Hemodynamic Monitoring Flashcards
What is ejection fraction?
Ratio of stroke volume to end-diastolic volume
What two things does preload impact the most?
Ventricular contractile response (Starling) and organ perfusion
What measurement tells you about the right ventricular preload?
CVP/RAP
What measurements tell you about left ventricular preload?
PAD/PAP and PAOP/PCWP
What assessment findings would you expect to see with increased left ventricular preload?
Lung issues: crackles, dyspnea, cough, etc
What assessment findings would you expect to see with increased right ventricular preload?
JVD, edema, HJR (assessed by pressing on the liver)
What would you administer if you wanted to reduce preload?
Diuretics, nitrates, beta and calcium channel blockers
What assessment findings would you expect to see with decreased preload?
Altered LOC, decreased urine output, tachycardia, hypotension, dry mucous membranes, poor skin turgor
What would you administer if you wanted to enhance preload?
Volume (crystalloids, colloids, blood) and norepinephrine (LEVOPHED)
What must you check before administering norepinephrine (LEVOPHED)?
That the patient has adequate volume
What is the most critical factor in determining after load?
Vascular resistance
Which assessment readings will give you information about after load?
MAP, SVR, PVR
What would you administer to reduce after load?
Vasodilators; nitroprusside, calcium channel blockers (NICARDIPINE), ACE-inhibitors, ARBs
What would you administer to enhance after load?
Vasopressors for vasoconstriction; norepinephrine (LEVOPHED), dopamine
What factors influence contractility?
coronary artery perfusion (HR), coronary oxygen supply, blood pressure, valve competence, intracellular calcium and ATP availability
Which measurements give you information about contractility?
CO, CI, EF
What findings are associated with low cardiac output?
dry, cool skin, decreased urine output, mental status changes, tachycardia, poor peripheral circulation
What would you administer to reduced contractility?
Negative inotropic agents; beta and calcium channel blockers
What would you administer to enhance contractility?
Volume to increase preload, positive inotropic agents; dobutamine, digoxin, dopamine
Stimulation of the beta one receptors produces what effect?
altered ventricular function, positive chronotropic and inotropic effects; faster heart rate and stronger force of contraction
Stimulation of the beta two receptors produces what effect?
bronchodilation and vasoconstriction
The parasympathetic system releases what NT? What effect does it have on the body?
Acetylcholine; negative dromotropic and chronotropic effects; slower conduction and heart rate
Stimulating the vagus nerve by bearing down on the glottis produces what effect?
Slows conduction and heart rate
A patient with invasive hemodynamic monitoring can have their head of bed no higher than what?
60 degrees
Where is the CVP measured and what does it tell you?
Measured from the right atrium; Right ventricular preload
Where is PAP measured and what does it tell you?
Pulmonary artery; systolic artery pressure and diastolic artery pressure (Left ventricular preload)
Where is PAOP measured and what does it tell you?
Pulmonary artery branch; most accurate measurement of left ventricular preload
How and where is CO measured?
Measured by calculating temperature changes from fluid bolus in right atrium; measured in the pulmonary artery
The transducer must always be connected to what lumen?
The most distal
Where does the proximal lumen open up to and what is its function?
Opens into right atrium; allows injection of fluid bolus to measured CO
If a patient with a pulmonary artery catheter begins coughing up bright red blood, what should the nurse suspect?
Pulmonary artery rupture
What is MAP a measure of?
Average pressure through the cardiac cycle; perfusion pressure (greater than 60 needed to perfuse vital organs; 70-90 ideal)
What is the nurse concerned about when she sees a wave reading with a low of 0 and a high of 25?
The PA catheter has slid back to the right ventricle; may cause ventricular dysrythmias
