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CMC > Monitoring and Diagnostics (CMC) > Flashcards

Monitoring and Diagnostics (CMC) Flashcards

1
Q

The cardiovascular system is regulated by two types of mechanisms:

(broad)

A

neural and hormonal mechanisms

neural: the autonomic nervous system modulates heart rate and vascular tone through SNS and PNS pathways.

hormonal: like adrenaline, influence CO and vascular resistance

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2
Q

cardiac output

A

SVxHR

the volume of blood pumped by the heart per minute

normal:

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3
Q

CVP

A

reflects right atrial pressure and is indicative of venous return and fluid status (? may be old news)

normal:

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4
Q

Pulmonary Artery Pressure (PAP)

A

provides information about the pressure in the PA and can indicate left heart function

normal:

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5
Q

Pulmonary Capillary Wedge Pressure (PCWP)

A

estimates left atrial pressure, aiding in diagnosing LV dysfunction

normal:

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6
Q

Systemic vascular resistance (SVR)

A

reflects resistance faced by blood flow through systemic circulation, impacting afterload

normal:

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7
Q

stroke volume (SV)

A

amount of blood ejected with each heartbeat

normal:

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8
Q

how does echocardiography work?

A

a transducer emits high-frequency sound waves that penetrate the chest wall and reflect off cardiac structures. The reflected waves are captured and translated into visual images by a computer, to observe heart chambers, valves, walls, and surrounding structures.

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9
Q

What does echo allow for the assessment of?

A

ventricular size and function, ejection fraction, and wall motion abnormalities

valve morphology (measuring blood flow velocities across valves, aiding in determining severity of valvular lesions)

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10
Q

stress echocardiography

A

combines exercise or pharmacological stress with US imaging to evaluate myocardial perfusion and ischemia. helps identify CAD by revealing areas of reduced blood flow under stress conditions.

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10
Q

echo can help diagnose

A

heart failure, cardiomyopathy, ischemic heart disease, valvular heart disease

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11
Q

three-dimensional echocardiography

A

advanced technique that offers volumetric imaging, enhancing the spatial understanding of complex cardiac anatomy. useful in pre-surgical planning and assessing congenital heart defects.

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12
Q

PR interval indicates

A

time taken for electrical conduction from atria to ventricles

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13
Q

QRS duration assesses

A

ventricular depolarization time

prolonged indicates BBB or ventricular hypertrophy

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14
Q

QT interval measures

A

total time for ventricular depolarization and repolarization

prolonged: increase risk for torsades de pointes

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15
Q

What do Troponin I and T measure?

A

myocardial injury/ infarction

used to diagnose ACS

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16
Q

What do B-type Natriuretic Peptide (BNP) and N-terminal pro B-type Natriuretic Peptide (NT-proBNP) measure?

A

heart failure

elevated levels correlate with increased cardiac stress and fluid overload.

helps differentiate between cardiac and non-cardiac causes of dyspnea

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17
Q

What is the purpose of a stress test?

A

evaluate CV systems response to increased physical activity or pharmacologic stimulation to assess how well the heart handles work and to identify potential CAD, arrhythmias, and other cardiac conditions.

primary goal is to detect ischemia (ST segment depression)

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18
Q

exercise stress test vs. pharmacologic stress test vs. nuclear stress test

A

exercise: most common. physical exertion.
pharm: used if cannot exercise. using agents like adenosine, dipyridamole, or dobutamine to mimic exercise by increasing workload of heart
nuclear: injection of radioactive tracer to highlight blood flow patterns in heart muscle during rest and stress conditions

19
Q

stress echocardiography:

A

uses US waves to visualize heart structures and function during stress

20
Q

why do stress echo or nuclear stress test instead of just exercise or pharm stress test?

A

used with stress testing for enhanced diagnostic accuracy

21
Q

what is remote cardiovascular monitoring? benefits?

A

wearable or implantable device that transmits data to healthcare providers via secure networks. (smartwatches, patches, implantable loop recorders, Holter monitors, event monitors, etc)

-continuous monitoring outside of hospital/clinic. early detection of potential issues, real time data vs periodic assessments

22
Q

What is a pulmonary artery sensor?

A

used in remote CV monitoring to assess hemodynamic parameters directly within pulmonary artery to detect changes in cardiac function via wireless sensor

23
Q

name the structures of the upper airway and their function

A

nose, nasal cavity, pharynx, and larynx

filter, warm, humidify incoming air

24
Q

name the structures of the lower airway

A

trachea, bronchi, bronchioles, and alveoli

25
Q

explain gas exchange in the alveoli

A

diffusion oxygen from inhaled air diffuses across the alveolar membrane into the pulmonary capillaries, while CO2 from deoxygenated blood diffuses into the alveoli to be exhaled. this exchange is driven by concentration gradients and facilitated by a thin respiratory membrane and a large surface area provided by numerous alveoli

26
Q

why is oxygenation/ventilation so important in cardiac patients?

A

effective ventilation ensures adequate oxygenation of blood returning t the left side of the heart for systemic circulation. inadequate ventilation or impaired gas exchange can lead to hypoxemia and hypercapnia, which can affect cardiac output and exacerbate cardiac conditions

also if they’re anemic: less hgb circulating to carry oxygen to tissues

27
Q

ABGs are used to monitor ______ via the levels of _______

A

oxygenation, ventilation, and acid-base status via the levels of oxygen (PaO2), carbon dioxide (PaCO2), and the pH of arterial blood

28
Q

the primary components measured in an ABG test include

A

pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), bicarbonate (HCO3), and oxygen saturation (SaO2)

29
Q

pH indicates

A

acidity or alkalinity of the blood

30
Q

partial pressure oxygen (PaO2) measures

A

oxygen levels in the blood with normal values ranging from 75 to 100 mmHg

helps assess how well oxygen is being transferred from the lungs to the blood

31
Q

partial pressure carbon dioxide (PaCO2) measure

A

effectiveness of ventilation by measuring CO2 levels, with normal between 35 to 45 mmHg.

elevated suggests hypoventilation or respiratory acidosis

low levels- hyperventilation or respiratory alkalosis

32
Q

bicarbonate (HCO3) measures

A

metabolic component and buffering capacity, with normal between 22 and 26 mmHg

distinguish between metabolic acidosis and alkalosis

33
Q

oxygen saturation (SaO2) measures

A

a more precise measurement of hemoglobin saturation with oxygen compared to the pulse oximetry (SpO2)

34
Q

mixed venous gas is a measurement of

A

gases in blood collected from the pulmonary artery, reflecting overall balance between oxygen delivery and consumption throughout the body.

assesses adequacy of tissue oxygenation and determining effectiveness of CO

35
Q

primary components of mixed venous gas

A

partial pressures of oxygen (PvO2) and carbon dioxide (PvCO2) as well as venous oxygen saturation (SvO2).

36
Q

Normal SvO2 values and abnormal indications

A

normal 60-80%

below: suggest increased oxygen saturation due to inadequate delivery or heightened demand.

above: decreased extraction or impaired utilization

37
Q

What does SvO2 assess?

A

how much oxygen remains in the blood after it has circulated through the body, offering insight into the body’s oxygen utilization.

38
Q

O2 and CO2 levels on ABG vs mixed venous

A

PvO2 usually lower than arterial oxygen partial pressure (reflecting consumption by tissues)

PvCO2 slightly higher than arterial representing CO2 production from cellular metabolism

39
Q

what does pulse oximetry measure?

A

oxygen saturation level of hemoglobin in the blood

40
Q

how does the pulse ox probe work?

A

the probe emits light wavelengths through the skin and measures the amount of light absorbed by the oxygenated and deoxygenated blood hemoglobin. this data is then used to calculate the percentage of hemoglobin saturated with O2, displayed as SpO2 on device screen

41
Q

end-tidal capnography (EtCO2) measures

A

partial pressure or concentration of carbon dioxide in exhaled breath at end of expiration

provides continuous graphical representation known as capnogram reflecting patient’s ventilatory status, perfusion, and metabolic activity

42
Q

normal EtCO2 levels and indications if high or low

A

35-45 mmHg

high: hypoventilation, increased metabolic activity, decreased CO

low: hyperventilation, decreased metabolic rate, pulmonary embolism

43
Q

describe the four phases of capnogram

A

1: baseline with no CO2 as fresh gas is inhaled
2. sharp rise as alveolar gas mixes with dead space gas
3. alveolar plateau, CO2 levels reach peak at end expiration
4. beginning of inhalation with rapid fall in CO2 levels

analyzing these phases helps identify ventilation-perfusion mismatches and airway obstructions

44
Q

EtCO2 is especially helpful in the ICU for

A

intubation and CPR

titrating ventilator settings

accidental extubation

equipment malfunction

CMC (4 decks)

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