Perfusion - Study guide 3

Question 1

Four determinants of cardiac output

Answer 1

• Heart rate
• Preload
• Afterload
• Contractability

Question 2

The number of cardiac contractions per minute. Can be affected by many variables depending on pressure.

Answer 2

Heart rate

Question 3

increases HR by releasing norepinephrine

Answer 3

Positive chronotropic effect

Question 4

decreases HR by releasing acetylcholine

Answer 4

Negative chronotropic effect

Question 5

• Directly related to stroke volume.
• The amount of blood in the ventricles at the end of diastole.
• Also refers to the amount of stretch of the muscle tissue at the end of filling.

Answer 5

Preload

Question 6

• Inversely correlated to stroke volume.
• The resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents.
• This is related to bp, vessel lumen diameter and or vessel compliance.

Answer 6

Afterload

Question 7

• The force of the mechanical contraction.
• Contractile force can be increased with sympathetic stimulation or calcium release.
• It can be decreased in the face of hypoxia or acidosis

Answer 7

Contractability

Question 8

Effects of an increased afterload

Answer 8

Decreases stroke volume and decreased cardiac output

Question 9

Effects of a decreased afterload

Answer 9

increases stroke volume, increases cardiac output

Question 10

Formula for calculating cardiac output

Answer 10

Heart Rate X Stroke Volume = Cardiac Output

Question 11

Normal cardiac output in a healthy adult

Answer 11

4-7L/min

Question 12

HR increases depending on what?

Answer 12

Pressure

Question 13

Conditions that cause alterations in perfusion

7 - CCCDEHM

Answer 13

• Clotting disorders
• Congenital cardiac defects
• CAD
• Dysrhythmias
• Early menopause
• Heart Failure
• MI

Question 14

Parameters that for someone to be dx with pre-eclampsia

Answer 14

• BP >140>90 on two occasions at least 4 hrs apart with Proteinuria.
• Occurs after 20 wks.
• Protein creatinine ration (PCR) >0.3 MG/DL

Question 15

Nursing Interventions for Pre-eclampsia

12

Answer 15

• Monitor BP
• Monitor weight
• Frequent provider visits
• Fetal kick counts
• Frequent rest/bedrest
• Adequate intake
• Monitor I and O
• Neuro status checks
• Evaluate renal function
• Evaluate Deep tendon reflexes and clonus
• Administer magnesium sulfate infusion as ordered
• Administer HTN medications

Question 16

test where you have the patient dangle legs off side of bed w/o feet touching the floor, support the back of the leg with one hand and push up on the toes (dorsiflex foot).

Answer 16

Clonus test:

Question 17

Normal response for a Clonus test

Answer 17

Foot returns to normal positon with no tremors

can be reffered to as a negative clonus

Question 18

Indications of a Positive clonus test

Answer 18

Foot starts to bounce or beat 3 or more times

Question 19

Theraputic range for mg

Answer 19

4-7 mEq/L

Question 20

Normal range for mg

Answer 20

1.5-2 mEq/L

Question 21

S/S of mg toxicity

think BURP

Answer 21

BP Decrease
Urine output decrease
Respiratory rate decrease
Patellar reflex absent

Question 22

Antidote for mg toxicity

Answer 22

Calcium gluconate

Question 23

Life-threatening and rare compication of pre-eclampsia.
Can manifest at anytime during pregnancy

Answer 23

HELLP Syndrome

Question 24

A pt with preeclampsia is experiencing the following that do you suspect

N/V
Epigastric pain
Headache
Vision problems
Hepatic dysfunction
liver failure
Acute renal failure
DIC
Respiratory Failure
Multi-organ system failure

Answer 24

HELLP Syndrome

Question 25

What does HELLP Syndrome stand for?

Answer 25

H-Hemolysis E-Elevated L-Liver Enzynes L-Low P-Platelets

Question 26

How to treat HELLP Syndrome | 9

Answer 26

* Priority is to deliver the baby * Fresh frozen plasma * Antihypertensive * Magnesium Sulfate Infusion * Keep calcium gluconate immediately available * Continuous monitoring of mother-fetus * Strict Bedrest * Hourly urine output measurement * Strict I and O

Question 27

Assessment tool for pre-eclampsia | Think SPASMS

Answer 27

S – Significant blood pressure changes may occur without warning P – Proteinuria is a serious sign of renal involvement A – Arterioles are affected by vasospasms that result in endothelial damage and leakage of fluid into the interstitial spaces. Edema occurs. S – Significant lab changes (Elevated LFTS and decreased platelet count) signal worsening of condition. M – Multiple organ systems involved (CV, Hematological, Hepatic, Renal, and CNS) S – Symptoms appear after 20 weeks gestation

Question 28

parameters for diagnosing someone with pre-eclampsia with severe features

Answer 28

BP > 160/ > 110 …..while on bedrest, on two occasions at least 4 hours apart

Question 29

If pre-eclampsia continues to deteriorate what should you prepare for?

Answer 29

* Prepare for induction of labor * Prepare for C-section delivery as indicated * Prepare for delivery of pre-term infant * Resuscitation supplies at bedside * Additional staff designated to care for pre-term infant * Provide teaching and support to the client and family

Question 30

HTN medications that are safe for pregnant patients

Answer 30

* Labetalol * Nifedipine * Hydralazine * Sodium Nitroprusside * HCTZ

Question 31

A positive clonus and hyper-reactive DTR indicates what?

Answer 31

CNS Irritibility and increased risk for seaizures