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130 Cards in this Set
- Front
- Back
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Cardiac Index (CI)
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The amount of blood pumped by the heart, per minute, per meter square of body surface area
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Afterload
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Afterload describes the resistance that the heart has to overcome, during every beat, to send blood into the aorta. These resistive forces include vasoactivity and blood viscosity.
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Cardiac Output (CO)
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The volume of blood pumped by the heart in one minute.
o Increased cardiac output may indicate a high circulating volume. o Decreased cardiac output indicates a decrease in circulating volume or a decrease in the strength of ventricular contraction |
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Central Venous Pressure (CVP)
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CVP readings are used to approximate the Right Ventricular End Diastolic Pressure (RVEDP). The RVEDP assesses right ventricular function and general fluid status.
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Hypovolemia or decreased venous return indicate a high or low CVP
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Low
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Overhydration, increased venous return or right sided cardiac failure indicate a high or low CVP
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High
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Mean Arterial Pressure (MAP)
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Reflects changes in the relationship between cardiac output (CO) and systemic vascular resistance (SVR) and reflects the arterial pressure in the vessels perfusing the organs.
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A decreased blood flow through the organs is a high or low MAP
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Low
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An increased blood flow through the organs is a high or low MAP
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High
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Preload
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Preload occurs during diastole. It is the combination of pulmonary blood filling the atria and the stretching of myocardial fibers. Preload is regulated by the variability in intravascular volume
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Volume reduction decreases or increases preload
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decreases
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What 3 things will volume increases do to Stroke index (SI), MAP, and preload
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increase all of them
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Pulmonary Artery Pressure (PA Pressure)
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Blood pressure in the pulmonary artery
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A left-to-right cardiac shunt, pulmonary artery hypertension, COPD or emphysema, pulmonary embolus, pulmonary edema, left ventricular failure are the result of increased or decreased PA pressure?
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increased
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Pulmonary Capillary Wedge Pressure (PCWP or PAWP)
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PCWP pressures are used to approximate LVEDP (left ventricular end diastolic pressure).
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Left ventricle failure, mitral valve pathology, cardiac insufficiency, cardiac compression post hemorrhage could all be the result of a high or low PCWP?
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High
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Pulmonary Vascular Resistance (PVR)
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The measurement of resistance or the impediment of the pulmonary vascular bed to blood flow.
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"Pulmonary Hypertension" is another name for what?
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Increased PVR · (Pulmonary Vascular Resistance)
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Pulmonary vascular disease, pulmonary embolism, or pulmonary vasculitis, or hypoxia can all cause what?
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"Pulmonary Hypertension" or increased PVR
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A decreased PVR is caused by what types of medications?
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calcium channel blockers, aminophylline, or isoproterenol or by the delivery of O2
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Right Ventricular Pressure (RV Pressure)
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A direct measurement that indicates right ventricular function and general fluid status
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pulmonary hypertension, right ventricle failure, congestive heart failure all are indicative of what type of Right ventricular(RV) pressure?
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high
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Stroke Index or Stroke Volume Index: (SI or SVI)
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The amount of blood ejected from the heart in one cardiac cycle, relative to Body Surface Area (BSA). It is measured in ml per meter square per beat.
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Early septic shock, hyperthermia, hypervolemia may be seen with increased or decreased SVI?
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increased
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CHF, late septic shock, beta blockers, or an MI, all may cause increased or decreased SVI?
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decreased
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Medications such as dopamine, dobutamine, or digitalis may cause increased or decreased SVI?
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Increased
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Stroke Volume (SV)
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The amount of blood pumped by the heart per cardiac cycle. It is measured in ml/beat.
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A decreased SV may indicate what in regards to cardiac contractility?
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impaired
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An increased SV may be caused by an increase or decrease in circulating volume?
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increase
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An increase in inotropy may cause an increase or decrease in SV
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Increase
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Systemic Vascular Resistance (SVR)
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The measurement of resistance or impediment of the systemic vascular bed to blood flow.
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Vasoconstrictors, hypovolemia, or late septic shock can cause what effect on SVR?
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Increase
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Vasodilators, morphine, nitrates, or hypercarbia can cause what effect on SVR?
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Decreased
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Afterload is increased if the circulating blood is concentrated and/or if systemic blood vessels are constricted. T or F?
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True
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After a significant hemorrhage, preload will be increased. T or F?
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True: preload is regulated by the variability in intrvascular volume. Volume reduction decreases preload.
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What determines Blood Pressure? (5 things)
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cardiac output, peripheral vascular resistance, circulating blood volume, blood viscosity, and vessel elasticity.
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What three characteristics will be assesed for pulse?
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Rate, strength, and rhythm
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What do HEAVES indicate when you inspect the anterior chest?
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ventricular hypertrophy due to an increased workload.
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A PMI that is displaced down and to the left could indicate what cardiac dysfunction?
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ventricular hypertrophy which may be due to volume overload
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An increase in force and duration of the PMI pulse may indicate what?
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an increase in pressure without volume overload.
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When percussing the heart, an increase in heart size may indicate what?
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increased ventricular volume or wall thickness.
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On cardiac inspection and palpation of the Peripheral Vascular status, what will you assess the skin for?
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color, texture, moisture and turgor.
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What do changes in the skin indicate during the cardiac assessment?
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Changes in skin indicate a change in tissue perfusion and cardiac output
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When inspecting the neck for jugular venous distention (JVD), what does JVD indicate?
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Indicates CVP. Full distention as the patient sits at a 45 degree angle indicates an increase in CVP
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A positive hepatojugular reflux indicates what?
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Heart Failure
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Define: hepatojugular reflux
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Distention of the veins of the neck when the liver is compressed during physical examination of the abdomen. Neck vein filling during liver examination commonly is seen in patients with congestive heart failure but also may be a normal finding
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Tissue perfusion can be assessed by checking nailbed capillary refill. Normal refill should occur in less than 4 seconds. Tor F?
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False: < 3 secs
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What is the most important Lab values to obtain and assess and treat ARDS?
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Arterial blood gas monitoring is vital to the successful treatment of respiratory failure, whatever the cause.
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Which chronic DZ on PMH could raise the risk of complications from arterial line insertion
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peripheral vascular disease
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What 3 steps are necessary to determine the suitability of a limb for insertion of an arterial line?
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Palpation, capillary refill and the Allen test
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What does The Allen test determine?
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determines the patency of the arm's radial and ulnar arteries
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What is the necessary equipment for placement or assisting in the placement of arterial lines?
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Skin cleansing supplies
Positioning aides Sterile gloves Sterile angiocath Airless, sterile and flushed pressure tubing/ transducer assembly Sterile supplies to secure and dress the angiocath (sterile suture and scissors). Monitor |
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What is the best method to determine correct placement
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Waveform evaluation is the best method to determine correct placement
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When will the normal peripheral arterial waveform display the peak systolic pressure in relation to the EKG?
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after the QRS
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On the waveform, what does the dicrotic notch reflects?
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the closure of the aortic valve
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Does the dicrotic notch display at the same time as the closure of the aortic valve?
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The aortic valve has closed prior to the display of the notch. This delay is the time it takes to reach the peripheral catheter and sensor
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What will the waveform of a patient with arteriosclerotic disease look like?
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The waveform would be steeper in ascent and descent, therefore shorter in duration and the notch would be less well defined.
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Central venous pressure is considered to be what?
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a direct measurement of the blood pressure in the right atrium and vena cava
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What is the best position for the pt to be in for CVP placement?
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trendelenberg positioning
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Where is the placement of the CVP cath?
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It is threaded so that the tip of the catheter rests in the lower third of the superior vena cava
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What is the CVP catheter most important for assessing?
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right ventricular function and systemic fluid status
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What is normal CVP?
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2-6 mm Hg
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The CVP catheter is important tool for which 3 teatments?
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1. Rapid infusion
2. Infusion of hypertonic solutions and medications that could damage veins 3. Serial venous blood assessment |
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Overhydration will have which effect on CVP?
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Elevate it
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What does overhydration do to venous return?
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Increases it
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Heart failure or PA stenosis will have what effect on CVP?
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Elevate it: HF and PA stenosis will limit venous outflow and lead to venous congestion
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Positive pressure breathing and/or straining will have what effect on CVP?
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Elevate it!
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Hypovolemic shock from hemorrhage, fluid shift, dehydration will have what effect on CVP?
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Decrease it
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Negative pressure breathing which occurs when the patient demonstrates retractions or mechanical negative pressure which is sometimes used for high spinal cord injuries will have what effect on CVP?
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Decrease it!
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Which 2 ways can you read a CVP waveform?
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1. Find the mean of the A wave
2. Find the Z-point |
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What are the steps to finding the mean of the A wave for CVP readings?
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1. read the high point of the A wave
2. read the low point of the A wave 3. add the high point to the low point 4. divide the sum by 2 the result is the mean CVP |
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What does the A wave represent in regards to cardiac activity?
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atrial contraction
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Where is the A wave in regards to the EKG reading?
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The A wave starts just after the P wave ends and represents the atrial contraction
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What does the high point of the A wave indicate?
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The high point of the A wave is the atrial pressure at maximum contraction; Therefore, the high point of the A wave closely parallels the right ventricular end diastolic pressure
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During the A wave the atrial pressure is less than or greater than the ventricular diastolic pressure?
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Greater than
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What is going on in the R side of the heart when CVP is measured?
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the tricuspid valve is open and the right ventricle is full, the ventricle, atrium and vena cavae are all connected
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How would you find the Z point for reading the CVP waveform?
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Find the Z-point which occurs mid to end QRS
Read the Z-point |
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How does the Z-point coincides with the EKG?
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coincides with the middle to end of the QRS wave
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When does the Z point occur in relation to the tricuspid valve?
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It occurs just before closure of the tricuspid valve; Therefore, it is a good indicator of right ventricular end diastolic pressure
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When is it best to use the Z point method instead of the mean of the A wave when interpreting CVP waveforms?
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when A waves are not visible, as in A Fib
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When does the C wave occur in relation to the tricuspid valve?
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occurs at closure of the tricuspid valve
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What does the crest of the C wave indiate?
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the atrial pressure increase caused by the tricuspid valve bulging back into the atrium
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What are two advantages of Arterial BP monitoring?
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1. offers clinicians a low risk and reliable method to continuously monitor systemic blood pressure
2. the ability to do serial blood sampling |
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What are the 3 major invasive hemodynamic monitoring methods?
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1. arterial lines (art lines)
2. Central Venous Pressure (CVP) caths 3. Pulmonary Artery catheter (PAC) |
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Name 5 things that the PAC will do (purpose).
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1. Indirectly measure the left ventricular end-diastolic pressure.
2. Evaluate the hemodynamic treatments and measure the patient’s hemodynamic status. 3. Draw mixed venous blood samples. 4. Obtain central vascular pressures measurements. 5. Measure cardiac output. |
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Name 4 major INDICATIONS for using a PAC.
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1. Conditions of shock such as septic and hypovolemic shock.
2. Evaluation of fluid volume status. 3. Evaluation of cardiac output in complex medical situations. 4. Prophylactic insertion for high-risk surgeries |
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PA catheters are useful to measure cardiac output in complex medical situations and evaluate fluid volume status in hypovolemic and septic shock. True or False
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True
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Which Hemodynamic tool can be used as a multi-funtion device?
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PAC: it has a port for CVP, CO, PA pressure, and PCWP!
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On the PAC, the proximal port is used for what things?
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is used to measure right atrial or central venous pressure. It is also used for medication infusion and fluid boluses for cardiac output measurement
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Which port on the PAC can be used for mixed venous blood gases?
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Distal
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What functions are carried out using the DISTAL port on the PAC?
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PA pressure measurements and PCWP measurements when the balloon is inflated
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What is the Pulmonary Capillary Wedge Pressure (PCWP or PAWP) used for?
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PCWP pressures are used to approximate LVEDP (left ventricular end diastolic pressure).
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How much air is used in the balloon on the PAC?
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< 1.5 CC
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When does the Z point occur in relation to the tricuspid valve?
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It occurs just before closure of the tricuspid valve; Therefore, it is a good indicator of right ventricular end diastolic pressure
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When is it best to use the Z point method instead of the mean of the A wave when interpreting CVP waveforms?
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when A waves are not visible, as in A Fib
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When does the C wave occur in relation to the tricuspid valve?
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occurs at closure of the tricuspid valve
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What does the crest of the C wave indiate?
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the atrial pressure increase caused by the tricuspid valve bulging back into the atrium
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What are two advantages of Arterial BP monitoring?
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1. offers clinicians a low risk and reliable method to continuously monitor systemic blood pressure
2. the ability to do serial blood sampling |
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What are the 3 major invasive hemodynamic monitoring methods?
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1. arterial lines (art lines)
2. Central Venous Pressure (CVP) caths 3. Pulmonary Artery catheter (PAC) |
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Name 5 things that the PAC will do (purpose).
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1. Indirectly measure the left ventricular end-diastolic pressure.
2. Evaluate the hemodynamic treatments and measure the patient’s hemodynamic status. 3. Draw mixed venous blood samples. 4. Obtain central vascular pressures measurements. 5. Measure cardiac output. |
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Name 4 major INDICATIONS for using a PAC.
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1. Conditions of shock such as septic and hypovolemic shock.
2. Evaluation of fluid volume status. 3. Evaluation of cardiac output in complex medical situations. 4. Prophylactic insertion for high-risk surgeries |
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PA catheters are useful to measure cardiac output in complex medical situations and evaluate fluid volume status in hypovolemic and septic shock. True or False
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True
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Which Hemodynamic tool can be used as a multi-funtion device?
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PAC: it has a port for CVP, CO, PA pressure, and PCWP!
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On the PAC, the proximal port is used for what things?
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is used to measure right atrial or central venous pressure. It is also used for medication infusion and fluid boluses for cardiac output measurement
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Which port on the PAC can be used for mixed venous blood gases?
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Distal
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What functions are carried out using the DISTAL port on the PAC?
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PA pressure measurements and PCWP measurements when the balloon is inflated
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What is the Pulmonary Capillary Wedge Pressure (PCWP or PAWP) used for?
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PCWP pressures are used to approximate LVEDP (left ventricular end diastolic pressure).
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How much air is used in the balloon on the PAC?
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< 1.5 CC
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What is the Thermistor port used for on the PAC?
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The thermistor port is connected to the patient’s monitor via a cable and allows the display of continuous temperature readings
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Why are the temp. readings on the PAC important?
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temperature readings are essential to calculate cardiac output measurements
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How do you determine CO using the PAC?
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1. cool injectate is delivered rapidly through the proximal port of the PA catheter.
2. A temperature curve is plotted over time as the cool injectate causes the pulmonary artery temperature to fall. 3. It then rises back to the previous core temperature as warm blood continues in circulation. |
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When inserting the PAC, what might the pt experience as the cath passes through the R ventrical?
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ventricular dysrhythmias that disappear as soon as the catheter exits the right ventricle
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Once inserted, what are the tasks of the ICU nurse?
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1. assessing the patient’s hemodynamic status
2. measuring and documenting pressures 3. adjusting the vasoactive or inotropic drips as necessary. 4. troubleshooting |
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What interventions should be done if a dampened arterial waveform appears for an art line and the pt BP reading deviates from baseline but all other vitals are WNL?
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1. flushing the arterial line
2. repositioning the pt wrist 3. checking the arterial line reading with a cuff blood pressure. |
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Mr. Smyth is normotensive and slightly tachycardic. His cardiac output and cardiac index are normal, but is PA pressures and PAWP are elevated. He is on a dobutamine drip; What effect does the dobutamine have on his current status?
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The dobutamine, an inotropic agent, strengthens cardiac contractions that subsequently support the CO and BP; the dobutamine sometimes results in vasoconstriction and could be responsible for the elevated PA pressures and SVR
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How and when should the nurse document the catheter placement?
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stated in centimeters, should be documented and assessed every shift
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Complications Associated with the PA Catheter: what may occur during initial placement?
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Pneumothorax
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Complications Associated with the PA Catheter: what can reslult from catheter migration?
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Dysrhythmias, or dampened waveforms
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Complications Associated with the PA Catheter: what can result from balloon rupture or air in the infusion line?
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Air embolism
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Complications Associated with the PA Catheter: what can an improper flushing technique cause to happen?
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Pulmonary thromboembolism
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Complications Associated with the PA Catheter: perforation during placement, overinflation of the balloon, overuse of the balloon can cause what to happen?
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Pulmonary artery rupture
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Complications Associated with the PA Catheter: the catheter migrating into the wedge position, the balloon left inflated, or thrombus formation around the catheter which causes an occlusion all can cause what?
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Pulmonary infarction
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PA catheter migration may cause which of the following complications?
a. Pulmonary infarcation b. Dysrhythmias c. Inaccurate measurements d. All of the above |
d. All of the above
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Hemodynamics are measured with which of the following?
a. PA catheter b. IV catheter c. Urinary catheter d. Arterial catheter |
PA catheter
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The term hemodynamics describes:
a. Intravascular volume b. Intropy c. Vasoactivity d. All of the above |
All of the above
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Chronotropy is considered a hemodynamic parameter. True or False?
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False
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Afterload:
1: Occurs during systole 2: Occurs during diastole 3: Is regulated by volume 4: Is reflected by MAP and SI |
3: Is regulated by volume
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Elevated Pulmonary Artery Pressure:
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Pulmonary hypertension predisposes the patient to PA rupture either by increasing the pressure gradient between the proximal PA and the distal wedge pressure or by distending the pulmonary vasculature and causing the catheter to wedge in a more distal, less compliant vessel
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In a ventilated pt, what will quickly indicate pulmonary artery rupture?
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Suddent bleeding from the endotracheal tube: The usual presentation in an intubated patient. Bleeding may be profuse and respiratory and cardiovascular status are quickly compromised.
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Following placement of the invasive monitors the following data are obtained:
BP 70/40 CVP 4 PA 17/9 CO 1.9 SVR 1800 Your initial impression is? |
The patient is relatively hypovolemic and intravenous fluid is indicated: A CVP of 4 and PA of 17/9 may be on the low end of normal in young healthy patients, but are definitely low for a patient with chronic myocardial dysfunction and reduced ventricular compliance.
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