Hemodynamics

Question 1

The Normal Value?

Right Arterial Pressure & Central Venous Pressure (CVP)

Answer 1

2-8mmHg

Question 2

The Normal Value?

Pulmonary Artery Wedge Pressure

Answer 2

6-12mmHg

Question 3

The Normal Value?

Stroke Volume?

Answer 3

60-150 mL/beat

Question 4

Cardiac Output?

Answer 4

4-8 L/min

Question 5

The Normal Value?

BUN?

Answer 5

10-20

Question 6

The Normal Value?

Creatinine

Answer 6

0.6-1.3mg/dL

Question 7

Define Cardiac Output?

Answer 7

The volume of blood in liters pumped by the heart in 1 minute.

Question 8

Define Stroke volume?

Answer 8

The volume of blood ejected with each heart beat.

Question 9

What factors determine Blood Pressure?

Answer 9

Cardiac Output and Systemic vascular resistance.

Question 10

What is the purpose of Hemodynamic monitoring?

Answer 10

To asses heart function, fluid balance, and the effects of fluids and drugs on Cardiac output.

Question 11

Preload is defined as?

Answer 11

The volume within the ventricle at the end of diastole.

Question 12

Left Ventricular Preload is also called?

Answer 12

Left Ventricular end diastolic pressure.

Question 13

What effects of increased preload have on the heart?

Answer 13

Contraction force increases
Stroke volume increases
Cardiac output increases
Greater myocardial stretch
Greater the O2 requirement

Question 14

Describe the measurement of
Pulmonary Artery Wedge Pressure?
PAWP

Answer 14

A measurement of pulmonary capillary pressure and it reflects left ventricular end diastolic pressure.
Reflecting the volume of blood in the ventricle at the end of diastole (The peak of the stretch).

Question 15

Describe the measurement of
Central Venous Pressure…
CVP

Answer 15

Measures Right ventricular preload. And also indicates the pressure in the blood returning to the heart.
Usually in the Right Atrium or Vena Cava.

Question 16

In Hemodynamics what does the term

Referencing mean?

Answer 16

Positioning the transducer so that the zero reference point is at the level with the atria. To do this we use the phlebostatic axis.

Question 17

The normal hourly urine output can be determined by calculating?

Answer 17

0.5cc/kg/hr

Question 18

ScvO2/SvO2 reflects?

Answer 18

The balance between oxygenation of the arterial blood, tissue perfusion, and tissue O2 consumption.

Question 19

Normal values of ScvO2/SvO2?

and What does this indicate?

Answer 19

60%-80%

Normal O2 supply and metabolic demand. A Balanced O2 supply and demand.

Question 20

A ScvO2/SvO2 value of 80%-95% indicates?

Answer 20

High ScvO2/SvO2 indicates More O2 than whats required, or decreased ability of tissues to use O2 at the cellular level.

Question 21

A ScvO2/SvO2 value of <60% indicates?

Answer 21

A low ScvO2/SvO2
May indicate decreased arterial oxygenation of the arterial blood, decreased tissue perfusion, or O2 consumption or extraction.

Question 22

Hypoxemia?

Answer 22

Deficient oxygenation of the blood.

Question 23

Hypoxia?

Answer 23

Diminished availability of oxygen to the body tissues.

Question 24

Give the normal value of Mean Arterial Pressure?

Answer 24

60mmHg-110mmHg

Question 25

What is the MAP defined as assessing?

Answer 25

The average pressure within the arterial system and asses perfusion to the vital organs.

Question 26

What is The Allen Test? | When would it be used?

Answer 26

A test to confirm that ulnar circulation to the hand is adequate for a arterial line. Pressure goes on the Radial and Ulnar pulses then release only the Ulnar and if pinkness fails to return within 6 seconds then don't use that arm.

Question 27

When Continuous Blood pressure monitoring is used what should the nurse be assessing? The system The site

Answer 27

Assess continuous flush system q 1-4hrs: Including pressure bag=300mmhg flush bag has fluid system is delivering 3-6ml/hr neurovascular status distal to site q hr (pale/cool) Cap refill >3sec, pain, numbers tingling.

Question 28

Pulmonary artery diastolic pressure (PAD) | Normal value?

Answer 28

4-12 mmHg

Question 29

What does Pulmonary artery diastolic monitoring do for the patient?

Answer 29

It helps guide the acute phase of patients with lung and heart problems by therapeutic manipulation of Preload which allows CO to be maintained and decreasing risk for pulmonary edema.

Question 30

What types of conditions would the PAD and PAWP be increased? What about decreased?

Answer 30

Increased: Heart failure, and fluid overload. Decreased: fluid volume depletion.

Question 31

Pulmonary Artery Catheter Insertion and procedure Check list include?

Answer 31

``` Evaluate Electrolytes, ABGs, O2, Coagulation times Zero reference the system position supine and flat Inflate balloon at Right atrium Monitor ECG for dysrhythmias Confirm placement with Xray Record measurement at exit point Occlusive dressing ```

Question 32

What does CVP measure?

Answer 32

Right ventricular preload and reflects fluid volume problems.

Question 33

What does a elevated CVP indicate?

Answer 33

Right ventricular failure or volume overload

Question 34

A decreased CVP indicates?

Answer 34

Hypovolemia.

Question 35

What is Absolute hypovolemia?

Answer 35

When fluid is lost through hemorrhage, gastrointestinal Loss such as vomiting or diarrhea, fistula drainage, diabetes insipidus, or diuresis.

Question 36

What is Relative hypovolemia?

Answer 36

Fluid volume moves out of the vascular space into the extravascular space.

Question 37

A loss of 15%-30% of blood results in?

Answer 37

SNS mediated response (Increased HR, CO, RR) | Decrease in Stroke volume, CVP, and PAWP

Question 38

What is the antidote for benzodiazepines?

Answer 38

Flumazenil (Romazicon)

Question 39

The two most important clinical manifestations of neurogenic shock include?

Answer 39

Hypotension from massive vasodilation. | Bradycardia

Question 40

Compensatory Stage of shock What is going on? Clinical observations?

Answer 40

The body attempts to overcome anaerobic metabolism and to maintain homeostasis. First sign is a drop in blood pressure then... HR increased, Increased RR, hypoactive bowel sounds

Question 41

Important find for the patient that entering progressive stage of shock?

Answer 41

Changes in mental status

Question 42

What nursing consideration is important to remember when giving large amounts of fluid?

Answer 42

Warm the fluid as its infused

Question 43

Septic shock individuals need tight glucose control...which is?

Answer 43

Below 180

Question 44

A patient in septic shock loses fluid after replacement and a target CVP of 8 is reached what is given?

Answer 44

Vasopressors 1st drug: norepinephrine | 2nd drug is Vasopressin (Pitressin)

Question 45

What effects do Vasopressors have?

Answer 45

May increase BP, but decrease stroke volume

Question 46

Inotropic...is defined as?

Answer 46

Increasing force of contraction...Enhance CO

Question 47

Chronotropic...is defined as?

Answer 47

Increasing HR....Enhancing CO

Question 48

Collaborative Care: Cariogenic Shock?

Answer 48

1. restore blood flow to myocardium 2. Hemodynamic management: 1. Drugs: nitrates(dilate coronary arteries), Diuretics (reduce preload), Vasodilators (Reduce after load), Beta-Blockers (reduce HR and contractility) 2. Mechanical devices: Intra-aortic balloon pump, Ventricular assist Device- Both Decrease SVR, Left ventricular workload.

Question 49

Criteria for SIRS

Answer 49

``` Temp <97.0 or >100.9 HR >90 RR >20/min PaCO2 <32 WBC >12K, <4K, >10% bands ```

Question 50

Criteria for Sepsis

Answer 50

SIRS+ Confirmed or suspected Infection

Question 51

Criteria for Sever Sepsis

Answer 51

Sepsis + Systolic BP <90mmHg, Lactate >4mmol, Signs of end organ damage.

Question 52

When would the Nurse expect to use Nipride?

Answer 52

Pt with Cariogenic shock with increased SVR Enhances vasodilation, Arterial and Venous Dilation Monitor BP, give with D5W, protect from light

Question 53

Within 3 hours of severe sepsis what should be done?

Answer 53

1. Measure lactate level 2. Obtain blood cultures before administration of antibiotics. 3. Administer broad-spectrum antibiotics 4. Administer 30mL/Kg crystalloids for hypotension or lactate >/=4mmol

Question 54

Within 6 hours of initial signs and symptoms of septic shock

Answer 54

Everything included with the 3 hours + 5. Apply vasopressors for hypotension that fails to respond to fluids to maintain a MAP of >65mmHg 6. Measure CVP/CVP pressure 7. Remeasure lactate level if first was elevated.