych)
Atenolol (Beta blocker)

64
Q

Drugs that affect hemodynamics: Vasodilators

A
  • Decrease Afterload
  • Decrease BP
65
Q

Drugs that affect hemodynamics: Antihypertensives

A
  • Decrease afterload
  • Decrease BP
66
Q

Drugs that affect hemodynamics: Loop diuretics

A
  • Decrease preload
  • Decrease BP
  • Taken long term it decreases afterload
67
Q

Drugs that affect hemodynamics: Morphine

A
  • Decreases vascular resistance and preload
68
Q

The three P’s of perfusion

A
  1. Pump
  2. Pipes
  3. Plasma
69
Q

Reduced CO

A
  • Reduce blood flow
  • Reduce perfusion
  • If not corrected quickly, shock
70
Q

Three main factors affecting blood flow

A
  • Blood volume (Plasma)
  • Cardiac pump function (EF) (Pumps)
  • Vaso Muscular tone (Pipes)
71
Q

An RN is assessing a patient with a PA catheter in place. The CVP is 4 and PCWP is 19 mmHg. Which of the following findings would the nurse expect?
1. Poor skin turgor
2. Bilateral crackles in the lungs
3. Jugular venous distension
4. Dry mucous membranes
5. Hepatomegaly

What if the CVP is 12 and PCWP is 9 mmHg?

A

Normal CVP ranges from 2-6, 4 is normal
Normal PCWP ranges from 6-15 mmHg, 19 is elevated

The PCWP measures the pressure of the left heart, higher pressure indicates congestion and a back up into the peripheral system, and due to the cvp being normal that means the lungs

  1. Bilateral crackles in the lungs

If the CVP is 12 it indicates an issue of increased preload on the right side which can indicate excess fluids and/or right sided heart failure

72
Q

Arterial Line

A
  • Placement of a cath into the lumen of an artery for continuous BP, and frequent Blood sampling
73
Q

Nursing actions ART line

A
  • Continually assess for the bleeding, dislodgement, hematoma formation and infection
  • Assess the patient for the 5 p’s
  • If art line becomes dislodged patient can hemorrhage and die fast
  • Zero the system with atmospheric pressure, hemodynamic pressure lines must be calibrated to read zero atmospheric pressure
  • Obtain initial readings as needed, compare art line reading to noninvasive BP
  • Document the patient’s response
  • Secure the art line!
74
Q

What do you do if a art line becomes dislodged

A

Put pressure on it or else they will die fast

NSG 478 (23 decks)

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