Hemodynamics Flashcards
HR
60-100 bpm
Stroke volume
vol/beat L = CO/HR
Pumping og the heart each beat.
Volume of blood ejected per beat
Heart pumps liters
Cardiac output
volume of blood pumped every min
EF
should be greater > 60
60 to above is normal
below 60 heart is failing
EF def
is the % of blood force out of LV each beat
EF
55 - 75%
Preload
the measure of the stretch when blood filing the heart
Afterload
force of the ventricles to open semi-lunar valve
SHOCK
not enough filing of heart is dehydration
No fluid, we need to give pt. vasopressor to increase contraction or volume of heart.
Pulmonary HTN fix
By relaxing the heart; give them vasodilators
Contractility
Force of the heart to eject or pump
Left ventricle
60 cc only eject and 40 cc is left.
E.g. if heart is ejecting only 50%, then heart is failing leading to HF
PPT #34
EF <60
HF
Difficulty of filling/ pumping EF<60
Complications
HTN
CAD slide #7
Comorbidities of HF
smoking/ diabetes/ obesity/ aging = overuse of heart = ventricles enlarge
2 Types of HR
LHF is most common type where ventricles enlarge leading to Pulmonary Edema = congestion in lungs
RHF = Right atrium affected
Lymphatic system edema
Edema in liver
Pt with HTN, Right sided HF, Jugalar vein distention, peropheral edema. Where you see distention in the pt
at 30 degress sit pt. up to see the Jugluar vein distention
HF can be chronic
but can also become acute
HF is
enlarged ventricles
dialated heart chambers
slide#35
Acute decompensated HF (ADHF)
slide # 37
Assess before intervention
Asculate lungs
Exacerbation listen to lungs
Put oxygen on pt
call HCP
LHF = Pulmonary Edema
is life threatening
slide #39
Clinical Manifestation of PE (Pulmonary Edema)
Cool & Clammy skin ## Exam
Orthopnea #Exam
Intervention for Pul Edema
Put pt. in 30 deg all the time
Manifestations of Pul Edema
Cough with frothy blood-tinged sputum
Tachycardia
HTN
Cyanotic
1st thing to do with Pul Edema
Lasix, Butinamide
How do you know Pulmonary Edema is resolved, or drug is effective?
Edema is down - better breathing
Crackles gone or reduced
No more tachypnea
Clear breathing sounds
Easy breathing
FACES indication for Pulmonary Edema
Fatigue
Limitation of Activities
Chest Congestion
Edema
SOB +++++ COUGH
CHF hx and having dry cough, Gained weight = assess again CHF exacerbation.
Did you gain some weight, look up all data, lab works, «coughing + chest congestion» and edema - lead to type of assessment you do as nurse.
Edema common in HF
More than 3lb in 2 days
Slide #47
Complications of HF
Pleural effusion
Dysrhythmia
Thrombus develops in Left Ventricles
Renal Failure
Slide # 49
Diagnostic HF
Chest X-ray to see how big your heart is.
Echo scheduled and takes time
Number 1 indication of HF
BNP
Slide #52
ADHF Interpersonal Care
Check O2 sat always when pt. comes in then supplement with oxygen
End-stage HF, then Mechanical ventilation. Emergency situation when pt pulls out ventilation ## bag the pt.
ET (Endotracheal Tube)
High flowers position when pt is on ventilator
Slide #53
Ultrafilteration SOAP extracted from blood
like dialysis to take sodium out of blood to control edema
Devices that pump the heart while pt. waits for transplant
IABP and VAPS for pumping your heart
slide#54
LVAD
VAD
slide#62
Every CHF pt should be on
ACE inhibitors / RASS inhibitors
prils like captopril to preserve the heart
Slide #55
Reduce circulating volume
Lasix, Butenamide 10 mg - 20 mg order of furosemide push in 1-2 mins and then repeat in 1-2 hours.
When can you repeat lasix?
In 1-2 hours
With Lasix monitor
BP because lowers BP
Hypokalemia
K anything 3.4 is critical - we have to supplement that
Lasix depletes Na and K
K=3.1 = call you doctor
K=3.1- Hypokalemia, s/s pt.
Weak
Dizzy
Cardiac Arrhythmia
Slide#55
To reduce circulating volume, we also give
Nitro (sodium prusside)
Morphine to reduce work load of heart - Reduce preload and Reduce afterload.
Digoxin to force contraction of heart
Slide #61 Pt. Teachiing
Walk slowly for tolerance, decrease dema, breathing
Slide#63
Beta blockers and vasodilation
Diet of Pt. What to avoid? NCLEX which food pt to avoid?
CHF exacerbation =
Fluid restriction. 500 cc easy to count than 100 cc. Change water give 500 cc
Ask when did you go to bathroom - what comes in = should come out
Slide#79 to slide#81
Early detection is better
Action of the drug
diuretic lab is hypokalemia
Signs of digoxin toxicity
Vomiting, Seeing Halos
slide #83
Pt. sick - write all medication - pt slow in thinking as they are sick
Beta blockers
decrease salt substiture
Reversible or Heart Transplantation check criteria for age and comorbidities
slide#95
Post Transplant Rejection
Cyclosporin = immunotherapy drugs
Endomyocardial Biopsy (EMB)
Every month to every 3 months.
