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COMPLEX - nicole > Week 4 - Cardiac Appraisal > Flashcards

Week 4 - Cardiac Appraisal Flashcards

1
Q

Regurgitation

A

Valves aren’t able to close properly –> retrograde of blood

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2
Q

Stenosis

A

Valves cannot open properly –> retrograde of blood

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3
Q

Grading of Murmurs

A 
1 - barely heart with stethoscope 
2 - Faint 
3 - Moderately Loud
4 - Loud
5 - Heard with edge of stethoscope on chest 
6 - Heard without touching
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4
Q

Thrills

A

Feel the murmur

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5
Q

Bruit

A

Hear the murmur

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6
Q

Mitral Regurgitation

A
  • Failure of mitral valve closure
  • Heard on systole
  • Leads to pulmonary edema and heart failure
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7
Q

Aortic Stenosis

A
  • Resistance of aortic valve opening on systole

- Leads to pulmonary edema and HF

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8
Q

S1

A
  • Closing of AV valves
  • Indicates beginning of systole
  • Best heard over the Apex (5th intercostal space along MCL)
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9
Q

S2

A
  • Closing of semilunar valves
  • Indicates end of systole
  • Best heard over the Base (2nd intercostal space)
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10
Q

S3

- alternate name?

A

Ventricular Gallop

  • Decreased L ventricular compliance
  • Early sign of HF (check BNP!)
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11
Q

S4

- alternate name?

A

Atrial Gallop

  • Sign of stiff ventricles
  • Sign for MI, ventricular hypertrophy, stenosis
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12
Q

Risks for patients with valve defects

A

LOW CO

  • Syncope
  • Angina
  • Infective Endocarditis
  • Dysrhythmia
  • HF
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13
Q

Preload

A

Volume in the ventricles at the end of diastole

  • decreased in hypovolemia
  • increased in constriction
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14
Q

4 Vs Affecting Preload

A
  • Volume
  • Veins
  • Ventricular
  • Ventilation
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15
Q

Afterload

A

Resistance that ventricles must overcome during systolic ejection = systemic arterial pressure
- increased in stenosis, HTN

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16
Q

3 Ps that control Afterload

A
  • Pee it
  • Pump it
  • Pool it
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17
Q

TEE - Transesophageal Echocardiography look at…. (5)

A
  • Heart size
  • Wall motion, thickness
  • Diagnosis for valve defects
  • Looks for thrombi (TEE is done before cardioversion)
  • Estimates ejection fraction
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18
Q

Hemodynamic Monitoring

A

Measures:

  • pressure
  • flow
  • oxygenation

in the cardiovascular system

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19
Q

CVP - Central Venous Pressure

A

Measures R ventricular preload pressure

- tip goes through jugular or subclavian vein –> vena cava –> R atrium

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20
Q

CVP manual level

A

3-12 cm/H2O

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21
Q

CVP computerized level

A

2-9 mmHg

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22
Q

Swanz Ganz Catheter (pulmonary artery catheter)

A

Sees what is happening in the L ventricle

  • allows for therapeutic manipulation of preload
  • inflated/wedged at pulmonic valve
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23
Q

How do you confirm Swanz placement?

A

X ray

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24
Q

Possible complications associated with pulmonary catheter

A
  • INFECTION
  • Air embolus
  • Thrombus
  • Arrhythmia
  • Pulmonary rupture
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25
Q

Principles of Invasive Pressure Monitoring

A
  • zero balance equipment
  • position the transducer at the PHLEBOSTATIC axis (level of atria)
  • always flush with saline
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26
Q

If the transducer is not at the phlebostatic axis…

A
  • HIGHER –> falsely low

- LOWER –> falsely high

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27
Q

What would decrease CVP?

A

LACK of VOLUME

  • dehydration
  • diuresis
  • shock
  • cardiac arrest
  • arrhythmia
  • bleeding
28
Q

Clinical implications of decreased CVP

A
  • Vasopressors
  • Fluid replacement
  • Blood
29
Q

What would increase CVP?

A

CONGESTION

  • HTN
  • Cardiomyopathy
  • HF
  • Fluid overload
  • Pulmonary edema
  • Hyperthyroid crises
  • Sepsis
  • MI
30
Q

Clinical implications of increased CVP

A

3 Ps

31
Q

PAP - Pulmonary artery pressure is measured when?

A

End of expiration

32
Q

PAS - pulmonary artery systolic pressure

A

20-30

33
Q

PAD - pulmonary artery diastolic pressure

A

5-10

34
Q

PAOP - pulmonary artery occlusion pressure (wedge pressure)

A

5-12 mmHg

35
Q

CO equation

A

SV x HR

36
Q

Normal CO

A

4-6 liters/min

37
Q

Normal SV

A

60-150 mL/beat

38
Q

What would decrease CO?

A

Opposite of CVP, PAS, PAD, PAOP – congestion!

  • HF
  • Cardiac arrest
  • MI
39
Q

Implications for decreased CO

A

3 Ps!

40
Q

What would increase CO?

A
  • Hypermetabolic states
  • Hyperdynamic
  • Fever
  • HTN
41
Q

Cardiac Index

A

More specific CO because it takes into account BSA

42
Q

Normal CI

A

2.2 - 4.0 liters/min/m2

43
Q

PAWP and CO have…

A

an inverse relationship

44
Q

Intra-Arterial Line

A

Continuous arterial pressure monitoring

  • indicated for low CO, poor volume status, inadequate tissue perfusion
  • more accurate BP
45
Q

MAP

A 
Mean Arterial Pressure
- more accurate BP 
- good picture of perfusion to major organs 
< 60 = hyperperfusion 
> 60 is better
70 - 90 is ideal for cardiac patients
46
Q

A Line Continuous Flush Irrigation System

A

Delivers 3 mL of saline/hr to

  • maintain line patency
  • limit thrombus formation
47
Q

For a patient with an A Line

A

Assess neurovascular status distal to arterial insertion site hourly

48
Q

When removing A Line

A

Apply pressure for 5-10 minutes and monitor site for bleeding

49
Q

Venous Oxygen Saturation (SvO2/ScvO2)

A

Shows balance between oxygenation of arterial blood + perfusion + tissue oxygen consumption
- shows the amount of O2 in the VEINS

50
Q

SvO2 rises when there is

A

Decrease in O2 demand

  • anesthesia
  • hypothermia
  • worsening sepsis
  • can indicate worsening or improvement
51
Q

SvO2 lowers in…

A
  • decreased arterial O2
  • low Co2 (high O2 demand)
  • low hemoglobin
  • increased oxygen consumption
52
Q

Nursing management in hemodynamic monitoring

A
  • general appearance
  • LOC
  • skin/temp
  • vitals
  • pulses
  • urine output
  • LABS - monitor trends
53
Q

Post op pacemaker

A
  • Incision site
  • Xray for placement
  • Minimize movement
  • 12 ECG
  • Patient teaching
54
Q

First letter on pacemaker code

A

Chamber PACED

55
Q

Second letter on pacemaker code

A

Chamber SENSED

56
Q

Third letter on pacemaker code

A

Response to sensing

57
Q

Most common code

A

DDD

  • both chambers paced
  • both chambers sensed
  • triggers and inhibits based on sensing
58
Q

Failure to Sense

A

Pacemaker does NOT recognize spontaneous activity and fire inappropriately

59
Q

Failure to Capture

A

When the electrical charge to the heart is insufficient to produce atrial or ventricular contractions

60
Q

Cardioversion delivers what kind of shock on …

A

Synchronized shock on the R wave

61
Q

Cardioversion indications

A
  • A fib
  • A flutter
  • V tach with a pulse
  • SVT
62
Q

Cardioversion Biphasic

A

AF - 120-200J
Unstable AFL & SVT 50-100 J
Monomorphic VT - 100 J

63
Q

Cardioversion Monophasic

A

AF - 200 J
AFL & SVT - 200 J
Monomorphic, Unstable with pulse - 100J

64
Q

Defibrillation

A

A-Synchronized shock delivered at any time

65
Q

Defibrillation Indications

A
  • V Fib
  • V Tach without a pulse
  • Torsade de Pointes
66
Q

Defibrillation Biphasic

A

Initial dose 120-200 J

  • if machine type is unknown –> use max available
  • second and subsequent doses should be same
67
Q

Defibrillation Monophasic

A
  • 360 (initial)

COMPLEX - nicole (10 decks)

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