Hemodynamics

Question 1

What 3 organs will your body try to conserve at all costs ?

Answer 1

brain, lungs, heart

Question 2

What is the significance and causes of bradycardia ?

Answer 2

HR < 60
- Sign: below 60 the heart usually can’t push around a person’s entire blood volume sufficiently
- Causes: sinus node issue (HB 1-3 degree), drug overdose, hypothermia (causes decrease in metabolic activities that lowers HR)

Question 3

What is the significance and causes of tachycardia ?

Answer 3

HR > 100
- Sign: body’s way of compensating for failing body system (going too fast the heart can’t fully fill up)
- Causes: dehydration, blood loss, pain, fever, decreased O2 level, dysrhythmias

Question 4

What is an ideal MAP ?

Answer 4

> 65
- average pressure during one cardiac cycle

Question 5

What is central venous pressure (CVP) ?

Answer 5

indicates a persons fluid status
- indirect measurement: JVD, skin turgor, cap refill, passive leg raise
- direct measurement: distal port of a triple lumen catheter using a transducer

Question 6

What is stroke volume ?

Answer 6

amount of blood ejected with each heart beat

Question 7

How to calculate CO ?

Answer 7

stroke volume X heart rate

Question 8

What is systemic vascular resistance (SVR) ?

Answer 8

resistance the left ventricle must overcome to open the aortic valve to eject blood to the body
- vessel diameter will greatly impact SVR

Question 9

How will vasoconstriction effect hemodynamics (SVR, BP, CO) ?

Answer 9

• SVR will increase
• BP will increase
• CO will increase or decrease depending on HR

Question 10

How will vasodilation effect hemodynamics (SVR, BP, CO) ?

Answer 10

• SVR will be decreased (being septic will cause dilation)
• BP will be decreased
• CO will increase or decrease depending on HR

Question 11

What is pulmonary vascular resistance (PVR) ?

Answer 11

resistance the Rt ventricle must overcome to open the pulmonic valve and eject blood into the pulmonary system

Question 12

What pulmonary conditions might cause an increase in PVR ?

Answer 12

• pulmonary hypertension
• cystic fibrosis (will eventually lead to pulmonary HTN)

Question 13

What is pulmonary artery occlusive pressure (PAOP aka wedge) ?

Answer 13

pressure created by volume of blood in the Lt side of the heart at the end of diastole

Question 14

What is pulmonary artery systolic & diastolic (PAS/PAD) ?

Answer 14

BP within the pulmonary system
- Sildenafil/viagra can decrease this BP

Question 15

What are some causes of pulmonary HTN ?

Answer 15

• Lt-sided HF
• valvular heart disease
• congenital heart disease
• lung disease: hypoxia, COPD

Question 16

What monitoring device can measure CVP only ?

Answer 16

triple lumen catheter
- distal port

Question 17

What is preload ?

Answer 17

• VOLUME
• effected by atrial kick, # circulation volume, condition of vascular system
• measured via CVP, PAOP/wedge

Question 18

What is afterload ?

Answer 18

RESISTANCE
- effected by conditions of vascular system (dilated vs constricted, leaky, medications)
- measured via PVR and SVR

Question 19

What are examples of meds that cause vasodilation ?

Answer 19

• nitroglycerin
• nitroprusside

Question 20

What are examples of meds that cause vasoconstriction ?

Answer 20

• vasopressors: vasopressin
• Epinephrine
• Norepinephrine

Question 21

What is contractility ?

Answer 21

• how hard the heart squeezes
• effected by strength and condition of heart muscle, preload and afterload
• measured via BP, and EF

Question 22

What are some clinical manifestations and lab results of infection/sepsis/SIRS ?

Answer 22

• S&S: fever, chills, sweating
• Labs: increased WBC & creatinine (kidneys aren’t being perfused), decreased platelets (infection process eats them) and pH (due to bad oxygenation)

Question 23

What are some VS and other findings of infection/sepsis/SIRS ?

Answer 23

• HR > 90
• RR > 20
• Temp >38
• SBP < 90
• low UO
• decreased LOC

Question 24

What are some risk factors for infection/sepsis/SIRS ?

Answer 24

• compromised immune system
• recent surgery
• mechanical ventilation
• invasive procedures or IV lines
• genetic tendency

Question 25

What are some treatments for infection ?

Answer 25

- Fluids: to increase CVP - Meds: - Acetaminophen: to lower fever - Antibiotics: easier to tx if you know bacterial infection - Vasopressors: to support BP

Question 26

What is important to remember about fluids before administering vasopressors ?

Answer 26

if they have a low CVP/dehydrated you need to give fluid bolus before you give vasopressors but if you don't, you'll need a higher dose of pressor to achieve your result which will increase the amount of side effects

Question 27

What are the clinical manifestations, VS and SNS response to pain ?

Answer 27

- S&S: anxious, sweating, grouchy - VS: increased HR, BP, RR - SNS response: releases potent vasoconstrictors (epi and norepi)

Question 28

What are some causes of dehydration ?

Answer 28

- GI bleeding/issues like vomiting and diarrhea - infection, fever - malnutrition

Question 29

What are the clinical manifestations of dehydration ?

Answer 29

- poor skin turgor - decreased cap refill and UO - weak pulse strength

Question 30

What are the VS and Labs for dehydration ?

Answer 30

- VS: increased HR, and temp, decreased BP & CVP - Labs: decreased electrolytes

Question 31

What is the treatment for dehydration ?

Answer 31

- fluids: IV (NS< LR or albumin, Hespan - correct cause: - tx fever - correct malnutrition - stop diarrhea (antidiarrheal: imodium-loperamide) - stop vomiting (anti-emetic: zofran- ondansetron)

Question 32

What 2 pt conditions must you be cautious of when giving fluid boluses ?

Answer 32

- HF: since the heart is already stressed out so if you add more fluid it can cause overload/work - Respiratory Issues: you could drown them

Question 33

What are clinical manifestation and labs for blood loss ?

Answer 33

- S&S: pale, sweating, anxious, mottled - Labs: decreased Hgb

Question 34

What are the VS and other findings for blood loss ?

Answer 34

- VS: HR >90, SBP <90, RR >20, narrowing BP (with systolic and diastolic start to come closer together like 80/60) - weak/thready pulse - vasoconstriction

Question 35

During what stage of hemorrhagic shock do you start to notice symptoms ?

Answer 35

stage 2 - 30% blood lost

Question 36

What is a late sign of blood loss ?

Answer 36

decreased Hgb - 2 units blood lost before you see a 1 point drop in Hgb - start blood transfusion when its at or below 7

Question 37

What is the treatment for blood loss ?

Answer 37

- PRBC: packed RBCS - platelets - FFP: fresh frozen plasma - Cryoprecepitate (Cryo): blood component deprived from plasma that is rich in clotting factors

Question 38

What will the O2 sat, Calcium and potassium look like for a pt with blood loss ?

Answer 38

- O2: decreased - Ca+: decreased - K+: increased (release of potassium from stored RBCs)

Question 39

What is the significance of a fast and slow arrhythmia ?

Answer 39

- Fast: doesn't allow for adequate filling or ejecting - Slow: doesn't allow for sufficient oxygenated blood flow to the tissues

Question 40

What is the tx for arrhythmias ?

Answer 40

- Meds: to slow or fasten HR - electric shock: cardioversion or defibrillate - Surgery: