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Nursing > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

Hemodynamic monitoring

A

The measurement of pressure, flow, and oxygenation within the cardiovascular system

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2
Q

CVP

term only

A

Central venous pressure

CVP = RAP

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3
Q

PAWP

Term only

A

Pulmonary artery wedge pressure

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4
Q

Cardiac output (CO)

A

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

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5
Q

Cardiac index

A

The measurement of the CO adjusted for body surface area (BSA)

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6
Q

Stroke volume (SV)

A

The volume ejected with each heartbeat

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7
Q

Stroke volume index

A

The measurement of SV adjusted for BSA

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8
Q

SV

Term only

A

Stroke volume

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9
Q

SVR

A

Systemic vascular resistance

  • resistance of the systemic vascular bed
  • opposition encountered by the left ventricle
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10
Q

PVR

A

Pulmonary vascular resistance

  • resistance of the pulmonary vascular bed
  • opposition encountered by the right ventricle
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11
Q

Preload

A

The volume within the ventricle at the end of diastole

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12
Q

Left ventricular end diastolic pressure (LVEDP)

A

Left ventricular preload

- Not measured directly; measured in pulmonary artery (PAWP)

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13
Q

PAWP

A

Pulmonary artery wedge pressure

  • measurement of pulmonary capillary pressure
  • reflects left ventricular end-diastolic pressure under normal conditions
  • Norm: 6-12 mmHg
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14
Q

Contractility

A

Describes the strength of contractions of the heart

- said to increase when preload is unchanged yet the heart contracts more forcefully

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15
Q

Drugs that increase/improve contractility (+ inotropes)

A 
Epinephrine; norepinephrine [Levophed]
Isoproterenol (Isuprel)
Dopamine (Intropin)
Dobutamine (Dobutrex)
Digitalis-like drugs
Calcium
Milrinone
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16
Q

Drugs that reduce contractility (negative inotropes)

A 
Alcohol
Calcium channel blockers
Beta-adrenergic blockers 
Anesthetics, sedatives, barbiturates
Some chemo agents
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17
Q

Impedance cardiography (ICG)

A

A continuous or intermittent, noninvasive method of obtaining CO and assessing thoracic fluid status.

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18
Q

Ejection fraction

A

Amount of blood pumped out of heart compared to how much is remaining

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19
Q

Normal CO value range

A

4-8 L/min

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20
Q

HR norm range

A

60-100 beats/min

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21
Q

Stroke volume (SV) normal range

A

60-150 mL/beat

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22
Q

PAWP normal range

A

6-12 mm Hg

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23
Q

CVP/RAP normal range

A

2-8 mmHg

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24
Q

SVR = ?

A

[(MAP - RAP) / CO] x 80

Norm CVR: 800-1200 dynes/sec/cm-5

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25
Q

SVR norm range

A

800-1200 dynes/sec/cm-5

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26
Q

CO = ?

A

SV x HR

Norm CO: 4-8 L/min
ml/min) = (beats/min) x (ml/beat

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27
Q

What does PAWP correlate/equal to?

A

PAWP = lung pressure = pulmonary vein pressure = LAP = LVEDP

28
Q

Normal MAP range

A

70-105 mm Hg

29
Q

Normal CI range

A

2.5-4 liters/min/meter(2)

30
Q

Drug(s) to reach for when HR is too low?

31
Q

Drug(s) to reach for if the HR is too high?

A

Beta blockers
Ca Channel blockers
Digoxin

32
Q

How does the sympathetic nervous system act on the heart?

A

Will increase HR with intervention

33
Q

What are the 3 levels of dopamine dosing?

A

Low – dopaminergic effect – (1-5 mcg/kg/min)
Moderate – beta effect – (5-10 mcg/kg/min)
High – alpha effect – (10-20 mcg/kg/min)

34
Q

How will the parasympathetic nervous system act on the heart?

A

Will decrease HR with intervention

35
Q

What are the 3 determinants of stroke volume?

A

Preload
Afterload
Myocardial contractility

36
Q

What may cause a decreased preload?

A

Hypovolemia
Loss of atrial kick (a-fib)
Venous vasodilation (sepsis, anaphylactic shock)

37
Q

What are some causes of increased preload?

A

Ventricular failure
Hypervolemia
renal disease (hyervolemia)

38
Q

How is the preload measured

A

Not measured directly (in L ventricle)

  • catheter in pulmonary artery (PAWP)
  • Left ventricular end diastolic pressure (LVEDP)
39
Q

PAWP of 18-20 mmHg; Clinical state?

A

Onset of pulmonary congestion

40
Q

PAWP of 20-25 mmHg; clinical state?

A

Moderate pulmonary congestion

41
Q

PAWP of 25-30 mmHg; clinical state?

A

Severe congestion

42
Q

PAWP of > 30 mmHg; clinical state?

A

Pulmonary edema

43
Q

What is the objective in treating low preload?

A

Increase circulating volume

44
Q

What is the treatment of low preload?

A 
Give fluids (crystalloids or colloids)
blood products
45
Q

What is the objective in treating high preload?

A

Decrease circulating volume OR venous return

46
Q

How is high preload treated?

A

Diuretics (lasix)

Vasodilators

47
Q

What are some causes of decreased afterload?

A

Vasodilation

sepsis, vasodilation tx, anaphylactic shock, hypotension

48
Q

What are some causes of increased afterload?

A

HTN
Aortic stenosis
Vasoconstriction

49
Q

Normal CVP/RAP range?

50
Q

What is the objective in treating low afterload?

A

Vasoconstriction

51
Q

How is low afterload treated?

A

Vasopressors

(epinephrine, norepinephrine, dopamine (>10), neosynephrine

52
Q

In treating a patient with low afterload, what is done before drug therapy?

A

Fluid bolus

53
Q

What is the objective in treating high afterload?

A

Decrease resistance to ejection of blood

54
Q

How is high afterload treated?

A 
Arterial vadodilators 
(nipride, Primacor (milrinone), nitroglycerin, Cardene)
Surgery -- Aortic valve replacement
55
Q

What are some causes of decreased contractility

A

Parasympathetic stimulation
Negative inotropics
Metabolic states (hyperK+, myocardial ischemia, hypoxia, acidosis)

56
Q

What is the objective in treating low contractility?

A

Improve the force of contraction

57
Q

How is low contractility treated?

A

Optimize preload

  • positive inotropic drugs
  • ventricular assist devices
58
Q

What are some causes of increased contractility

A

Sympathetic stimulation
Positive inotropic drugs
Metabolic states (hyperthyroidism)

59
Q

What is the objective in treating high contractility?

A

Decrease myocardial work & oxygen consumption

60
Q

How is high contractility treated?

A

negative inotropic drugs

61
Q

cardiac index (CI) = ?

A

CI = CO/BSA

normal CI = 2.5-4 liters/min/meter(2)

62
Q

What may interfere with reliable PAWP readings?

A

Mitral valve disease

High intra-alveolar pressure (ventilators)

63
Q

In a pulmonary artery (PA) catheter with 4 ports, what are the ports?

A
  • cardiac output balloon
  • PAWP distal port
  • PA pressure readings proximal port
  • CVP reading
64
Q

Normal pulmonary artery pressures?

A

25/10 (quarter over dime)

65
Q

What three things must you “tell a transducer”

A

Put it to pressure (300 mmHg of pressure in transducer )
Zero the transducer
Line/level the transducer with the source

66
Q

Important nursing care with an A-line

A
  • Never put meds in an A-line
  • be able to See the line (provide some degree of modesty)
  • check connections – make sure it is tight
  • ensure alarms on
  • infection prevention
  • Hemorrhaging
67
Q

What are two invasive techniques for measuring cardiac output?

A 
Intermittent Bolus thermodilution CO (TDCO)
Continuous CO (CCO)

Nursing (4 decks)

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