G270 Exam #2 > Hemodynamics > Flashcards

Hemodynamics Flashcards

(46 cards)

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1
Q

Hemodynamics Goal

A

delivery of oxygen

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2
Q

biggest factors of hemodynamic monitoring

A

Hg and SaO2

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3
Q

normal Stroke Volume

A

60-120 ml/beat

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4
Q

What is. CVP?

A

volume reaching the right ventricle

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5
Q

What is PCWP?

A

indirect measure of volume left ventricle volume (uses Pulmonary Artery Catheter wedged in a branch of the pulmonary artery)

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6
Q

Normal preload values for right and left ventricle

A

R: ventricle CVP- 2-6 mmHg

L Ventricle: PCWP-6-12 mmHg

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7
Q

How to increase preload (5)

A
  • Increase fluids (NS, LR): bolus
  • Colloids (blood, albumin)
  • Vasoconstrictors
  • Anti-embolism stockings
  • Elevate the legs
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8
Q

How to decrease preload (3)

A
  • Decrease fluids
  • Vasodilators: ex. Hydralazine
  • Diuretics: ex. Furosemide
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9
Q

What is afterload? What is it based on?

A
  • Pressure LV must overcome to eject stroke volume

- Based on distensibility or compressibility of arterial vessels

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10
Q

normal LV afterload

A

Systemic Vascular Resistance (SVR): 800-1200 dynes/sec/cm-3

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11
Q

Normal RV afterload

A

: Peripheral Vascular Resistance (PVR) 150-250 dynes/sec/cm-3

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12
Q

in afterload….increased ___= decreased __

A

SVR=CO

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13
Q

How to increase afterload (2)

A
  • fluids

- vasoconstrictors

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14
Q

how to decrease afterload (2)

A
  • fluids

- vasodilators

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15
Q

What is contractility dependent on?

A

oxygenation and electrolyte balance

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16
Q

How to enhance contractility

A

Calcium, catecholamines

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17
Q

How to decrease contractility

A

dopamine, norepinephrine, epinephrine

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18
Q

Determinants of SV (3)

A
  • preload
  • afterload
  • contracility
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19
Q

stroke volume definition

Study These Flashcards
A

blood ejected by the heart per BEAT

20
Q

CO definition

Study These Flashcards
A

volume of blood ejected each minute

21
Q

CO equation

22
Q

normal CO range

23
Q

difference between CO and cardiac index

Study These Flashcards
A

cardiac index takes into consideration the patient’s body surface area

24
Q

Cardiac index equation

25
factors causing Low CO (inadequate left ventricular filling)- 7
* Tachycardia * Dysrhythmias * Hypovolemia * Mitral or tricuspid stenosis * Pulmonic stenosis * Constrictive pericarditis or tamponade * Restrictive cardiomyopathy
26
factors causing Low CO (inadequate left ventricular ejection)-7
* CAD causing LV ischemia or infarction * Myocarditis, Cardiomyopathy * Increased afterload (HTN, aortic stenosis) * Mitral regurgitation * NEGATIVE inotropes * Metabolic disorders
27
decreased perfusion fail safe mechanisms primary (skin and GI)-4
- cool, clammy, cyanotic, ashen skin - decreased Bowel sounds - constipation or diarrhea - increased GI tube output
28
decreased perfusion fail safe mechanisms secondary (kidneys, liver, lungs)-6
- increased RR and effort - SOB - decreased UO - increased BUN, creatinine, K+ - decreased GFR - increased ALT, AST, coag times
29
decreased perfusion fail safe mechanisms final (brain and heart)-6
- ALOC - slow reacting pupils - chest pain or pressure - tachy or bradycardia - arrythmias - ST elevation
30
Noninvasive hemodynamic monitoring-4
- MAP - JVP - serum lactate - BP Cuff
31
map should be above......
65
32
What does measuring JVD estimate
CVP
33
What does serum lactate show?
information on end organ perfusion
34
Normal CVP
2-6 mmHg
35
Causes of increased CVP-4
- fluid overload - cardiac tamponade - R heart dysfunction (cor pulmonale) - venoconstriction
36
causes of decreased CVP-3
- dehydration - volume loss - venodilaton
37
Arterial line monitoring nursing responsibilities
- Patient education - Gather equipment - Assist provider: set up pressure bag (300 mm Hg), prime tubing - Zero/level transducer (phlebostatic axis), monitor waveform - Dress site (Immobilize wrist, Limit flexion of hip to 30 degrees if femoral, Monitor for bleeding) - Compare to cuff
38
A-line complications-4
- Air embolus - Hemorrhage and Hematoma - Thrombosis: keep pressure bag full and at 300 pressure - Infection
39
What is Flo-Trac?
proprietary transducer added to a-line
40
flotrac limitations-4
 Spontaneous Breathing: inaccurate SVV  Open chest  Arrythmias  However provides hemodynamic measures without the need for a PA** catheter
41
Pulmonary artery pressure elevation causes (5)
* Pulmonary hypertension * Left ventricular failure * Mitral stenosis (stiff) * Mitral valve regurgitation (incompetent) * Atrial or septal defect
42
Normal PCWP
6-12 mmHg
43
causes of increased PCWP-7
- fluid overload - aortic stenosis - aortic regurgitation - mitral stenosis - LV failure - cardiac tamponade - constrictive pericarditis
44
causes of decreased PCWP-2
- hypovolemia | - vasodilation
45
PCWP Reminders (3)
 DO NOT LEAVE BALLOON INFLATED  NEVER INFLATE FOR > 10-15 SECs  Never pull back air from syringe-passive move
46
normal cardiac index
2.5-4.0
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