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Complex Care Exam 2 > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

Hemodynamics

A

The flow of blood as ejected from the heart to circulate throughout the body to effectively oxygenate the tissues of the body

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2
Q

Intraarterial Blood Pressure Monitoring (Arterial Line)

A
  • Catheter tht is inserted in an artery
  • Continuous blood pressure measurement
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3
Q

Central Venous Pressure Monitoring (Central Venous Catheter)

A
  • Catheter tht is inserted in a vein; the distal tip of the catheter is in a central vein (superior or inferior vena cava)
  • Monitor alterations in fluid volume
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4
Q

Pulmonary Artery Catheter (PA catheter, Swan Ganz)

A
  • Catheter tht is inserted in a vein; the distal tip of the cath is in the pulm artery
  • Provide info about PA pressures (systolic, diastolic, mean), PAOP, & CO
    > the location of the PA cath provides access for the measurement of mixed venous ozygen sat
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5
Q

Intra-Arterial Blood Pressure Monitoring

A
  • Primary Purpose: blood pressure
  • Most common insertion sites: radial artery and femoral artery
    > Allen’s test
  • At risk for
    > infection
    > bleeding, hematoma
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6
Q

What can Affect the Arterial Waveform

A
  • Low arterial perfusion (pulse deficit)
    > PVCs, afib, tachyarrhythmias
    > an electrical problem
  • Low left ventricle function
    > pulsus alternans: later stages of CHF, every other arterial pulsation is weak
    > pulsus paradoxus: cardiac tamponade, pericardial effusion, or constrictive pericarditis; a dcr of more than 10 mmHg in art waveform during inhalation
  • If strip looks normal, look at L vent
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7
Q

Dynamic Response

A
  • A damped waveform can affect the arterial waveform
  • Zeroing or square wave test
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8
Q

Optimal Square Wave Test

A
  • Series of 1-2 oscillations
  • Oscillations 1-2 small boxes apart or < 0.8 sec
  • Fast flush
  • Square off
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9
Q

Underdamped Square Wave Test

characteristics
causes
corrective actions

A
  • Charactistics
    > extra oscillations
    > mroe than 2 little boxes apart
    > narrow, peaked tracing
  • Causes
    > long catheter length
    > incrd vascular resistance or a lof of vasoconstrictors
    > hypothermia
  • Corrective Actions
    > remove excess tubing
    > insert dampening device or filter
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10
Q

Underdamped Results

A
  • Overestimation of SBP
  • Underestimatioon of DBP
  • MAP unchanged
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11
Q

Overdamped Square Wave Test

characteristics
causes
corrective actions

A
  • Characteristics
    > slurred upstroke
    > loss of oscillations
  • Causes
    > air bubble
    > kink in tubing
    > overly compliant/old tubing
    > blood clots/fibrin
    > check stopcocks
    > no fluid in flush bag
    > low flush bag pressure
  • Corrective Actions
    > clear air or blood
    > straighten tubing
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12
Q

Overdamped Results

A
  • Underestimated SBP
  • Overestimation of DBP
  • MAP unchanged
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13
Q

Preload

A
  • Volume in the ventricle at end of diastole
  • Left Ventricle Preload
    > measured by pulm artery occlusive pressure (PAOP) or pulm artery diastolic pressure (PAD)
    > Normal PAOP: 5-12mmHg
  • Right Ventricle Preload
    > measured bu the central venous pressure (CVP) or right artial pressure
    > Normal CVP: 2-5mmHg
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14
Q

Ejection Fraction (EF)

A
  • The percentage of preload volume ejected form the left ventricle per beat
  • Normal: 50-70%
    > not all will be ejected
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15
Q

Low Preload

A
  • Associated with: dehydration
    > low filling pressure, or low volume of blood at end of diastole = low CO = low BP
  • Assessment Findings
    > low urine output, hypotension, orthostatic hypo
    > PAOP & CVP
  • Give fluids (bolus) or blood (if bleeding)
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16
Q

High Preload

A
  • Associated with: fluid overload
    > high filling pressing, or high volume of blood at end of diastole = high BP
  • Assessment Findings
    > L & R heart failure
    > incrd CVP = right side: periph edema, JVD
    > incrd PAOP = left side: pulm edema
  • Fluid restriction
  • Venous dilators
    > nitroglycerin; give fluids more space to occupy
  • Diuretics
17
Q

Afterload

A

The pressure of ventricle generates to overcome the resistance to ejection created by the arteries and arterioles
not a waveform

18
Q

Left Ventricle Afterload

A
  • Measurement of resistance of blood flow through systemic vasculature
  • Measured as systemic vascular resistance (SVR)
  • Normal value: 800-1400 dynes-sec-cm
19
Q

Afterload - High SVR

too constricted

A
  • In a normal, health heart
    > not much impact of cardiac output
    > may incr BP
  • Left Ventricle Dysfunc
    > dcrd contractility (MI), global damage: cardiomyopathy, or regionally damage (MI)
    > lowers CO
    > lowers BP
20
Q

Afterload - High SVR Treatment

A
  • Caused by too much arterial constriction
  • To lower SVR:
    > continuous infusions of vasodilators: sodium nitroprusside
    > high dose nitro
21
Q

Afterload - Low SVR Treatment

A
  • Caused by too much arterial dilation
  • To incr SVR
    > first give volume, then vasopressors
    > fluids to fill dilated vascular bed
    > vasoconstrictors: norepinephrine; incrs MAP by vasoconstriction of peripheral vasculature
22
Q

Afterload - Nursing Considerations

A

Frequent assessment of the. peripheral circulation is required when meds tht incr SVR are used bc excessive vasoconstriction will negatively affect tissue perfusion

23
Q

Contractility

A

The force with which theheart muscle contracts
not a waveform

24
Q

Left and Right Ventricular Stroke Work Index Values

A

These values estimate the force of ventricular contraction

25
Q

Left Ventricular Stroke Work Index (LVSWI)

A
  • Amnt of work the LV performs w/ each heartbeat
  • Pressure generated by LV (MAP) x volume pumped SV x a conversion factor to change ml/mmHg to gm
    > LVSWI: 50-62 g-m/m
26
Q

Right Ventricular Stroke Work Index (RVSWI)

A
  • Mean pulmonary artery pressure (PAPm) x volume pumped (SV) a conversion factor to change ml/mmHg to g-m
    > RVSWI: 7.9-9.7 g-m/m
27
Q

Possible causes of High LVSWI & RVSWI

A
  • Incrd vol in ventricle
    > incrd stretch of vent
  • Low systemic vascular resistance
    > contractility is augmented
  • CNS stimulation
    > exercise, fever, infection, pain, anxiety
28
Q

Possible Causes of Low LVSWI & RVSWI

A
  • Overdistended ventricle
    > vol overload in vent
  • High systemic vascular resistance
    > incr resistance to vent ejection
  • Hypoxemia
    > negative inotropic effect
  • Dcrd myocardial function
    > CHF, MI, cardiomyopathy
  • Electrolyte imbalance
29
Q

Medications tht Increase Contractility

A
  • Dopamine
  • Dobutamine
  • Milrinone
30
Q

Medications tht Decrease Contractility

A
  • Beta Blockers
    > Propranolol
    > Metoprolol
31
Q

How does the nurse know if the pt’s contractility is responding to treatment?

A

CO goes down
BP goes down

32
Q

Factors That Impact Contractility

A
  • Preload vol as measured by PAOP
  • SVR
  • Myocardial oxygenation
  • Amnt of myocardium available to contract
  • Positive & negative inotropic meds
  • Amnt of functional myocardium available to contribute to contraction
  • Electrolyyte balance
33
Q

Significant Factors r/t Contractility tht can be Measured by the PA cath

A
  • Preload filling pressures
    > as vol in vent rises, contractility incrs, if vent is overdistended w/ vol, contractility falls
  • SVR
    > change in resistance to vent ejection
    > if SVR is high, contractility is dcrd
    > if SVR is low, contractility is augmented
  • Hypoxemia acts as a negative inotrope bc the myocardium must have oxygen available to cells to contract efficiently

Complex Care Exam 2 (9 decks)

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