Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Critical Care > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

what is hemodynamic monitoring?

A

monitoring of tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is cardiac output a good indicator of?

A

best indicator of the heart’s contractile or inotropic ability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the meanings of + & - inotropes?

A

+ inotropic = better contraction (squeeze)
- inotropic = less forceful contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the definition of cardiac output?

A

volume of blood ejected by the heart in 1 minute into the systemic circuit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is normal cardiac output amount per minute & at rest?

A

4-8 L of blood per minute (4-6 L at rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

does CO equate for differences in body size?

A

No!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is cardiac index?

A

the CO divided by an individual’s body surface area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is considered a normal CI range?

A

2.2 - 4.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if CI drops below 2.2, what is usually used to help get more blood ejected systemically?

A

a + inotrope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the formula for cardiac output?

A

CO = SV x HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is stroke volume?

A

volume of blood ejected by the left ventricle during each systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the normal SV range?

A

60-100 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what 3 factors is SV affected by?

A
  1. preload
  2. afterload
  3. contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how does increased preload affect stroke volume, ventricular work & myocardial O2 requirements?

A

increases all of them!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some assessment findings w a right-sided elevated preload? list 3

A
  1. JVD
  2. edema
  3. Hepato-jugular reflux (HJR) (when pressing on the liver, jugular veins begin to bulge)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are some assessment findings w left-sided elevated preload? list 5

A
  1. Orthopnea (trouble breathing when lying down)
  2. Dyspnea
  3. cough
  4. crackles
  5. S3 (indicates severe HF, mitral regurgitation, low EF, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what types of medications are given to reduce preload? name 2

A
  1. Diuretics (directly reduce blood volume)
  2. Nitrates (promote vasodilation; decreases pressure esp on venous side)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

give an example of a nitrate med

A

Nitroglycerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how should a patient w a high preload be positioned?

A

semi-fowler’s / high-fowlers position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are some things that can cause a decreased preload? name 5

A
  1. hypovolemia
  2. hemorrhage
  3. third spacing (capillaries become more permeable so fluid begins to leak from the intravascular space into the interstitial space)
  4. diuresis (peeing off all volume decreasing preload)
  5. vasodilation (SHOCK)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are some assessment findings associated w a decreased preload? name 6

A
  1. tachycardia / hypotension (compensation)
  2. dry, cool skin
  3. dry mucous membranes
  4. poor skin turgor
  5. alteration in LOC
  6. decrease urine output / vital organ perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the hemodynamic parameters for right sided preload? where are they inserted?

A

CVP (inserted into the intra jugular or subclavian vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the hemodynamic parameters for left sided preload? where are they inserted? list 2

A
  1. PAWP (wedge pressure)
  2. pulmonary artery occlusive pressure (PAOP)
    catheter goes through right side of the heart & sits on the pulmonary artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is used as an estimate if we can’t get physical wedge pressures?

A

pulmonary artery diastolic pressure (PADP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how do we increase preload on a patient? list 4 ways & specific conditions they are commonly used for

A
  1. crystalloids (often used for dehydration) (NS, LR)
  2. Colloids (often used for third spacing)
  3. PRBC (for hemorrhages)
  4. modified tredelenburg / supine w legs raised positionings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is afterload?

A

increased ventricular wall tension or stress during systolic ejection (pressure that the ventricle has to over come to eject blood into circulation during systole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the most crucial factor for determining afterload?

A

systemic vascular resistance (SVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are 3 ways to measure afterload?

A
  1. MAP (measures tissue perfusion)
  2. SVR (specific to left ventricle)
  3. pulmonary vascular resistance (PVR) (specific to right ventricle)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what type of catheter is needed to calculate SVR & what must you know to calculate it?

A

invasive one that goes into the pulmonary artery
must know cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what conditions are commonly seen w a high PVR

A

pulmonary embolism or severe pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are some things that cause an elevated afterload? list 5

A
  1. vasoconstriction (increased SVR)
  2. meds (alpha 1 agonists) Epi, Norepi
  3. catecholamine releases or compensatory mechanisms (hypovolemia, pain, hypoxia, SHOCK, hypothermia)
  4. hypertension
  5. increased aortic impedance (EX: aortic stenosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which 4 classes of meds are used to reduce afterload?

A
  1. vasodilators (EX: nitroprusside or Nipride)
  2. Ca channel blockers (EX: Nicardiopine)
  3. ACE-Inhibitors (prils)
  4. angiotension receptor blockers (sartans)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are some things that cause a decreased afterload? list 4

A
  1. vasodilation (decreased SVR) from meds or shock states
  2. inadequate aortic valve function (aortic valve regurgitation or back flow)
  3. inflammatory response
  4. hyperthermia
34
Q

which meds are used to increase afterload? give examples

A

vasopressors e.g. adrenergic stimulants (Norepi, Phenylphrine, Dopamine & vasopressin)

35
Q

what is important to know about vasopressin for increasing afterload?

A

it’s used as an augumenting therapy so the pt will already be on norepi, phenylphrine or dopamine before they are on this med

36
Q

what is contractility?

A

the inotropic action of the heart during systole or the force of each ventricular contraction

37
Q

what factors influence contractility? list 6

A
  1. intracellular Ca & ATP (Ca chloride is sometimes pushed during code situations)
  2. coronary artery perfusion
  3. cardiac O2 supply / demand balance
  4. HR
  5. BP
  6. valve competence
38
Q

what are some assessment findings w low contractility? list 5

A
  1. tachycardia (compensation)
  2. cool, pale skin
  3. decreased urine output (body is trying to hold onto more fluid –> RAAS system)
  4. mental status changes
  5. poor peripheral circulation
39
Q

what are 3 ways we measure contracility?

A
  1. CO (measured w pulmonary artery or PA cath)
  2. CI (pulmonary artery or PA cath)
  3. ejection fraction (measured w an echo)
40
Q

what is a normal ejection fraction?

A

around 70% but anything above 50% is appropriate (100% is not normal!)

41
Q

what are ways we can increase contracility? list 2

A
  1. increasing the preload = volume expansion, increasing stretch
  2. positive inotropic agents (Dopamine, Digoxin, Milirinone) all affect Beta 1 receptors
42
Q

how do we decrease the contractility or workload of the heart? give examples

A

Negative inotropic agents (Beta blockers & Ca channel blockers that block beta 1 receptors)

43
Q

what are the meanings of + & - chronotropes?

A

+ = increasing the HR
- = decreasing the HR

44
Q

what does dromotropic mean & which meds affect this?

A

rate of electrical conduction; affected by meds like Digoxin or Ca channel blockers

45
Q

name two meds that are beta 1 agonists

A

Dobutamine & Digoxin

46
Q

name a med that is considered a beta 1 antagonist

A

Metoprolol

47
Q

name a med that is an example if a beta 2 agonist. what does it produce?

A

Epinephrine; produces vasodilation for asthma or anyone w broncho constriction or in anaphylactic shock

48
Q

what is an example of a nonselective beta blocker?

A

Labetalol

49
Q

what do alpha 1 receptors produce & how do they affect the SVR?

A

vasoconstriction; they increase the SVR

50
Q

what type of response does the PNS create & what does it produce?

A

cholinergic response; it produces acetylcholine & produces negative dromotrophic & chronotropic effects on the heart

51
Q

which nerve innervates the PNS w the heart?

A

vagus nerve (people passing out)

52
Q

what do arterial lines monitor?

A

continuous BP monitoring & ABGS

53
Q

what does CVP monitoring show?

A

right sided preload

54
Q

what does a PA cath monitor show?

A

shows all hemodynamic parameters EXCEPT a systemic BP

55
Q

name the 3 arterial line sites

A
  1. radial (most common)
  2. femoral
  3. brachial
56
Q

what must be done to monitoring systems at each HOB change up to 60 degrees supine?

A

leveling the stopcock (air/fluid interface) of transducer to phlebostatic level

57
Q

what is part of the initial assessment with monitors?

A

zeroing the balance of the transducer

58
Q

what is the phlebostatic axis?

A

rough height of the atrium & reference level for placement of the transducer to ensure accuracy of measurements

59
Q

the phlebostatic axis is located at the intersection of which two reference lines?

A

4th ICS at sternum & mid-axillary line

60
Q

when looking at the arterial pressure monitoring, what does the systolic wave represent?

A

represents ejection phase of left ventricular systole; it’s the highest point recorded at peak of waveform

61
Q

when is the diastolic wave measured in arterial pressure monitoring?

A

measured at end-diastole just prior to the next systolic pressure

62
Q

what is the normal MAP range?

A

70 - 90 mm Hg

63
Q

describe the Allen’s test & when it must be done

A

occluding the radial artery to make sure there is still perfusion to the fingers; must be done prior to placing an arterial line

64
Q

If a pt’s BP changes quickly on an arterial line monitor, what should you do?

A

check pt, connections & level of transducer!!

65
Q

what does CVP measure?

A

pressure in the right atrium or vena cava & provides info regarding intravascular volume

66
Q

where is a central venous cath inserted into?

A

vena cava

67
Q

how many mm of mercury is the invasive catheter bag pumped up to?

A

300

68
Q

what are some complications related to CVP monitoring? name 5

A
  1. infection
  2. dislodgement
  3. pneumothorax
  4. thrombosis
  5. air embolism (can happen esp when catheter is being removed)
69
Q

when removing a central venous cath, what instructions will you give to the pt?

A

lie them flat & have them hold their breath when removing to create positive pressure

70
Q

what is the PA cath also known as?

A

Swan-Ganz Catheter

71
Q

With a PA cath, why is there always just an estimated wedge pressure on the left?

A

if the cath were to cross over to the left side, it would hit the lungs

72
Q

what was a CV wave form look like on a monitor?

A

squiggly line when it reaches the right atrium

73
Q

what does a PA cath wave form look like on a monitor?

A

wedge wave form

74
Q

explain the thermodilution CO method

A

injection of 10 ml of room temp solution, subsequent change in core blood temp at the distal end of catheter sensed by thermistor; computer calculates CO

75
Q

what are some complications with a PA cath? name 5

A
  1. pneomothorax
  2. infection
  3. ventricular dysrhymias (passing through the right atrium & right ventricle)
  4. pulmonary artery rupture or perforation (internal bleeding)
  5. air embolus (esp during removal)
76
Q

if a clot is present in a line, what should you do before flushing it?

A

aspirate

77
Q

what factors determine cardiac output?

A

stroke volume & HR

78
Q

what is preload?

A

the mount of stretch placed on cardiac muscle fibers just before systole / volume (intravascular space or within the vesicles) of blood in the ventricle at the end of diastole

79
Q

what does the volume of blood in preload create?

A

a filling pressure

80
Q

what are some things that cause an elevated preload? name 4

A
  1. volume overload
  2. left & right ventricular dysfunction (both affect that inotropic action of the heart)
  3. valvular defects (stenosis or insufficiency)
  4. cardiac tamponade (fluid fills up pericardial space affecting the overall stretch leading to a less forceful contraction)
81
Q

what parameters are measured w a PA cath?

A

CVP & pulmonary artery pressures

82
Q
A

Critical Care (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions