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331 > week 5 > Flashcards

week 5 Flashcards

1
Q

Sodium Nitroprusside MOA

A

Acts directly on vascular smooth muscle to cause vasodilation and drop of BP; does not inhibit CV reflexes and tachycardia; renin release will occur

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2
Q

Sodium Nitroprusside indications

A

Severe HTN, maintenance of controlled hypotension during anesthesia or acute heart failure

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3
Q

Sodium Nitroprusside Nursing interventions

A

Protect from light
Monitor BP, HR, Rhythm, LOC
Toxicity: metabolizes to cyanide– monitor for change in LOC, delirium
Follow via lab draw

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4
Q

Nitroglycerine (NTG) MOA

A

Forms free radical nitric oxide (NO) which activates guanylate cyclase, resulting in an increase of guanosine 3’5’ monophosphate (cyclic GMP) in smooth muscle and other tissues

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5
Q

Nitroglycerine (NTG) indications

A

Perioperative HTN, angina, CHF in the setting of MI

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6
Q

Nitroglycerine (NTG) nursing interventions

A

Monitor for headache, chest pain, hypotension and reflex tachycardia
Monitor LOC

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7
Q

Milrinone indications

A

Cardiac support in patients with acute heart failure, pulmonary HTN, or chronic heart failure; Indicated for ST use for those who didn’t respond to digoxin or diuretics; limited to severe situations

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8
Q

Milrinone MOA

A

Positive inotrope and vasodilator; blocks enzye phosphodiesterase inhibitor leading to increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium level in the cell, leading to increased contraction, vasodilation, oxygen consumption, and arrhythmias

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9
Q

milrinone nursing interventions

A

Monitor for DECREASEDE BP, HR and cardiac dysrhythmias, LOC
Urine output, skin color, assess for perfusion
Invasive: CO
Sudden Cardiac Death r/t toxicity

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10
Q

Dobutamine indications

A

Cardiac decompensation due to depressed contractility; low cardiac output

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11
Q

Dobutamine MOA

A

Inotropic; increases contractility, leading to decreased end-systolic volume and increase SV

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12
Q

Dobutamine nursing interventions

A

Monitor BP, HR, Cardiac Rhythm, LOC
Assess skin, capillary refill, urine output
Invasive: Monitor CO & CI

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13
Q

phenylephrine indications

A

Hypotension resulting primarily from vasodilation in settings such as shock or anesthesia

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14
Q

phenylephrine MOA

A

Activation of Alpha1 receptors, increasing systemic vascular resistance without an associated increase in contractility

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15
Q

phenylephrine nursing interventions

A

Monitor BP, HR and urine out.
Monitor IV site for infiltration and extravasation

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16
Q

Norepinephrine indications

A

Treatment of acute hypotensive states

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17
Q

norepinephrine MOA

A

Acts predominantly on alpha-adrenergic receptors to produce constriction of resistance; increasing systemic blood pressure and coronary artery blood flow

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18
Q

norepinephrine nursing interventions

A

Monitor blood pressure, heart rate and urine output
Monitor IV site for infiltration and extravasation

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19
Q

epinephrine indications

A

Treatment of hypotension associated w/shock; Emergency treatment of anaphylaxis; Produce a local vasoconstriction that prolongs the effects of local anesthetics

20
Q

epinephrine MOA

A

binds w/ both α and β adrenergic receptors to cause vasoconstriction and vasodilation; smooth muscle contraction in blood vessels in skin, GI tract, kidney, and brain

21
Q

epinephrine nursing interventions

A

Assess lung sounds, respiratory pattern, BP and HR
Can cause tachycardia, hypertension
May cause coronary ischemia, and arrhythmias.

22
Q

epinephrine side effects

A

Pallor, tachycardia and palpitations, nervousness, muscle twitching, sweating, anxiety, insomnia, hypertension, headache and hyperglycemia.

23
Q

dopamine indications

A

Correction of hemodynamic imbalances present in shock

24
Q

dopamine MOA

A

Acts directly and by release of norepinephrine from sympathetic nerve terminals

25
Q

dopamine nursing interventions

A

Monitor blood pressure, urine output, cardiac output
Monitor IV site

26
Q

formula for cardiac output

A

CO= HR x Stroke volume

27
Q

what is stroke volume

A

amount of blood ejected each time LEFT ventricle contracts

28
Q

what affects stroke volume

A

preload, afterload, contractility

29
Q

what is preload?

A

myocardial stretch just before contraction

30
Q

what is afterload?

A

pressure to overcome ventricle to open aortic valve

31
Q

What does a low MAP mean for the patient?

A

tissue and organ ischemia

32
Q

what does a high MAP mean?

A

> 100 indicates elevated pressure in the arteries

33
Q

Hemodynamic Numbers: what is the Phlebostatic Axis?

A

where the stopcock of the transducer is positioned at the level of the atrium

34
Q

Hemodynamic Numbers: where is the Phlebostatic Axis?

A

0-60 degrees
4th intercostal space
mid-axillary line
*PAP monitoring

35
Q

Hemodynamic Numbers: PA & PA-Wedge

A

Left sided heart function

36
Q

Hemodynamic Numbers: Cardiac Output (CO) & Cardiac Index (CI)

A

blood ejected per min
-indicates tissue perfusion

37
Q

Normal Ranges: MAP

A

65-70 mmHg (65)

38
Q

Normal Ranges: SVR

A

800-1200 dyn/sec/cm

39
Q

Normal Ranges: CVP

A

2-8 mmHg

40
Q

Normal Ranges: PAWP

A

4-12 mmHg

41
Q

Normal Ranges: CO

A

4-7 L/min

42
Q

Normal Ranges: CI

A

2.7-3.2 L/min/m2

43
Q

Line Priorities: CVP Central Venous Pressure monitoring

A

XRay to confirm placement

44
Q

Line Priorities: Arterial Line

A

ischemia from catheter

45
Q

What is SVR?

A

Systemic Vascular Resistance (SVR)- amount of resistance blood viscosity and arteriolar diameter the left ventricle must overcome

46
Q

What is PVR?

A

Pulmonic Vascular Resistance (PVR)- amount of resistance blood viscosity and arteriolar diameter the right ventricle must overcome

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