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Test 3 > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

1
Q

What is Hemodynamic Monitoring?

A

refers to the CONTINUOUS assessment of the CARDIOVASCULAR system to evaluate the HEART’S function and BLOOD flow throughout the body

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2
Q

the total amount of blood ejected from the heart per minute

A

Cardiac Output (CO)

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3
Q

What is the normal range for cardiac output?

A

4-8 Liters of blood each minute

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4
Q

Why is cardiac output important?

A

It indicates adequate blood flow and oxygen delivery to tissues, which is crucial for overall health.

  • aka ‘perfussion’
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5
Q

amount of blood pumped by the VENTRICLE with each contraction

A

Stroke volume (SV)

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6
Q

What is the normal range for stroke volume?

A

A: Each contraction should move between 60 to 100 ml of blood.

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7
Q

Q: Why is stroke volume important?

A

A: It helps assess heart function and influences overall cardiac output.

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8
Q

What is the cardiac output formula

A

CO = SV x HR

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9
Q

What are the 2 determinantes of cardiac output

A
  • Stroke volume
  • heart rate
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10
Q
  • The determinant that can go up and down.
  • Most easiest of the equation
A

Heart Rate

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11
Q

The determinant of the equation that is more trickier bc it is influenced by MULTIPLE variables

A

Stroke Volume

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12
Q

What 3 variables can influence Stroke Volume (SV)

A

Preload, Contractility, and Afterload

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13
Q

Determinants of Stroke volume:

  • Fill & stretch
  • The VOLUME within the ventricles at the end of diastole

is called

A

Preload

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14
Q

Determinants of Stroke volume:

  • “Squeeze”
  • How strong the heart squeezes

is called

A

Contractility

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15
Q
  • “Resistance”
  • the resistance the LEFT ventricle must overcome to eject blood during contraction.
  • The higher the resistance, the harder the heart must work

is called

A

Afterload

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16
Q

Review:

Helps us to determine the volume status of our patient

A

Preload

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17
Q
  • Preload is measured on the RIGHT side of the heart as ___.
  • “RIGHT ATRIAL PRESSURE”
A

CVP (CENTRAL VENOUS PRESSURE)

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18
Q

Preload can be measured on the LEFT side of the heart as ___.

A

PCWP/PAWP
(Pulmonary Capillary/Artery Wedge Pressure)

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19
Q

What is Central Venous Pressure (CVP)

A
  • CVP is the pressure in the thoracic vena cava, near the right atrium & ventricle of the heart.
  • It reflects the amount of blood returning to the right side of the heart and the heart’s ability to manage that blood volume.
  • “RIGHT ATRIAL PRESSURE”
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20
Q

What is the normal levels of Central Venous Pressure (CVP)

A

2-8 mmHg

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21
Q

HIGH CVP the patient will present with

A

fluid OVERLOAD- HYPERvolemia

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22
Q

LOW CVP, the patient will present with

A

DEHYDRATION- HYPOvolemia

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23
Q

Review:
How do you treat Hypervolemia?

A

Diuretics- classes include
* Loop diuretics: ‘furosemide’
* Thiazides: end in -thiazide
* Potassium-sparing: end in -one (Spironolactone, Amiloride, Triamterene)

know these

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24
Q

How would you treat DEHYDRATION

A
  • IV FLUIDS
  • ALBUMIN
  • BLOOD TRANSFUSSION

ETC

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25
Q

Most “vasodilators” dilate ___.

A

ARTERIES (systemic or pulmonary).

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26
Q

Which drug is the one of the drug classes you know that dilate arteries, but also cause the VEINS to dilate as well.

A

nitrates

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27
Q

This effectively shows you the preload for the left side of the heart.

A

“Wedge Pressure”
Pulmonary Capillary/Artery Wedge Pressure (PCWP or PAWP)

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28
Q

What is the normal “Wedge Pressure”

A

Normal 6-12 mmHg

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29
Q

HIGH Wedge Pressure in pt’s means ___.

A

Fluid OVERLOAD

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30
Q

LOW Wedge Pressure in pt’s means ___.

A

HYPOvolemia.

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31
Q

Can you determine if a heart issue exists with just one measurement?

A

No

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32
Q

A simple calculation which measures CO relative to the patient’s size.

A

Cardiac Index
on test, number will provided for you- no formula needed

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33
Q

medications or substances that increase the strength of heart muscle contractions, enhancing the heart’s ability to pump blood.

A

Positive Inotropes

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34
Q

Normal Cardiac Index

A

2.2 - 4.0 L/min/m2

know normal levels- no calculations needed on test

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35
Q

Q: Which drugs are considered positive inotropes that increase CONTRACTILITY?

List 6

A
  • dopamine
  • dobutamine
  • epinephrine
  • norepinephrine
  • milrinone **
  • digoxin **

know

36
Q

Positive Inotropes also increase ___.

A

Cardiac workload
increasing the heart’s O2 demands

37
Q

Medications or substances that decrease the strength of heart muscle contractions, leading to a reduction in CONTRACTILITY.

A

Negative Inotropes

38
Q

Q: Which drugs are considered negative inotropes that decrease CONTRACTILITY?

A
  • calcium channel blockers
  • beta blockers
    They reduce the force of contraction, reducing cardiac workload and O2 demands of heart
39
Q

Going back to Afterload:

Afterload can be measured using what 2 measurements?

A

SVR and MAP.

40
Q

Measures the RESISTANCE of blood flow out of the LEFT ventricle into the AORTA.

A

Systemic Vascular Resistance (SVR)

  • refers to the resistance that the body’s blood vessels provide against the flow of blood from the heart through the systemic circulation.
41
Q

Systemic Vascular Resistance (SVR) normal value is

A

800 -1200 dynes/sec/cm-5

42
Q

Increased SVR indicates

A

Vasoconstriction

43
Q

Decreased SVR indicates

A

Vasodilation

44
Q

Drugs that cause VASOCONSTRICTION

List 4

A
  • Epinepherine
  • norepinephrine
  • phenylephrine
  • vasopressin - “press in”

think meds that increase BP

KNOW

45
Q

Drugs that cause VASODILATION

List 4

A
  • Calcium channel blockers
    -verapamil, nifedipine, diltiazem
  • ace-inhibitors- “pril
  • nitrates- NTG
  • direct vasodilators (ex: hydralazine)

KNOW

46
Q
  • CRITICAL measure of blood pressure that represents the average pressure in a person’s arteries AFTER blood leaves LEFT side of heart.
  • It is an important indicator of perfusion to vital organs.
A

MAP = Mean Arterial Pressure

47
Q

Normal MAP is

A

70 - 105 mmHg
(>60 necessary to sustain vital organs)

48
Q

What is the MAP formula

A

MAP = (SBP + DBP x 2) ÷ 3

(diastolic is added 2x)

know

49
Q

To calculate Preload (both sides of heart), what 2 parameters are needed

A
  • CVP (right side of heart)
  • Wedge pressure (left side of heart)
50
Q

To calculate Contractility, what 2 parameters are needed

A
  • Cardiac Output
  • Cardiac Index
51
Q

3 Non-Invasive methods for hemodynamic monitoring

A
  1. Central Lines
  2. Arterial Lines
  3. Swan Catheters **
52
Q

Arterial lines give us CONTINUOUS

A

BP & MAP readings

53
Q

What should we assess if a patient has an ART- line and how often?

A
  • Assess neurovascular status distal to the arterial insertion site - 6 P’s
  • Q 1 hr **
54
Q

List the 6 P’s
(review)

55
Q

Can you use ARt- lines as an extra lumen for administering medications?

A

No! The only thing running should be NS

56
Q

If your’e arterial pressure monitor alarms are going off… what will you assess FIRST!?

A

ALWAYS ASSESS PT FIRST!!!

57
Q

What risks follow a Pulmonary Artery Pressure Monitoring (PA catheters) -“SWANS”

List 3

A
  • Blocks blood flow through PULMONARY artery
  • Balloon can rupture
  • Tear of pulmonary artery
58
Q

For testing purposes, if the question states ‘The patient is wedged..’, OR ‘Patient has a SWAN/PA catheter and is in distress’ OR ‘Pt turns and accidentaly inserts air into the ballon’ …. what would most likely be the answer you would choose?

A

DEFLATE THE BALLOON

59
Q

When a PA Catheter/SWAN is being removed, theres a posibility that patients can go into __.

A

VTACH or VFIB

60
Q

VTACH can be both

A

with PULSE or PULSELESS

61
Q

HOW TO TREAT VTACH

A
  • With Pulse: antidysrhythmics or cardioversion (if rx ineffective
  • Pulseless: IMMEDIATELY START CPR, SHOCK, CPR 2 mins, SHOCK, CPR 2 mins, Epi (1mg) Q3-5 mins, SHOCK, CPR 2 mins, Amiodarone (1st: 300mg, wait 3-5mins, 2nd: 150mg) or lidocaine (1st: 1mg, 2nd: 0.5)
62
Q

Q: What is referencing in the context of a PA-Art line?

A

It means positioning the transducer of the PA catheter so that the zero reference point is at the level of the atria of the heart.

63
Q

Where is the reference point that ensures correct pressure readings from the PA catheter

A

Is the phlebostatic axis,
* located at the 4th intercostal space at the midaxillary line (approximately at the level of the right atrium).

64
Q

Confirms that when pressure within the system is zero, the monitor reads zero

65
Q

When should you Zero?

A

With initial setup, periodically thereafter, or when questioning measurements.
* for this- dont zero when patient moves around

66
Q

What should you check FIRST before troubleshooting a system?

A

Assess your patient!!!!
- treat the pt not the monitor

67
Q

Q: Why should clinicians avoid relying on a single hemodynamic measurement?

A

A single hemodynamic value is rarely significant; evaluating multiple values provides a clearer picture of the patient’s cardiovascular status.

68
Q

Increased blood pressures in the pulmonary arteries
What am I?

A

Pulmonary Hypertension

68
Q

What happens to the pulmonary arteries in Pulmonary Hypertension?

A

thicken, narrow, and stiffen

69
Q

What can Pulmonary Hypertesion cause in the HEART?

A

right-sided heart failure (RS HF)
* if untreated RS HF occurs and death within a few years

69
Q

Pulmonary Vascular Resistance (PVR) will be ___ in Pulmonary Hypertension

70
Q

What is the word that means Right Side heart failure that is NOT caused by true heart failure

A

“Cor pulmonale”

71
Q

How essential are medications for patients with pulmonary hypertension?

A
  • Medications are considered the lifeline for these patients
  • NEVER stop taking them.
72
Q

3 Levels of Pulmonary HTN

A
  1. Mild
  2. Moderate
  3. Severe
73
Q

What meds are used for MILD Pulmonary HTN?

A

Calcium Channel Blockers

  1. Dihydropyridines: End in “-dipine.”
  2. Non-Dihydropyridines: “VD” for Verapamil and Diltiazem.
74
Q

CCB for MILD Pulmonary HTN are used in patients WITHOUT

A

RIGHT-sided heart failure

75
Q

In MODERTE Pulmonary HTN, what meds are used?

A

Phosphodiesterase Enzyme Inhibitors
* prolonged vasodilation, increased blood flow, and enhanced smooth muscle relaxation.

76
Q

What are the 2 Phosphodiesterase Enzyme Inhibitors (PEI) meds we need to know?

A
  1. sildenafil (Viagra)
  2. tadalafil (Cialis)

End in -afil

know

77
Q

Phosphodiesterase Enzyme Inhibitors (PEI) should NOT be given to patients who are already taking ___.

A

NTG- may cause refractory hypotension (persistent low blood pressure that does not respond to standard treatments or interventions)

78
Q

What meds will we give to a pt with SEVERE pulmonary HTN

A

Vasodilators (inhaled)
Teach pt how to use nebulizer

79
Q

2 Vasodilators (inhaled) meds we need to know

A
  1. iloprost (Ventavis)
  2. treprostinil (Tyvaso

-prost in the name

80
Q

How many times a day will INHALED Vasodilators be administerd?

A

6-9 times /day

81
Q

Main side effect of Vasodilators

A

orthostatic hypotension

82
Q

What are the 3 Vasodilator meds used for SEVERE Pulmonary HTN that we give via PARENTERAL.

A
  • treprostinil (Remodulin)
  • epoprostenol (Flolan)
  • epoprostenol (Veletri)

end in -prostinil/prostenol

83
Q

Strategies to Manage Hemodynamic Alterations: Overall

A
WOULD BE GOOD TO KNOW
84
Q

Pulmonary HTN:

Vasodilator Parenteral meds are given what 2 routes?

A
  • IV - central line
  • SubQ

Test 3 (7 decks)

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