Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSG 478 > lecture #1 - hemodynamic monitoring > Flashcards

lecture #1 - hemodynamic monitoring Flashcards

1
Q

what is systole?

A

contraction; when two ventricles contract causing blood to be ejected into aorta and pulmonary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is diastole?

A

relaxation; blood vessels return blood to the heart in preparation for the next ventricular contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the properties of myocardial cell?

A

automaticity, conductivity, contractility, excitability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is chronotropy?

A

the rate of contractions; positive chronotropic inc HR; negative chronotropic dec HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what type of medications do you give when the heart is inc contracting (HF, HTN)?

A

beta-blockers (-“lol”) - metoprolol or atenolol
calcium channel blockers (-“pine” or “-zem”) - amlodipine or cadizem
antiarrhythmic drugs - amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do inotropes do?

A

inc or dec force of contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do positive inotropes do?

A

strengthen the heart’s contraction, pump more blood w/ fewer heartbeats (used in CHF, cardiomyopathy, recent MI, cardiogenic shock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what do negative inotropes do?

A

weaken the heart’s contraction + slow the HR
tx CHF, HTN, arrythmias, chest pain + MI pt to red stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what do dromotropy agents do?

A

affect the conduction speed in the AV node + subsequently the rate of electrical impulse
(+) pos inc conduction velocity (epi)
(-) neg dec velocity (vagal stim)

**important in tx cardiac arrythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is cardiac output (CO)?

A

the amount of blood pumped by heart in one minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is preload?

A

the stretch of the ventricle when the heart is at the end of diastole (LVEDP) just before contraction

inc pre load - HF, valve disease, inc O2 demand
dec pre load - ACE, ARBS, diuretics, nitrates, CCB
dec pre load - shock, hemorrhage, dec blood return to heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is afterload?

A

the pressure the the heart must work against to eject blood during systole

inc afterload = inc BP + aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is stroke volume?

A

the volume of blood pumped out of the left ventricle to the heart during each systolic cardiac contraction

norm (50 - 100 mL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is venous return?

A

the flow of blood back to the heart, the vol of blood that returns from the veins to the atria each minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is systemic vascular resistance (SVR)?

A

total peripheral resistance, amount of force exerted on circulating blood by the vasculature of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is pulmonary vascular resistance?

A

the resistance against blood flow from the pul artery to the left atrium

17
Q

what is the goal of hemodynamic monitoring?

A

to maintain adequate tissue perfusion

18
Q

what factors affect HR?

A

autonomic innervation, hormones, fitness levels, age

19
Q

what factors affect SV?

A

heart size, fitness levels, gender, contractility, duration of contraction, preload (EDV), afterload (resistance)

20
Q

what does hemodynamic tell us?

A

the numbers can change before s/s
an inc in PAP means early indicator of: LV failure, pulmonary edema, fluid overload (hypervolemia)

*needs early tx

21
Q

indications of hemodynamic monitoring?

A

critical illness, shock, hemodynamic instability, HF, unstable post op pt, ARDS, acute kidney injury, severe burn injury, trauma

22
Q

expected reference ranges

A

Central venous pressure (CVP) = 2-6 mmHg
Pulmonary artery systolic (PAS) = 15-28 mmHg
Pulmonary artery diastolic (PAD) = 5-16 mmHg
Pulmonary artery wedge pressure (PAWP) = 6-15 mmHg
Cardiac output = 3-6 L/min
mixed venous (SVO2) = 60-80%

23
Q

what are the pre-procedure nursing actions?

A

ensure pt’s understanding of procedure
assemble the pressure monitoring system
place pt in supine or trendelenburg position
level transducer w/ phlebostatic axis

24
Q

what is the phlebostatic axis?

A

the anatomical point that corresponds to the RA and most accurately reflect’s a pt hemodynamic status

25
Q

what are the post procedure nursing actions?

A

obtain CXR to confirm cath placement
continually mon respiratory + cardiac status
maintain line placement + integrity
observe + document waveforms; report changes as this can indicate catheter migration or displacement
place in supine position; HOB can be elevated 15-30 degrees
zero system to atmospheric pressure;monitor trends

**secure that PA catheter

26
Q

nursing actions for infection/sepsis?

A

change dressings per protocol/document
use surgical aseptic technique (mask, sterile gloves, maintain sterile field)
mon for evidence of infection (fever, inc WBC)
collect specimens as ordered
admin antibiotics; IVFs; vasopressors

27
Q

nursing actions for embolism?

A

use 0.9% sodium chloride for flushing system (heparin)
avoid introduction of air to prev embolism
recognize risk of pneumothorax w/ line insertion
recognize risk of arrythmias w/ insertion or line movement

28
Q

what is hemodynamic instability?

A

systolic BO <= 90 mmHg
sustained low BP + dropping

GOAL: MAP > 60 mmHg

29
Q

s/s of altered hemodynamic (preload)?

A

elevated: crackles in lungs, jugular vein distention, hepatomegaly, peripheral edema, taut skin turgor

dec: poor skin turgor, dry mucous membranes

R heart: CVP
L heart: PCWP

30
Q

s/s of altered hemodynamics (afterload)?

A

elevated: cool extremities, weak pulses
decreased: warm extremities, bounding pulses

R heart: pulmonary vascular resistance
L heart: systemic vascular resistance

31
Q

what drugs used to treat hemodynamic instability?

A

vasopressors
inotropic drugs
vasodilators
anti htn
loop diuretic
morphine

32
Q

what do vasopressors do?

A

inc SVR + inc BP; induce vasoconstriction inc MAP

Phenylephrine, Norepinephrine, Epinephrine, Dopamine, Vasopressin

Vasopressors = vasoconstriction

33
Q

what do inotropic drugs do?

A

inc CO, inc BP

pos (+) = Epinephrine, Norepinephrine, Dopamine, Dobutamine, Milrinone, Digoxin

neg (-) = Flecainide, Verapamil, Cardizem, Clonidine, Atenolol

34
Q

what do vasodilators/anti htn do?

A

dec afterload + BP

35
Q

what do loop diuretics do?

A

dec preload + BP

*if taken long term will dec afterload

36
Q

what does morphine do?

A

dec VR + preload

37
Q

why is cardiac output important?

A

it affects PERFUSION
tissue perfusion is dependent on blood flow
3 factors = circulating vol, cardiac pump function, vasomotor tone

*any inc in CO will inc BP = better blood flow

38
Q

nursing actions for arterial line?

A

assess for signs of bleeding, dislodgement, hematoma, infection

assess for 5 P’s: pain, pallor, pulses, paresthesia, paralysis

if line gets dislodged = PRESSURE!

NSG 478 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions