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Critical Care > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

1
Q

What is ejection fraction?

A

Ratio of stroke volume to end-diastolic volume

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2
Q

What two things does preload impact the most?

A

Ventricular contractile response (Starling) and organ perfusion

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3
Q

What measurement tells you about the right ventricular preload?

A

CVP/RAP

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4
Q

What measurements tell you about left ventricular preload?

A

PAD/PAP and PAOP/PCWP

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5
Q

What assessment findings would you expect to see with increased left ventricular preload?

A

Lung issues: crackles, dyspnea, cough, etc

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6
Q

What assessment findings would you expect to see with increased right ventricular preload?

A

JVD, edema, HJR (assessed by pressing on the liver)

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7
Q

What would you administer if you wanted to reduce preload?

A

Diuretics, nitrates, beta and calcium channel blockers

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8
Q

What assessment findings would you expect to see with decreased preload?

A

Altered LOC, decreased urine output, tachycardia, hypotension, dry mucous membranes, poor skin turgor

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9
Q

What would you administer if you wanted to enhance preload?

A

Volume (crystalloids, colloids, blood) and norepinephrine (LEVOPHED)

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10
Q

What must you check before administering norepinephrine (LEVOPHED)?

A

That the patient has adequate volume

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11
Q

What is the most critical factor in determining after load?

A

Vascular resistance

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12
Q

Which assessment readings will give you information about after load?

A

MAP, SVR, PVR

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13
Q

What would you administer to reduce after load?

A

Vasodilators; nitroprusside, calcium channel blockers (NICARDIPINE), ACE-inhibitors, ARBs

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14
Q

What would you administer to enhance after load?

A

Vasopressors for vasoconstriction; norepinephrine (LEVOPHED), dopamine

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15
Q

What factors influence contractility?

A

coronary artery perfusion (HR), coronary oxygen supply, blood pressure, valve competence, intracellular calcium and ATP availability

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16
Q

Which measurements give you information about contractility?

A

CO, CI, EF

17
Q

What findings are associated with low cardiac output?

A

dry, cool skin, decreased urine output, mental status changes, tachycardia, poor peripheral circulation

18
Q

What would you administer to reduced contractility?

A

Negative inotropic agents; beta and calcium channel blockers

19
Q

What would you administer to enhance contractility?

A

Volume to increase preload, positive inotropic agents; dobutamine, digoxin, dopamine

20
Q

Stimulation of the beta one receptors produces what effect?

A

altered ventricular function, positive chronotropic and inotropic effects; faster heart rate and stronger force of contraction

21
Q

Stimulation of the beta two receptors produces what effect?

A

bronchodilation and vasoconstriction

22
Q

The parasympathetic system releases what NT? What effect does it have on the body?

A

Acetylcholine; negative dromotropic and chronotropic effects; slower conduction and heart rate

23
Q

Stimulating the vagus nerve by bearing down on the glottis produces what effect?

A

Slows conduction and heart rate

24
Q

A patient with invasive hemodynamic monitoring can have their head of bed no higher than what?

A

60 degrees

25
Q

Where is the CVP measured and what does it tell you?

A

Measured from the right atrium; Right ventricular preload

26
Q

Where is PAP measured and what does it tell you?

A

Pulmonary artery; systolic artery pressure and diastolic artery pressure (Left ventricular preload)

27
Q

Where is PAOP measured and what does it tell you?

A

Pulmonary artery branch; most accurate measurement of left ventricular preload

28
Q

How and where is CO measured?

A

Measured by calculating temperature changes from fluid bolus in right atrium; measured in the pulmonary artery

29
Q

The transducer must always be connected to what lumen?

A

The most distal

30
Q

Where does the proximal lumen open up to and what is its function?

A

Opens into right atrium; allows injection of fluid bolus to measured CO

31
Q

If a patient with a pulmonary artery catheter begins coughing up bright red blood, what should the nurse suspect?

A

Pulmonary artery rupture

32
Q

What is MAP a measure of?

A

Average pressure through the cardiac cycle; perfusion pressure (greater than 60 needed to perfuse vital organs; 70-90 ideal)

33
Q

What is the nurse concerned about when she sees a wave reading with a low of 0 and a high of 25?

A

The PA catheter has slid back to the right ventricle; may cause ventricular dysrythmias

Critical Care (3 decks)

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