T1: Cardiovascular Assessment (2)

Question 1

What information does HEMODYNAMIC MONITORING provide?

Answer 1

(Continuously shows the BP)

• vascular capacity
• blood volume
• pump effectiveness
• tissue perfusion

Question 2

Hemodynamic monitoring is usually done in the _____ artery.

Answer 2

Radial

Question 3

Responsibilities of the nurse during hemodynamic monitoring:

Answer 3

• What is being MEASURED?
• Is the device ACCURATE & working properly?
• Survey for COMPLICATIONS
• Monitor for TRENDS in values
• What other PARAMETERS need to be assessed?
• When, what, who to NOTIFY?

Question 4

Components of hemodynamic monitoring equipment:

Answer 4

• high pressure tubing
• flush system
• transducer
• monitor

Question 5

What is the pressure bag set at?

Answer 5

300 mmHg

Question 6

Where is the transducer positioned?

Answer 6

phlebostatic axis

Question 7

Where is the phlebostatic axis?

Answer 7

4th intercostal space, mid-way of the AP diameter of chest

Question 8

What should the bed position be during hemodynamic monitoring?

Answer 8

Keep consistent at 0-60 degrees

Question 9

To calibrate, “zero” with transducer open to _____ _____ every shift and every position change.

Answer 9

atmospheric pressure

Question 10

What does a FAST FLUSH WAVEFORM TEST evaluate?

Answer 10

checks the monitoring system’s ability to transmit accurate waveforms

Question 11

What is an Allen’s test?

Answer 11

checks patency in both radial & ulnar arteries

Question 12

If the systolic BP declines > 10 mmHg during INSPIRATION during normal spontaneous respiration, this is called ____ ____. What condition does this often accompany?

Answer 12

pulsus paradoxus

cardiac tamponade

Question 13

When the pulse alternates in strength it is called ____ ____. What condition is this seen in?

Answer 13

pulsus alterans

heart failure

Question 14

4 common locations of a central line:

Answer 14

1) internal jugular
2) subclavian
3) femoral
4) peripheral

Question 15

4 values of a central line:

Answer 15

1) provides access for RAPID INFUSION of large volumes of fluid or blood
2) safer for infusion of CAUSTIC meds
3) allows measurement of filling PRESSURES of the right side of heart
4) can be used to measure MIXED VENOUS blood

Question 16

Complications of central lines:

Answer 16

• INFECTION!!!
• pneumothorax
• bleeding
• thrombus
• air embolus

Question 17

Interventions for air embolus:

Answer 17

(treat the pt first, THEN call for help…or have someone else call while you intervene)

• Trendelenburg
• left side
• 100% O2
• notify MD

Question 18

What is a CLABSI?

Answer 18

central line associated blood stream infection

Question 19

Name 2 ways central venous pressure (CVP) is measured:

Answer 19

• H2O manometer (intermittent)

- Mercury (continuous)

Question 20

H2O manometer normal value:

Answer 20

3-8 cm H2O

Question 21

Mercury normal value:

Answer 21

2-5 mmHg

Question 22

A pulmonary artery catheter monitors the pressure of the ___ ___.

Answer 22

left ventricle

Question 23

What needs to function normally for the pulmonary artery pressure to be accurate?

Answer 23

heart valves

Question 24

Normal PAS pressure:

Answer 24

20-30 mmHg

systolic pressure of pulmonary artery

Question 25

Normal PAD pressure:

Answer 25

5-10 mmHg | diastolic pressure of the pulmonary artery

Question 26

Normal PAPm:

Answer 26

10-15 mmHg | mean pressure of the pulmonary artery

Question 27

Normal PAWP:

Answer 27

(Remember, animals have 4 paws) 4-12 mmHg AKA PAOP...reflects the filling pressures in the pulmonary vasculature LEFT sided pressures

Question 28

Central venous pressure (CVP) measures ____ side of the heart. Wedge pressure measures ____ side of the heart.

Answer 28

CVP --> RIGHT (remember the venous system feeds into the right side of the heart) Wedge --> LEFT (remember the wedge pressure is in the pulmonary artery which feeds into the left side of the heart)

Question 29

Right side of heart: | Normal preload pressure

Answer 29

2-5 mmHg

Question 30

Right side of heart: | ____ reflects filling pressures

Answer 30

CVP (central venous pressure) | AKA: RVEDP, right ventricular end diastolic pressure

Question 31

Right side of heart: | Abnormal values are caused by what 4 things?

Answer 31

1) volume overload 2) right heart failure 3) dehydration 4) hypovolemia

Question 32

Right side of heart: | Treatment for abnormal values:

Answer 32

- diuretics - fluid restriction - fluid bolus - blood or blood products

Question 33

Left side of heart: | Normal preload pressure

Answer 33

5-12 mmHg

Question 34

Left side of heart: | ____ reflects filling pressures

Answer 34

PAWP (pulmonary artery wedge pressure) | AKA: LVEDV, left ventricular end diastolic pressure

Question 35

Left side of heart: | Abnormal values are caused by what 4 things?

Answer 35

1) volume overload 2) left heart failure 3) dehydration 4) hypovolemia

Question 36

Left side of heart: | Treatment for abnormal values:

Answer 36

- fluid restriction - venodilation - diuresis - fluid - blood & blood products

Question 37

What is SVR (peripheral vascular resistance)?

Answer 37

Resistance of ejection of blood from the LEFT side of the heart

Question 38

Normal SVR:

Answer 38

800-1400 dynes/sec/cm-5

Question 39

Formula for SVR:

Answer 39

(MAP-CVP/CO) x 80

Question 40

Drugs to INCREASE SVR:

Answer 40

dopamine, norepinephrine | vasoconstriction & increased CO

Question 41

Drugs to DECREASE SVR:

Answer 41

nitroprusside, NTG, hydralazine | vasodilation

Question 42

What is PVR (pulmonary vascular resistance)?

Answer 42

Resistance of ejection of blood from RIGHT side of heart

Question 43

Normal PVR:

Answer 43

100-250 dynes/sec/cm-5

Question 44

PVR is ___ of SVR.

Answer 44

1/6th

Question 45

What 4 factors effect CONTRACTILITY?

Answer 45

1) preload volume 2) afterload 3) drugs with positive inotropic effects 4) drugs with negative inotropic effects

Question 46

How is LEFT SIDED preload volume measured?

Answer 46

PAOP

Question 47

How is LEFT SIDED afterload measured?

Answer 47

SVR

Question 48

What drugs have POSITIVE inotropic effects?

Answer 48

dopamine | dobutamine

Question 49

What drugs have NEGATIVE inotropic effects?

Answer 49

beta blockers | calcium channel blockers

Question 50

What 2 ways can contractility be measured?

Answer 50

- cardiac output (from swangans catheter) | - left ventricular stroke work index (LVSWI)

Question 51

What 3 things effect stroke volume?

Answer 51

preload afterload contractility

Question 52

What 2 things effect cardiac output?

Answer 52

HR x SV = CO