Hemodynamics

Question 1

CVP or RAP (Preload RV)

Answer 1

Preload RV; Measured directly in R. Atrium; 2-6 mmHg. Estimates of venous return and volume status of the R.Heart

Question 2

Causes of Elevated CVP/RAP

Answer 2

Increased pressure: tricuspid stenosis, pulmonary hypertension, cardiac tamponade, tension pneumothorax.

Increased volume: RorL Heart failure.

Question 3

Causes of Decreased CVP/RAP

Answer 3

Decreased volume: hemorrhage, dehydration, diuretics, 2nd + 3rd spacing, vasodilation, protein loss

Question 4

S/s of Elevated CVP/RAP

Answer 4

JVD, peripheral edema, ascities, weight gain, RUQ tenderness

Question 5

S/s of Decreased CVP/RAP

Answer 5

Fluid loss: poor skin turgor, dry mucous membranes, flat veins, low u/o

Question 6

Interventions for Elevated CVP/RAP

Answer 6

Reduce volume (I/O’s, daily weight, diuretics, Na & fluid restriction)

Question 7

Interventions for Decreased CVP/RAP

Answer 7

Restore volume (blood & volume replacement, antibiotics, vasoconstrictors)

Question 8

PAWP/LAP (Preload LV)

Answer 8

Measured in Pulmonary artery; 4-12 mmHg. Estimates volume status of L.Heart

Question 9

Causes of Elevated PAWP/LAP

Answer 9

Increased pressure (mitral/aortic stenosis, hypertension, cardiac tamponade); Increased volume (hypervolemia, LHF)

Question 10

Causes of Decreased PAWP/LAP

Answer 10

Decreased volume: hemorrhage, dehydration, diuretics, 3rd spacing, vasodilation, protein loss

Question 11

S/s of elevated PAWP/LAP

Answer 11

Dyspnea, orthopnea, cough, crackles

Question 12

Interventions for Elevated PAWP/LAP

Answer 12

Decrease volume (daily weight)

Question 13

Interventions for Decreased PAWP/LAP

Answer 13

Increase volume (antibiotics for sepsis, dopamine to raise BP, daily weights)

Question 14

RV Afterload

Answer 14

PVR or PAP (Pulmonary)

Question 15

LV Afterload

Answer 15

SVR or ABP (Systemic)

Question 16

PAP/PVR (Afterload RV)

Answer 16

Measured in pulmonary artery.

Question 17

Causes of Elevated PAP

Answer 17

Increased pressure or volume or vasoconstriction (pulmonary hypertension, chronic lung disease, pulmonary embolism, cardiac tamponade, hypervolemia)

Question 18

Causes of Decreased PAP

Answer 18

Hypovolemia

Question 19

Interventions for High PAP

Answer 19

O2 (for lung disease), diuretics, Na and fluid restriction

Question 20

Interventions for Low PAP

Answer 20

Volume replacement

Question 21

ABP or SVR (Afterload LV) & S/s

Answer 21

800-1200 dynes S/s of Increased (cool, clammy skin, HTN, Nonhealing wounds); S/s of Decreased (Warm flushed skin, hypotension)