Week 3 Hemodynamic Monitoring & Cardiovascular Flashcards
Hemodynamic monitoring
- Measurement of pressure flow & oxygenation within CV system
- Purpose: Assess heart fxn, fluid balance, & effects of fluids & drugs on CO
Cardiac output (CO)
- Definitions
- ↓CO s/s
- Meds ↑CO
Cardiac index (CI)
CO adjusted for body surface area (BSA)
Stroke volume (SV)
Volume of blood coming out of aorta w/ every heartbeat
Stroke volume index
SV adjusted to BSA
Systemic vascular resistance (SVR)
Opposition encountered by left ventricle
Pulmonary vascular resistance
- Opposition encountered by right ventricle
- Resistance to blood flow by vessels
Stroke volume variation (SVV)
- Variation of arterial pulsation caused by heart-lung interaction
+ Sensitive indicator if preload responsiveness
+ Helps predict if pt benefits from additional IV fluid boluses
Preload
- Volume that fills up at end-diastole
- Low v High preload
- Measurements of L & R sided preload
Afterload
- Forces/resistance ventricles has to overcome to push blood forward
- Measurements of L & R sided afterload
Diastole
When heart is filling; amt of filling in ventricles at end-diastole (preload)
Systole
Time when heart contracts
Contractility
- Strength of ventricular contraction
- Positive inotropes (↑contractility)
- Negative inotropes (↓contractility)
Formula for CO
Cardiac output = HR x Stroke volume
Pulmonary artery catheter (Swanz Ganz)
- Obtains measurements for fluid status, cardiac status, & heart fxn
- Indications
- Characteristics
+ Insertion - Complications
- Lumens (blue, white, red, yellow)
- Pulmonary artery wedge pressure (PAWP)
- Line placement procedure
- Ensure accuracy
- Infection prevention
Arterial line (A-line)
- Indications
- Insertion
- Main purpose
- Characteristics
- Invasive arterial BP monitoring
+ Purpose
+ Zero-reference point
+ Square wave test - Complications
- Documentation
Acute Coronary Syndrome (ACS)
- Blood supply to heart muscle SUDDENLY blocked (by thrombus made of plaque)
- STEMI v NSTEMI
- Stable v Unstable angina
- S/S + Assessment
- Priority intervention
- Diagnostics
+ Cardiac biomarkers - Procedures
+ Angiography/Cardiac catheterization
+ Angioplasty balloon - Post-angio site care
- Priority nursing considerations
+ Pt comes in w/ CP
+ Unstable angina & NSTEMI
+ STEMI - Nutrition
- Complications
ACS Medication: Vasodilators
- Nitroglycerin
- Actions
- Nursing actions
ACS Medication: Analgesics
- Morphine
- Actions
- Nursing actions
ACS Medication: Beta-blockers
- Metoprolol
- Actions
- Nursing actions
ACS Medication: Thrombolytics
- Alteplase
- Action
- Nursing actions
- STEMI v NSTEMI
ACS Medication: Antiplatelets
- Aspirin & Clopidogrel (Plavix)
- Actions
- Nursing actions
ACS Medication: Anticoagulants
- Heparin & Enoxaparin
- Actions
- Nursing actions
ACS Medication: Lipid lowering statin
- Atorvastatin
- Actions
- Nursing actions
Coronary Artery Bypass Graft (CABG)
- Surgical procedure to restore vascularization of myocardium & improve client quality of life; open heart surgery
- Indications
- Machine
+ Pre-procedure
+ Post-procedure - Common grafts/vessels used
- Complications
Pacemakers
- Helps control abnl heart rhythms w/ low-electrical pulses to prompt heart to beat at normal rate
- Types (Transcutaneous, epicardial, transvenous)
- Indications
+ Implantable Cardioverter/Defibrillator (ICD)
+ Pacemaker - A/V-paced PM
- Nursing care
+ ECG monitoring for malfunction
+ Complications
Aneurysm
- Weakness in a section of a dilated ARTERY => Widening or balloon in wall of blood vessel
- Risk factors
- Types (saccular v fusiform)
- Common sites
+ Aortic dissection
+ Thoracic aortic aneurysm
+ Abdominal aortic aneurysm - Nursing priorities
- Complications
- Tx & nursing interventions
Abdominal Aortic Aneurysm (AAA)
- Risk factors
+ Non/modifiable - Complications
- Diagnostics
- Manifestations
+ Asymptomatic
+ Symptomatic - Aneurysm rupture s/s
- Treatments
Aortic Dissection
- Blood accumulating through inner layer of aorta => TEAR b/w inner & middle layers => Splits apart aorta (dissect)
- Manifestations
+ Acute Type A/B
+ Dissection pain v. MI pain
+ Aortic arch involved
+ Type A
+ Subclavian artery
+ Aortic progression - Classifications
+ Location of dissection
+ Duration of onset - Risk factors
- Diagnostics
- Treatments
- Nursing interventions
+ Preoperative
+ Postoperative
+ Discharge teaching
