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Critical Care Nursing Exam 2 > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

what is hemodynamics?

A

force by which blood circulates through the body.

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2
Q

What does the term Hemodynamics describe?

A

the intravascular pressure and flow that occurs when heart muscle contracts and pumps blood through the body.

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3
Q

What are the two techniques of hemodynamics?

A

invasive

noninvasive

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4
Q

what is hemodynamics a combination of?

A

Cardiac output and blood pressure for effective tissue perfusion

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5
Q

What are the two types of arterial pressures?

A

Systemic and Pulmonary

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6
Q

what is preload?

A

Volume of blood within ventricle at end of diastole

Degree of muscle fiber stretching in the ventricles right before systole

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7
Q

What is left ventricular preload reflected by?

A

PCWP

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8
Q

What is right ventricular preload reflected by?

A

CVP

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9
Q

What are factors that increase preload?

A
  • exercise
  • Hypervolemia
  • Neuroendocrine excitement (sympathetic tone)
  • AV fistula
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10
Q

Why can an AV fistula cause an increase in preload?

A

An arteriovenous fistula can increase preload: AV shunts, and fistulas decrease the afterload of the heart. This is because the blood bypasses the arterioles which results in a decrease in the total peripheral resistance (TPR). AV shunts/fisulas increase both the rate and volume of blood returning to the heart.

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11
Q

Factors that decrease. preload?

A
  • Hypovolemia
  • Narrowing or stenosis of valves
  • Afib
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12
Q

Factors that increase afterload?

A
  • systemic resistance
  • Aortic stenosis
  • myocardial infarction
  • Cardiomyopathy
  • Polycythemia (increased blood viscosity)
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13
Q

Factors that decrease afterload?

A
  • decreased volume
  • septic shock
  • end stage cirrhosis
  • vasodilators
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14
Q

Why can septic shock decrease afterload?

A

Increased CO, decreased peripheral vascular resistance, third spacing due to vasodilation from histamine release, making capillaries more permeable.

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15
Q

What is afterload?

A

the resistance the left ventricle must overcome to circulate blood

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16
Q

what is contractility?

A

Strength of ventricular contraction

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17
Q

what is inotropic?

A

force or energy of contraction, inotropic agent increases force of contraction

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18
Q

What is chronotropic?

A

related to time, chronotropic agent changes rate of contraction

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19
Q

what is stroke volume?

A

amount of blood ejected by the ventricles with contraction

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20
Q

what is cardiac output?

A

HR x SV, determined by HR & rhythm, preload, afterload, contractility

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21
Q

what is cardiac index?

A

Cardiac Index (CI): CO adjusted for BSA (CO/BSA)- more specific to each patient

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22
Q

what do vasopressors do?

A

stimulates smooth muscle contraction of the capillaries and arteries

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23
Q

what do ionotropes do?

A

increase the force of contraction of myocardial muscle

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24
Q

what are some types of invasive monitoring?

A
  • CVP
  • ART
  • Pulmonary Artery monitoring
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25
Q

How do you ensure accuracy with invasive monitoring?

A
  • Equipment must be referenced and zero balanced to environment and dynamic response characteristics optimized
  • Referencing: Positioning transducer so zero reference point is at level of atria of heart or Phlebostatic axis for cardiac pressure/systemic arterial readings
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26
Q

where is the Phlebostatic axis?

A
  • 4th intercostal space
  • midchest
  • this is equivalent to the level of the right atrium
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27
Q

how do you zero a line?

A

-Open the stopcock to air, hit zero function on the monitor and digital returns to zero. Confirms that when pressure within system is zero, monitor reads zero

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28
Q

when do you zero a line?

A
  • During initial setup of arterial line
  • Immediately after insertion of arterial line
  • When transducer has been disconnected from pressure cable or pressure cable has been disconnected from monitor
  • When accuracy of values is questioned
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29
Q

what type of monitoring can use a central line?

A

-central venous pressure

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30
Q

What type of monitoring can use the PA?

A
  • CVP
  • PAP
  • PAWP/PCWP
  • PVR/PVRI
  • SVR/SVRI
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31
Q

what type of monitoring can use the swan Ganz?

A
  • CVP
  • PAP
  • PAWP/PCWP
  • PVR/PVRI
  • SVR/SVRI
  • CO/CI
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32
Q

what does CVP measure?

A

Right atrial filling (preload)

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33
Q

what does pulmonary artery pressure measure?

A

Left atrial preload

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34
Q

what does pulmonary artery wedge pressure measure?

A

Left atrial pressure

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35
Q

What does pulmonary vascular resistance measure?

A

resistance of pulmonary bed

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36
Q

what does Systemic vascular resistance measure?

A

resistance of vascular bed (afterload)

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37
Q

Normal range of CVP

A

0-8mmHg

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38
Q

Normal range of Pulmonary artery pressure?

A

15-25/8-15

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39
Q

Normal range of pulmonary artery wedge pressure?

A

6-12mmHg

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40
Q

Normal range of pulmonary vascular resistance?

A

100-250dynes/sec/cm

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41
Q

Normal range of systemic vascular resistance?

A

800-1200dynes/sec/cm

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42
Q

Normal range of cardiac output?

A

4-8L/min

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43
Q

Normal range of cardiac index?

A

2.2-4L/min/M

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44
Q

what does central venous pressure reflect?

A

Reflects amount of fluid returning to the right side of the heart – preload

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45
Q

Fill in the blank:

Right atrial and right ventricular are _______ at end diastole.

A

the same

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46
Q

How to get a CVP (3)

A
  • transducing a central line
  • attachment of a water filled column to the line
  • Proximal lumen of Swan/PA line
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47
Q

how does spontaneous breathing ventilation affect CVP?

A

inspirations decrease CVP

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48
Q

How does Positive pressure ventilation affect CVP?

A

inspirations increase CVP

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49
Q

Risks Associated With CVP monitoring

A
  • Superior Vena Cava perforation
  • Guidewire induced arrhythmias
  • Venous thrombosis
  • Infection
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50
Q

What might a sudden decrease in CVP indicate?

A
  • fluid deficit

- hemorrhage

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51
Q

What might a sudden increase in CVP indicate?

A
  • hypervolemia

- HF

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52
Q

reasons for ART line?

A
  • Severe Hypertension
  • Severe Hypotension
  • Respiratory Failure/shock
  • Use of pressors
  • Frequent ABG’s
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53
Q

what is the Allens test?

A
  • Hold the hand up and clench and unclench the hand.
  • Compress the radial & ulnar arteries.
  • Lower the hand and relax.
  • Quickly release the ulnar artery – color should return quickly (5-7 sec)
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54
Q

steps to obtain blood through ART line?

A
  • Turn Stopcock so that it is OFF to the transducer. And open to the patient.
  • Pull back on blood reservoir/syringe plunger until adequate discard is obtained.
  • Insert specimen syringe into stopcock port and aspirate specimen
  • Ice if needed, label and transport specimen
  • Return blood in VAMP if present
  • Flush Line Completely
55
Q

What part of the ART line waveform should you look for?

A

Dichotic notch

56
Q

What does a Dichotic notch indicate?

A

Aortic valve closure

57
Q

Complications of art lines?

A
  • Line Disruption
  • Vasospasm
  • Arterial Embolism
  • Vascular compromise
  • Line Identification errors
58
Q

What is overdampening?

A

the loss of the dicrotic notch, usually caused by a clot in catheter tip or a bubble in the tubing

59
Q

What is underdampening?

A

Extreme wave forms; usually caused by excessive tubing length, multiple stopcocks, tachycardia, High CO

60
Q

What does under-dampening cause?

A

A systolic bp reported higher than it actually is, diastolic reported lower than it usually is

61
Q

True or False?

Cuff pressures are the same as art line pressures

A

FALSE

Art line pressures are much more accurate

Art line pressures are often 5-10mmHg higher than cuff pressures

62
Q

What is a pulmonary catheter used for?

A

-Provides hemodynamic information that cannot be obtained by physical assessment.

63
Q

What do pulmonary catheters measure? (7)

A
  • Stroke volume
  • cardiac output
  • intracardiac pressure
  • pulmonary artery pressure
  • systemic vascular resistance
  • pulmonary vascular resistance
  • mixed venous oxygen data from blood
64
Q

What is PA diastolic pressure an indication of?

A

cardiac function and fluid volume status

65
Q

What does monitoring PA pressures allow for?

A

therapeutic manipulation of preload

66
Q

Advantages of swan ganz? (3)

A
  • provides continuous hemodynamic monitoring
  • easy to place
  • the standard hemodynamic tool
67
Q

Disadvantages of a swan Ganz? (4)

A
  • Invasive and potentially harmful
  • never been shown to demonstrate clinical benefit
  • requires training to interpret waveforms and pressures
  • requires knowledgable and continuous nursing care
68
Q

What does a swan Ganz monitor?

A

CVP
PAP
Cardiac OP

69
Q

Indications for use of a Swan Ganz? (6)

A
  • Post MI
  • Cardiac surgery/major surgery
  • resuscitation
  • shock
  • pulmonary edema
  • oxygen transport: ventilation and perfusion
70
Q

Use of PA monitoring and measurement?

A

Guides management of patients with complicated cardiac, pulmonary, and intravascular volume problems

71
Q

When do you obtain. measurement for a PA?

A

at end expiration

72
Q

how do you obtain PAWP?

A

by inflating balloon with air until PA waveform changes to a PAWP waveform

DO NOT OVERINFLATE!!

73
Q

how should the balloon be inflated?

A

slowly and for no more than 4 respiratory cycles or 8-15 seconds

74
Q

What is the amount the balloon is inflated to?

A

1-1.5mLs

75
Q

What does high PA and PAWP indicate?

A

Left sided heart failure

76
Q

What does high PA pressure and normal PAWP indicate?

A

pulmonary disease

77
Q

What does low PA pressure indicate?

A

low volume

78
Q

What does low PAWP indicate?

A

fluid volume deficit

79
Q

what does high PAWP indicate?

A
  • fluid overload

- Left ventricular failure

80
Q

What does the the PA measure in relation to CVP?

A

right atrial

proximal port

reflects preload

blood sampling
normal:2-8

81
Q

What does the PA measure in relation to PA pressure?

A

right ventricle

reflects preload of left side

normal: 25/10mmHg

82
Q

What does the PA measure in relation to PAWP?

A
  • reflects left ventricular pressure

normal: 4-12mmHg

83
Q

What does PA measure in relation to cardiac output?

A

the amount of blood pumped by the heart in one minute

4-6L/min

84
Q

What does the PA measure in relation to SVR?

A

afterload

normal:800-1200 dynes

85
Q

what does a decreased SVR indicate?

A

vasodilation

86
Q

what is a drug or cause of decreased afterload?

A

Nipride

shock states

87
Q

What does a high SVR indicate?

A

vasoconstriction

88
Q

what is a drug or cause of high SVR?

A

hypovolemia

vasoactive agents

89
Q

how does the PA measure CO? (3)

A
  • right ventricular portion of the PA catheter generates heat signals produced from electrical impulses
  • change in pulmonary artery blood temperature measured by the PA Cath thermistor
  • calculates the average CO for the last 3-5minutes
90
Q

what is a normal CO?

A

4-8L/minute

91
Q

how often should you zero the monitor and vigileo?

A

once a shift

92
Q

what is stroke volume?

A

blood ejected from the right ventricle per beat

low value indicates poor ventricular performance

93
Q

what Is a normal stroke volume?

A

60-100mL/min

94
Q

What type of patients is stroke volume variance used for?

A

ventilated patients

95
Q

what do you adjust SVV for

A

arterial pulsations caused by volume change with positive pressure ventilation

96
Q

what does a SVV of over 15% indicate?

A

hypovolemia

97
Q

What is a normal SVV?

A

10-15%

98
Q

what is a normal Cardiac index?

A

2.5-4L/min

99
Q

what is a normal SVI?

A

33-47mL/beat

100
Q

what is a normal SVR?

A

800-1200dynes-sec/cm

101
Q

What is a normal SVRI?

A

1970-2390 dynes-sec/cm

102
Q

what is a normal SVV?

A

<15%

103
Q

what is a normal Scv02?

A

greater than or equal to 70%

104
Q

what do watch for in relation to infection and sepsis?

A
  • asepsis for insertion and maintenence of catheter and tubing mandatory
  • change flush bag, pressure tubing, transducer, and stopcock every 96hours
105
Q

what to watch for on PA catheter insertion?

A

ventricular dysrhythmias

106
Q

what does it mean if the PA catheter cannot be wedged?

A

may need repositioning

107
Q

reasons complications can occur

A
  • Pulmonary infarction or PA rupture
  • balloon rupture
  • prolonged inflation
  • spontaneous wedging
  • thrombus or embolus formation
108
Q

What types of baseline data need to be obtained to note sudden changes? (6)

A
  • general appearance
  • LOC
  • skin color/temperature
  • vital signs
  • peripheral pulses
  • UOP
109
Q

examples of baseline biotechnology readings? (6)

A
  • ECG
  • Arterial BP
  • CVP
  • PA
  • PAWP
  • Sv02
110
Q

what is ICP?

A

Intracranial pressure monitoring uses a device, placed inside the head.

111
Q

what does the ICP monitor sense?

A

pressure inside the skull and sends measurements to a recording device

112
Q

what is a normal ICP?

A

5-15mmHg

113
Q

What are the 3 essential components of the skull?

A
  • brain tissue
  • blood
  • CSF
114
Q

what percentage of the brain does CSF take up?

A

10%

115
Q

what percentage of the brain does intravascular blood take up?

A

12%

116
Q

what percentage of the brain does brain tissue take up?

A

78%

117
Q

What is cerebral perfusion pressure?

A

pressure needed to ensure blood flow to the brain

118
Q

What is the formula to calculate CPP?

A

CPP=MAP-ICP

119
Q

what is a normal CPP?

A

70-100mmHg

120
Q

what is a CPP of less than 50mmHg associated with?

A

ischemia or brain death

121
Q

where can ICP be measured?

A
  • ventricles
  • subarachnoid space
  • epidural space
  • brain parenchymal tissue
122
Q

where is the reference point for the pressure transducer?

A

tragus of the ear

123
Q

what is a normal ICP?

A

0-15mmHg

124
Q

what is the gold standard for ICP monitoring?

A

ventriculostomy

125
Q

True or False:

It is possible to control ICP by removing CSF

A

TRUE

ICP is based off the CSF in the brain, and if you remove some, this will lower the ICP

126
Q

What is the biggest consideration with ICP monitoring?

A

infection risk

127
Q

when should ICP be measured?

A

mean pressure at the end of expiration

128
Q

what does an ICP monitor look similar to?

A

arterial BP

129
Q

What can cause inaccurate ICP readings? (5)

A
  • CSF leaks
  • Obstruction in catheter
  • differences in height of bolt/transducer
  • kinks in tubing
  • incorrect height of drainage system relative to patients reference point
130
Q

What is the optimal level of CPP?

A

60 or above

131
Q

what does a normal CPP indicate?

A

adequate vascular volume

132
Q

What drives MAP?

A

vasopressors

fluids

133
Q

Things that can minimize ICP? (3)

A
  • sedation
  • osmotic agents
  • ventriculostomy
134
Q

what are the commonly used vasopressors fro the maintenance of CPP? (4)

A
  • Dopamine
  • Norepinephrine
  • Neosynephrine
  • vasopressin

Critical Care Nursing Exam 2 (2 decks)

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