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G270 Exam #2 > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

Hemodynamics Goal

A

delivery of oxygen

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2
Q

biggest factors of hemodynamic monitoring

A

Hg and SaO2

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3
Q

normal Stroke Volume

A

60-120 ml/beat

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4
Q

What is. CVP?

A

volume reaching the right ventricle

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5
Q

What is PCWP?

A

indirect measure of volume left ventricle volume (uses Pulmonary Artery Catheter wedged in a branch of the pulmonary artery)

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6
Q

Normal preload values for right and left ventricle

A

R: ventricle CVP- 2-6 mmHg

L Ventricle: PCWP-6-12 mmHg

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7
Q

How to increase preload (5)

A
  • Increase fluids (NS, LR): bolus
  • Colloids (blood, albumin)
  • Vasoconstrictors
  • Anti-embolism stockings
  • Elevate the legs
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8
Q

How to decrease preload (3)

A
  • Decrease fluids
  • Vasodilators: ex. Hydralazine
  • Diuretics: ex. Furosemide
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9
Q

What is afterload? What is it based on?

A
  • Pressure LV must overcome to eject stroke volume

- Based on distensibility or compressibility of arterial vessels

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10
Q

normal LV afterload

A

Systemic Vascular Resistance (SVR): 800-1200 dynes/sec/cm-3

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11
Q

Normal RV afterload

A

: Peripheral Vascular Resistance (PVR) 150-250 dynes/sec/cm-3

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12
Q

in afterload….increased ___= decreased __

A

SVR=CO

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13
Q

How to increase afterload (2)

A
  • fluids

- vasoconstrictors

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14
Q

how to decrease afterload (2)

A
  • fluids

- vasodilators

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15
Q

What is contractility dependent on?

A

oxygenation and electrolyte balance

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16
Q

How to enhance contractility

A

Calcium, catecholamines

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17
Q

How to decrease contractility

A

dopamine, norepinephrine, epinephrine

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18
Q

Determinants of SV (3)

A
  • preload
  • afterload
  • contracility
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19
Q

stroke volume definition

A

blood ejected by the heart per BEAT

20
Q

CO definition

A

volume of blood ejected each minute

21
Q

CO equation

A

HR x SV

22
Q

normal CO range

A

4-8 L/min

23
Q

difference between CO and cardiac index

A

cardiac index takes into consideration the patient’s body surface area

24
Q

Cardiac index equation

A

CO/BSA

25
Q

factors causing Low CO (inadequate left ventricular filling)- 7

A
  • Tachycardia
  • Dysrhythmias
  • Hypovolemia
  • Mitral or tricuspid stenosis
  • Pulmonic stenosis
  • Constrictive pericarditis or tamponade
  • Restrictive cardiomyopathy
26
Q

factors causing Low CO (inadequate left ventricular ejection)-7

A
  • CAD causing LV ischemia or infarction
  • Myocarditis, Cardiomyopathy
  • Increased afterload (HTN, aortic stenosis)
  • Mitral regurgitation
  • NEGATIVE inotropes
  • Metabolic disorders
27
Q

decreased perfusion fail safe mechanisms primary (skin and GI)-4

A
  • cool, clammy, cyanotic, ashen skin
  • decreased Bowel sounds
  • constipation or diarrhea
  • increased GI tube output
28
Q

decreased perfusion fail safe mechanisms secondary (kidneys, liver, lungs)-6

A
  • increased RR and effort
  • SOB
  • decreased UO
  • increased BUN, creatinine, K+
  • decreased GFR
  • increased ALT, AST, coag times
29
Q

decreased perfusion fail safe mechanisms final (brain and heart)-6

A
  • ALOC
  • slow reacting pupils
  • chest pain or pressure
  • tachy or bradycardia
  • arrythmias
  • ST elevation
30
Q

Noninvasive hemodynamic monitoring-4

A
  • MAP
  • JVP
  • serum lactate
  • BP Cuff
31
Q

map should be above……

A

65

32
Q

What does measuring JVD estimate

A

CVP

33
Q

What does serum lactate show?

A

information on end organ perfusion

34
Q

Normal CVP

A

2-6 mmHg

35
Q

Causes of increased CVP-4

A
  • fluid overload
  • cardiac tamponade
  • R heart dysfunction (cor pulmonale)
  • venoconstriction
36
Q

causes of decreased CVP-3

A
  • dehydration
  • volume loss
  • venodilaton
37
Q

Arterial line monitoring nursing responsibilities

A
  • Patient education
  • Gather equipment
  • Assist provider: set up pressure bag (300 mm Hg), prime tubing
  • Zero/level transducer (phlebostatic axis), monitor waveform
  • Dress site (Immobilize wrist, Limit flexion of hip to 30 degrees if femoral, Monitor for bleeding)
  • Compare to cuff
38
Q

A-line complications-4

A
  • Air embolus
  • Hemorrhage and Hematoma
  • Thrombosis: keep pressure bag full and at 300 pressure
  • Infection
39
Q

What is Flo-Trac?

A

proprietary transducer added to a-line

40
Q

flotrac limitations-4

A

 Spontaneous Breathing: inaccurate SVV
 Open chest
 Arrythmias
 However provides hemodynamic measures without the need for a PA** catheter

41
Q

Pulmonary artery pressure elevation causes (5)

A
  • Pulmonary hypertension
  • Left ventricular failure
  • Mitral stenosis (stiff)
  • Mitral valve regurgitation (incompetent)
  • Atrial or septal defect
42
Q

Normal PCWP

A

6-12 mmHg

43
Q

causes of increased PCWP-7

A
  • fluid overload
  • aortic stenosis
  • aortic regurgitation
  • mitral stenosis
  • LV failure
  • cardiac tamponade
  • constrictive pericarditis
44
Q

causes of decreased PCWP-2

A
  • hypovolemia

- vasodilation

45
Q

PCWP Reminders (3)

A

 DO NOT LEAVE BALLOON INFLATED
 NEVER INFLATE FOR > 10-15 SECs
 Never pull back air from syringe-passive move

46
Q

normal cardiac index

A

2.5-4.0

G270 Exam #2 (5 decks)

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