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NUR 213 > Perfusion - Study guide 3 > Flashcards

Perfusion - Study guide 3 Flashcards

1
Q

Four determinants of cardiac output

A
  • Heart rate
  • Preload
  • Afterload
  • Contractability
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2
Q

The number of cardiac contractions per minute. Can be affected by many variables depending on pressure.

A

Heart rate

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3
Q

increases HR by releasing norepinephrine

A

Positive chronotropic effect

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4
Q

decreases HR by releasing acetylcholine

A

Negative chronotropic effect

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5
Q
  • Directly related to stroke volume.
  • The amount of blood in the ventricles at the end of diastole.
  • Also refers to the amount of stretch of the muscle tissue at the end of filling.
A

Preload

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6
Q
  • Inversely correlated to stroke volume.
  • The resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents.
  • This is related to bp, vessel lumen diameter and or vessel compliance.
A

Afterload

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7
Q
  • The force of the mechanical contraction.
  • Contractile force can be increased with sympathetic stimulation or calcium release.
  • It can be decreased in the face of hypoxia or acidosis
A

Contractability

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8
Q

Effects of an increased afterload

A

Decreases stroke volume and decreased cardiac output

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9
Q

Effects of a decreased afterload

A

increases stroke volume, increases cardiac output

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10
Q

Formula for calculating cardiac output

A

Heart Rate X Stroke Volume = Cardiac Output

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11
Q

Normal cardiac output in a healthy adult

A

4-7L/min

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12
Q

HR increases depending on what?

A

Pressure

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13
Q

Conditions that cause alterations in perfusion

7 - CCCDEHM

A
  • Clotting disorders
  • Congenital cardiac defects
  • CAD
  • Dysrhythmias
  • Early menopause
  • Heart Failure
  • MI
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14
Q

Parameters that for someone to be dx with pre-eclampsia

A
  • BP >140>90 on two occasions at least 4 hrs apart with Proteinuria.
  • Occurs after 20 wks.
  • Protein creatinine ration (PCR) >0.3 MG/DL
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15
Q

Nursing Interventions for Pre-eclampsia

12

A
  • Monitor BP
  • Monitor weight
  • Frequent provider visits
  • Fetal kick counts
  • Frequent rest/bedrest
  • Adequate intake
  • Monitor I and O
  • Neuro status checks
  • Evaluate renal function
  • Evaluate Deep tendon reflexes and clonus
  • Administer magnesium sulfate infusion as ordered
  • Administer HTN medications
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16
Q

test where you have the patient dangle legs off side of bed w/o feet touching the floor, support the back of the leg with one hand and push up on the toes (dorsiflex foot).

A

Clonus test:

17
Q

Normal response for a Clonus test

A

Foot returns to normal positon with no tremors

can be reffered to as a negative clonus

18
Q

Indications of a Positive clonus test

A

Foot starts to bounce or beat 3 or more times

19
Q

Theraputic range for mg

A

4-7 mEq/L

20
Q

Normal range for mg

A

1.5-2 mEq/L

21
Q

S/S of mg toxicity

think BURP

A

BP Decrease
Urine output decrease
Respiratory rate decrease
Patellar reflex absent

22
Q

Antidote for mg toxicity

A

Calcium gluconate

23
Q

Life-threatening and rare compication of pre-eclampsia.
Can manifest at anytime during pregnancy

A

HELLP Syndrome

24
Q

A pt with preeclampsia is experiencing the following that do you suspect

N/V
Epigastric pain
Headache
Vision problems
Hepatic dysfunction
liver failure
Acute renal failure
DIC
Respiratory Failure
Multi-organ system failure

A

HELLP Syndrome

25
Q

What does HELLP Syndrome stand for?

A

H-Hemolysis
E-Elevated
L-Liver Enzynes
L-Low
P-Platelets

26
Q

How to treat HELLP Syndrome

9

A
  • Priority is to deliver the baby
  • Fresh frozen plasma
  • Antihypertensive
  • Magnesium Sulfate Infusion
  • Keep calcium gluconate immediately available
  • Continuous monitoring of mother-fetus
  • Strict Bedrest
  • Hourly urine output measurement
  • Strict I and O
27
Q

Assessment tool for pre-eclampsia

Think SPASMS

A

S – Significant blood pressure changes may occur without warning
P – Proteinuria is a serious sign of renal involvement
A – Arterioles are affected by vasospasms that result in endothelial damage and leakage of fluid into the interstitial spaces. Edema occurs.
S – Significant lab changes (Elevated LFTS and decreased platelet count) signal worsening of condition.
M – Multiple organ systems involved (CV, Hematological, Hepatic, Renal, and CNS)
S – Symptoms appear after 20 weeks gestation

28
Q

parameters for diagnosing someone with pre-eclampsia with severe features

A

BP > 160/ > 110 …..while on bedrest, on two occasions at least 4 hours apart

29
Q

If pre-eclampsia continues to deteriorate what should you prepare for?

A
  • Prepare for induction of labor
  • Prepare for C-section delivery as indicated
  • Prepare for delivery of pre-term infant
  • Resuscitation supplies at bedside
  • Additional staff designated to care for pre-term infant
  • Provide teaching and support to the client and family
30
Q

HTN medications that are safe for pregnant patients

A
  • Labetalol
  • Nifedipine
  • Hydralazine
  • Sodium Nitroprusside
  • HCTZ
31
Q

A positive clonus and hyper-reactive DTR indicates what?

A

CNS Irritibility and increased risk for seaizures

NUR 213 (29 decks)

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