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Nursing 4th Semester > Hemodynamics > Flashcards

Hemodynamics Flashcards

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1
Q

The Normal Value?

Right Arterial Pressure & Central Venous Pressure (CVP)

A

2-8mmHg

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2
Q

The Normal Value?

Pulmonary Artery Wedge Pressure

A

6-12mmHg

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3
Q

The Normal Value?

Stroke Volume?

A

60-150 mL/beat

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4
Q

Cardiac Output?

A

4-8 L/min

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5
Q

The Normal Value?

BUN?

A

10-20

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6
Q

The Normal Value?

Creatinine

A

0.6-1.3mg/dL

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7
Q

Define Cardiac Output?

A

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

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8
Q

Define Stroke volume?

A

The volume of blood ejected with each heart beat.

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9
Q

What factors determine Blood Pressure?

A

Cardiac Output and Systemic vascular resistance.

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10
Q

What is the purpose of Hemodynamic monitoring?

A

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

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11
Q

Preload is defined as?

A

The volume within the ventricle at the end of diastole.

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12
Q

Left Ventricular Preload is also called?

A

Left Ventricular end diastolic pressure.

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13
Q

What effects of increased preload have on the heart?

A 
Contraction force increases
Stroke volume increases
Cardiac output increases
Greater myocardial stretch
Greater the O2 requirement
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14
Q

Describe the measurement of
Pulmonary Artery Wedge Pressure?
PAWP

A

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).

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15
Q

Describe the measurement of
Central Venous Pressure…
CVP

A

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

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16
Q

In Hemodynamics what does the term

Referencing mean?

A

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

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17
Q

The normal hourly urine output can be determined by calculating?

A

0.5cc/kg/hr

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18
Q

ScvO2/SvO2 reflects?

A

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

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19
Q

Normal values of ScvO2/SvO2?

and What does this indicate?

A

60%-80%

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

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20
Q

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

A

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

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21
Q

A ScvO2/SvO2 value of <60% indicates?

A

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

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22
Q

Hypoxemia?

A

Deficient oxygenation of the blood.

23
Q

Hypoxia?

A

Diminished availability of oxygen to the body tissues.

24
Q

Give the normal value of Mean Arterial Pressure?

A

60mmHg-110mmHg

25
Q

What is the MAP defined as assessing?

A

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

26
Q

What is The Allen Test?

When would it be used?

A

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.

27
Q

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

A

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.

28
Q

Pulmonary artery diastolic pressure (PAD)

Normal value?

A

4-12 mmHg

29
Q

What does Pulmonary artery diastolic monitoring do for the patient?

A

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.

30
Q

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

A

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

31
Q

Pulmonary Artery Catheter Insertion and procedure Check list include?

A 
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
32
Q

What does CVP measure?

A

Right ventricular preload and reflects fluid volume problems.

33
Q

What does a elevated CVP indicate?

A

Right ventricular failure or volume overload

34
Q

A decreased CVP indicates?

A

Hypovolemia.

35
Q

What is Absolute hypovolemia?

A

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

36
Q

What is Relative hypovolemia?

A

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

37
Q

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

A

SNS mediated response (Increased HR, CO, RR)

Decrease in Stroke volume, CVP, and PAWP

38
Q

What is the antidote for benzodiazepines?

A

Flumazenil (Romazicon)

39
Q

The two most important clinical manifestations of neurogenic shock include?

A

Hypotension from massive vasodilation.

Bradycardia

40
Q

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

A

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

41
Q

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

A

Changes in mental status

42
Q

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

A

Warm the fluid as its infused

43
Q

Septic shock individuals need tight glucose control…which is?

A

Below 180

44
Q

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

A

Vasopressors 1st drug: norepinephrine

2nd drug is Vasopressin (Pitressin)

45
Q

What effects do Vasopressors have?

A

May increase BP, but decrease stroke volume

46
Q

Inotropic…is defined as?

A

Increasing force of contraction…Enhance CO

47
Q

Chronotropic…is defined as?

A

Increasing HR….Enhancing CO

48
Q

Collaborative Care: Cariogenic Shock?

A
  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)
  3. Mechanical devices: Intra-aortic balloon pump, Ventricular assist Device- Both Decrease SVR, Left ventricular workload.
49
Q

Criteria for SIRS

A 
Temp <97.0 or >100.9
HR >90
RR >20/min
PaCO2 <32
WBC >12K, <4K, >10% bands
50
Q

Criteria for Sepsis

A

SIRS+ Confirmed or suspected Infection

51
Q

Criteria for Sever Sepsis

A

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

52
Q

When would the Nurse expect to use Nipride?

A

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

53
Q

Within 3 hours of severe sepsis what should be done?

A
  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
54
Q

Within 6 hours of initial signs and symptoms of septic shock

A

Everything included with the 3 hours +

  1. Apply vasopressors for hypotension that fails to respond to fluids to maintain a MAP of >65mmHg
  2. Measure CVP/CVP pressure
  3. Remeasure lactate level if first was elevated.

Nursing 4th Semester (6 decks)

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