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Lab Values > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

MAP is…

A

the measure of the average arterial perfusion pressure, which determines blood flow to the tissues

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2
Q

MAP equation

A

[2(DBP) + SBP] / 3

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3
Q

MAP normal range

A

70-105 mmHg

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4
Q

CVP is…

A

volume in the right side of the heart, when the tricuspid valve is open; reflects the filling pressures in the right ventricle

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5
Q

guide for overall fluid balance

A

CVP

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6
Q

CVP normal range

A

2 - 5 mmHg

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7
Q

CO is…

A

the measurement of the amt of blood ejected by the ventricles EACH MINUTE. it reflects pump efficiency and is a determinant of tissue perfusion

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8
Q

CO equation

A

HR x SV = CO

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9
Q

CO normal range

A

4 - 8 L/min

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10
Q

CI is…

A

the measurement of the cardiac output adjusted for body size. it is a more precise measurement of pump efficiency than CO

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11
Q

CI equation

A

CI = CO / BSA (body surface area)

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12
Q

CI normal range

A

2.5 - 4.0 L/min

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13
Q

SV is…

A

represents the volume of blood ejected from the ventricle with EACH CONTRACTION

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14
Q

SV is influenced by

A

preload, afterload, and contractility

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15
Q

SV equation

A

SV = CO / HR

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16
Q

SV normal range

A

60-80 ml/beat (60-70)

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17
Q

SVR is ..

A

a measurement of the left ventricular afterload.

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18
Q

SVR equation

A

(MAP - CVP) / (CO x 80)

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19
Q

SVR normal range

A

900-1400 dynes/sec/cm-5

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20
Q

a diseased valve and resitance in the systemic arterial circulation (increases/decreases) SVR

A

increase

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21
Q

PVR is

A

measurement of right ventricular afterload

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22
Q

PVR equation

A

(PAM - PCWP) / (CO x 80)

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23
Q

PVR normal range

A

100-250 dynes/sec/cm-5

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24
Q

EF is..

A

a measurement of the ratio fo the amt of blood ejected from the LV to the amt of blood remaining in the ventricle at the end of diastole.

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25
Q

indirect measurement of contractility

A

EF

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26
Q

EF equation

A

SV / (EDV x 100)

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27
Q

EDV is…

A

the amt of blood available for ejection at the end of diastole

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28
Q

EF normal range

A

60% or greater

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29
Q

EDV normal range

A

100-160 ml/m2

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30
Q

SBP normal range

A

90-130 mHg

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31
Q

DBP normal range

A

60-90 mmHg

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32
Q

normal HR

A

60-100

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33
Q

normal RR

A

10-25

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34
Q

normal SaO2

A

92-100%

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35
Q

what causes low CO?

A

shock,
hypovolemia,
low O2 delivery

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36
Q

what causes high CO?

A

increased volume given
improved contractility
volume replenished

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37
Q

what causes high CVP?

A 
hypervolemia
R/L HF 
RV failure 
pulmonic valve stenosis
pulmonary HTN
tamponade
tricuspid valve dz 
RV infarct
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38
Q

what causes low CVP?

A

hypovolemia (poor venous return to R. heart)
sepsis (vasodilation)
vasodilation/decreased venous return

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39
Q

what causes high RR?

A

hypercapneic
septic
hypoxic

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40
Q

what causes low temp?

A

sepsis

impaired immune response

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41
Q

what causes high MAP?

A

peripheral vasoconstriction

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42
Q

what causes low MAP?

A

hypoperfusion

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43
Q

what happens if afterload is high?

A

ventricle dose not empty
low CO
low SV

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44
Q

what happens if afterload is low?

A

weak contraction
low CO
low SBP

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45
Q

what happens if preload is high?

A

overstretch

impedes contraction

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46
Q

what happens if preload is low?

A

not enough volume to make muscle stretch and push volume through the heart

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47
Q

what is SvO2?

A

whether the heart and lungs effort to supply O2 to the tissues is sufficient to meet the tissue’s O2 demands. (Is CO adequate?)

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48
Q

what causes high SvO2?

A

high O2 supple (high CO from inotropic drugs, IABP, afterload reduction, early septic shock)
high O2 sat
High hemoglobin (blood transfusion)
low O2 demand (hypothermia, fever reduction, late sepsis, paralysis, pain relief, anesthesia)
PAWP balloon inflated
wedged deflated balloon in cap bed

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49
Q

what causes low SvO2

A

low O2 supply – low CO – heart failyre, hypovolemia, dysrhythmias, cardiac depressants (beta blockers)
low O2 sats – resp failure, pulomnary infiltrates, suctioning, vent disconnected, low Hemoglobin (anemia or hemorrhage)
high O2 consumption: hyperthermia, seizures, shivering, pain, high work of breathing, high metabolic rate, exercise, agitation

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50
Q

estimate of L vent afterload

A

SVR

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51
Q

estimate of R ventricular afterload

A

PVR

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52
Q

what causes high SVR?

A 
aortic stenosis
periph vasoconstriction (hypothermia--warm pt, hypovolemia)
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53
Q

what causes low SVR?

A

vasodilation or shock (septic, neurogenic, anaphylactic)

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54
Q

what causes high PVR?

A

pulm HTN

increased afterload of R vent

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55
Q

what causes low PVR?

A

decreased afterload of R vent (Right HF, hypovolemia)

56
Q

what increases CI?

A

hyperthyroidism
low SVR
fever
increased O2 demand

57
Q

what decreases CI

A 
LV failure
acidosis
increased SVR
hemorrhage
hypovolemia
tamponade
58
Q

PAOP normal range

A

5-12 mmHg

59
Q

what increases PAOP>

A 
LV failure
mitral valve dz
increased SVR
hypervolemia
tamponade
60
Q

what decreases PAOP?

A

hypovolemia

severe vasodilation

61
Q

if the trandsucer is too high, what kind of reading will you get?

A

falsely low reading

62
Q

if the transducer is too low, what kind of reading will you get?

A

falsely high reading

63
Q

if the pt is above the level of the transducer, what kind of reading will you get?

A

falsely high reading

64
Q

if the pt is below the level of the transducer, what kind of reading will you get?

A

falsely low reading

65
Q

what pressure should the bag be set to?

A

300 mmHg

66
Q

can you give meds through an A-line?

A

NO! not through arteries, only through veins

67
Q

indications for intraarterial BP monitoring?

A

unstable cardiac pt; hx of HTV, hx of low BP
titrating meds to BP
for any major medical or surgical condition that compromises CO, tissue perfusion, or fluid volume status

68
Q

sites for a-lines

A

radial artery
femoral artery
brachial artery

69
Q

highest point of a-line waveform?

A

systole – when blood ejected from left ventricle

70
Q

lowest point of a-line waveform?

A

diastole

71
Q

what is the dicrotic notch?

A

closure of the aortic valve – diastole is about to begin

72
Q

if communication from the artery to the transducer is interrupted, what kind of waveform will be produced?

A

dampened

73
Q

causes for a dampened waveform?

A

kink in line or clot

74
Q

an narrow upward systolic peak that produces a falsey high systolic reading?

A

underdampened waveform ; overshoot or fling

75
Q

what is CVP measuring?

A

filling pressure of the RIGHT side of the heart

76
Q

sites for CVP monitoring?

A

subclavian – preferred
IJ – most common
femoral – easiest but cant bend at hip

77
Q

after inserting CVP, what should you do next?

A

check breath sounds – pneumothroax

and get CXR – tip in SVC

78
Q

what is normal CVP?

A

2-5 mmHg

79
Q

what measures the preload of the right side of the heart? (right atrial pressure)

A

CVP

80
Q

what measure the amount of volume in the heart at the end of diastole?

A

CVP

81
Q

what are indications for monitoring CVP?

A

HF
fluid overload
dehydration
bleeding out

82
Q

what do we use to check fluid volume status?

A

CVP

83
Q

what is the volume of blood in the left ventricle at the end of diastole?

A

preload

84
Q

what affects preload?

A

venous return to heart
total blood volume
atrial kick

85
Q

does the heart failure pt have (too much/too little) preload?

A

too much

86
Q

does the hypovolemic pt have (too much/too little) preload?

A

too little

87
Q

what is used to measure preload?

A

PAOP

88
Q

tx for an air embolus?

A

100 O2

left lateral trendelenburg position

89
Q

what is an excellent ealry warning system for pt who is bleeding, vasodilating, receiving diuretics or being rewarmed after cardiac surgery?

A

CVP monitoring

90
Q

which falls first, CVP or MAP?

A

CVP

91
Q

if pt has high BP, will they have low or high CVP?

A

high

92
Q

if pt is fluid overloaded, what will CVP be?

A

high CVP

93
Q

if a pt is dehydrated, what will CVP be?

A

low CVP

94
Q

if pt has blood loss, what will CVP be?

A

low CVP

95
Q

if pt is bleeding, what will CVP be?

A

low

96
Q

what does the swanz ganz measure?

A

PAP

97
Q

what measures left atrial pressure?

A

CVP

98
Q

what measures right atrial pressure?

A

PAOP

99
Q

the output in one minute?

A

CO

100
Q

if the pump is weak, what will CO be?

A

low

101
Q

if the BP is high, what will CO be?

A

low bc more difficult for the heart to pump against

102
Q

if the CVP is low, what will the CO be?

A

low – low fluid

103
Q

amount of blood ejected with EACH BEAT?

A

SV

104
Q

what mesures preload of right side of heart?

A

CVP

105
Q

what measure preload of left side of heart?

A

PAOP

106
Q

in heart failure pts, preload is…

A

increased

107
Q

in fluid overload pts.. preload is..

A

increased

108
Q

in hypervolemic pts.. preload is…

A

increased

109
Q

in a dehydrated pt.. preload is…

A

decreased

110
Q

normal PAOP

A

5-12 mmHg

111
Q

what the LV has to pump against to get blodo from the heart all the way around body and back to heart

A

SVR

112
Q

what RV has to pump against to get through lungs

A

PVR

113
Q

if afterload is increased, the workload of the heart is..

A

increased

114
Q

vasoconstriction causes afterload to

A

increase (increases SVR)

115
Q

hypertension causes afterload to

A

increase

116
Q

aortic stenosis causes afterload to

A

increase

117
Q

the lower the SVR, the __________ the CO

A

higher

118
Q

conditions that increase SVR?

A

HTN

vasoconstriction

119
Q

conditions that decrease SVR?

A

vasodilation

120
Q

factors that affect contractility

A 
preload
afterload: increasing afterload makes it more difficult to contract
myocardial oxygenation
electrolyte balance
positive or negative inotropic meds
functional myocardium
121
Q

if HR is fast can the heart adequately fill? how does this affect CO?

A

NO, so CO decreases

all increasing the O2 requirement to the heart, but cant get it bc not getting O2 out

122
Q

what hemodynamics does the PAC (swans ganz) measure?

A

CVP, PVR, SVR

123
Q

normal DO2 (delivery of O2 to tissues)

A

900-1100 ml/min

124
Q

normal VO2 (oxygen consumption)

A

200-300 ml/min

1/4

125
Q

how can O2 delivery be improved?

A 
vasodilate pt if high afterload
sedate
give them oxygen 
give them blood bc H&H is low
improve the "pump"
126
Q

what is SvO2?

A

mixed venous oxygen saturation

127
Q

what is normal SvO2?

A

65-75%

128
Q

if anemic or hypoxic, SVO2 will be

A

decreased

129
Q

how do we measure SVO2?

A

swanz ganz

130
Q

if SOB and stresses, what will happen to SVO2?

A

decrease

131
Q

if HR is increased (fever, infection), what will SVO2 be

A

decreased

132
Q

if oxygen consumption is increased, what will SVO2 be?

A

decreased

133
Q

if shivering or seizureing, SVO2 will be

A

decreased

134
Q

what if pt is afebrile and sedated? what else can make SVO2 decrease?

A

delivery problem (instead of consumption)– so is preload low? is afterload high? is heart bad?

135
Q

sedation and anesthesia.. what will SVO2 be?

A

high

136
Q

hypothermia.. what will SVO2 be?

A

high

137
Q

sepsis.. what will SVO2 be

A

high – tissue cant use the oxygen

Lab Values (2 decks)

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