Week 4 - Cardiac Appraisal Flashcards
1
Q
Regurgitation
A
Valves aren’t able to close properly –> retrograde of blood
2
Q
Stenosis
A
Valves cannot open properly –> retrograde of blood
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
4
Q
Thrills
A
Feel the murmur
5
Q
Bruit
A
Hear the murmur
6
Q
Mitral Regurgitation
A
- Failure of mitral valve closure
- Heard on systole
- Leads to pulmonary edema and heart failure
7
Q
Aortic Stenosis
A
- Resistance of aortic valve opening on systole
- Leads to pulmonary edema and HF
8
Q
S1
A
- Closing of AV valves
- Indicates beginning of systole
- Best heard over the Apex (5th intercostal space along MCL)
9
Q
S2
A
- Closing of semilunar valves
- Indicates end of systole
- Best heard over the Base (2nd intercostal space)
10
Q
S3
- alternate name?
A
Ventricular Gallop
- Decreased L ventricular compliance
- Early sign of HF (check BNP!)
11
Q
S4
- alternate name?
A
Atrial Gallop
- Sign of stiff ventricles
- Sign for MI, ventricular hypertrophy, stenosis
12
Q
Risks for patients with valve defects
A
LOW CO
- Syncope
- Angina
- Infective Endocarditis
- Dysrhythmia
- HF
13
Q
Preload
A
Volume in the ventricles at the end of diastole
- decreased in hypovolemia
- increased in constriction
14
Q
4 Vs Affecting Preload
A
- Volume
- Veins
- Ventricular
- Ventilation
15
Q
Afterload
A
Resistance that ventricles must overcome during systolic ejection = systemic arterial pressure
- increased in stenosis, HTN
16
Q
3 Ps that control Afterload
A
- Pee it
- Pump it
- Pool it
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
18
Q
Hemodynamic Monitoring
A
Measures:
- pressure
- flow
- oxygenation
in the cardiovascular system
19
Q
CVP - Central Venous Pressure
A
Measures R ventricular preload pressure
- tip goes through jugular or subclavian vein –> vena cava –> R atrium
20
Q
CVP manual level
A
3-12 cm/H2O
21
Q
CVP computerized level
A
2-9 mmHg
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
23
Q
How do you confirm Swanz placement?
A
X ray
24
Q
Possible complications associated with pulmonary catheter
A
- INFECTION
- Air embolus
- Thrombus
- Arrhythmia
- Pulmonary rupture
25
Principles of Invasive Pressure Monitoring
- zero balance equipment
- position the transducer at the PHLEBOSTATIC axis (level of atria)
- always flush with saline
26
If the transducer is not at the phlebostatic axis...
- HIGHER --> falsely low
| - LOWER --> falsely high
27
What would decrease CVP?
LACK of VOLUME
- dehydration
- diuresis
- shock
- cardiac arrest
- arrhythmia
- bleeding
28
Clinical implications of decreased CVP
- Vasopressors
- Fluid replacement
- Blood
29
What would increase CVP?
CONGESTION
- HTN
- Cardiomyopathy
- HF
- Fluid overload
- Pulmonary edema
- Hyperthyroid crises
- Sepsis
- MI
30
Clinical implications of increased CVP
3 Ps
31
PAP - Pulmonary artery pressure is measured when?
End of expiration
32
PAS - pulmonary artery systolic pressure
20-30
33
PAD - pulmonary artery diastolic pressure
5-10
34
PAOP - pulmonary artery occlusion pressure (wedge pressure)
5-12 mmHg
35
CO equation
SV x HR
36
Normal CO
4-6 liters/min
37
Normal SV
60-150 mL/beat
38
What would decrease CO?
Opposite of CVP, PAS, PAD, PAOP -- congestion!
- HF
- Cardiac arrest
- MI
39
Implications for decreased CO
3 Ps!
40
What would increase CO?
- Hypermetabolic states
- Hyperdynamic
- Fever
- HTN
41
Cardiac Index
More specific CO because it takes into account BSA
42
Normal CI
2.2 - 4.0 liters/min/m2
43
PAWP and CO have...
an inverse relationship
44
Intra-Arterial Line
Continuous arterial pressure monitoring
- indicated for low CO, poor volume status, inadequate tissue perfusion
- more accurate BP
45
MAP
```
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
A Line Continuous Flush Irrigation System
Delivers 3 mL of saline/hr to
- maintain line patency
- limit thrombus formation
47
For a patient with an A Line
Assess neurovascular status distal to arterial insertion site hourly
48
When removing A Line
Apply pressure for 5-10 minutes and monitor site for bleeding
49
Venous Oxygen Saturation (SvO2/ScvO2)
Shows balance between oxygenation of arterial blood + perfusion + tissue oxygen consumption
- shows the amount of O2 in the VEINS
50
SvO2 rises when there is
Decrease in O2 demand
- anesthesia
- hypothermia
- worsening sepsis
- can indicate worsening or improvement
51
SvO2 lowers in...
- decreased arterial O2
- low Co2 (high O2 demand)
- low hemoglobin
- increased oxygen consumption
52
Nursing management in hemodynamic monitoring
- general appearance
- LOC
- skin/temp
- vitals
- pulses
- urine output
- LABS - monitor trends
53
Post op pacemaker
- Incision site
- Xray for placement
- Minimize movement
- 12 ECG
- Patient teaching
54
First letter on pacemaker code
Chamber PACED
55
Second letter on pacemaker code
Chamber SENSED
56
Third letter on pacemaker code
Response to sensing
57
Most common code
DDD
- both chambers paced
- both chambers sensed
- triggers and inhibits based on sensing
58
Failure to Sense
Pacemaker does NOT recognize spontaneous activity and fire inappropriately
59
Failure to Capture
When the electrical charge to the heart is insufficient to produce atrial or ventricular contractions
60
Cardioversion delivers what kind of shock on ...
Synchronized shock on the R wave
61
Cardioversion indications
- A fib
- A flutter
- V tach with a pulse
- SVT
62
Cardioversion Biphasic
AF - 120-200J
Unstable AFL & SVT 50-100 J
Monomorphic VT - 100 J
63
Cardioversion Monophasic
AF - 200 J
AFL & SVT - 200 J
Monomorphic, Unstable with pulse - 100J
64
Defibrillation
A-Synchronized shock delivered at any time
65
Defibrillation Indications
- V Fib
- V Tach without a pulse
- Torsade de Pointes
66
Defibrillation Biphasic
Initial dose 120-200 J
- if machine type is unknown --> use max available
- second and subsequent doses should be same
67
Defibrillation Monophasic
- 360 (initial)
