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56 Cards in this Set
- Front
- Back
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Cardiac Output is what formula
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Heart rate X Stroke Volume
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Amy who is a CHF patient has a Heart rate of 60BPM Her stroke volume was 67ml a min.
Calculate her Cardiac output. |
(HR) 60X (SV) 60ml
60X67ml= 4020ml = 4.02L |
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1.What is normal cardiac output
2.What is normal cardiac output at rest |
1. 4-8 Liters a min
2. 4-6 Liters a min It increases with exercise and decreases with rest |
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1.What does stroke volume measure?
2.What is the normal level of stroke volume? |
1. The volume (amount) of blood pumped with each beat.
2. 60-70ml a min |
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What does Cardiac Output measure?
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The volume (amount) of blood ejected in one min.
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Preload is what?
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The Priming of the pump of the heart or the filling pressure.
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What are the three types of preload
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1. (CVP or RA) Central venous pressure or right atrium pressure and Vena cava
2. (PAOP) Pulmonary arterial Pressure of Wedge Pressure 3. (LVEDP) Left ventricular end diastolic pressure |
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What are the normal (textbook) values of the three types of preload?
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1. CVP or RA= 2-5mmhg
2. PAOP or Wedge =5-12 mmhg 3. LVEDP = 10-12mmhg (measured in cath lab) |
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How do you increase preload with a patient?
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1.Colloids (Hetastarch, Hepspan
2. Blood 3. Albumin 4. Positioning Head up feet down |
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How do you decrease preload with a patient?
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1.Crystaloid solutions (LR NACL D5W)
2. Diuretics r/t decreased volume 3. Vasodilators (vein specific) 4. Positioning Head up feet down (best position for CHF pt. |
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If a patient had a CVP of 1mmhg and you want to increase their preload would you give them
500ml of NACL or 500ml 5% albumin and why |
Answer: 500ml of 5% albumin.
Rational: albumin is a colloid. Colloids draw fluid out of the ECF and help replace ICF. 500ml of NACL (crystaloid) would dilute the ICF decreasing CVP. |
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What are three colloid solutions?
What are three crystaloid solutions |
1. Albumin, Hetastarch, Hepspan, BLOOD
2. NaCl, Lactated Ringers, D5W |
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Reasons why CVP might be low?
CVP less than 2mmhg |
1. Hypovolemia r/t to
a) Bleeding b) Vasodilating c) Diuresis d) rapid warmth postop CVP will fall before you see changes in the EKG/HR. HR will compensate for approximatly 5 mins. Decreased Prime= Decreased CVP 2. Equipment malfunctions *** check Pt. Before equipment |
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Reason why CVP might be high?
CVP more than 5mmhg |
1. Fluid overload. Too much volume in the right atrium increases the amount of pressure.
Increase Priming= Increased CVP Fluid volume overload causes increased Cardiac workload and oxygen demand. Conditions include CABG, CHF |
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After load is what?
How is it measured? |
1. The force the left and right must overcome to eject blood.
2. (SVR) systemic vascular resistance 3. (SVRI) more specific based on BSA 4. (PVR) Pulmonary Vascular Resistance |
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What does SVR and SVRI Measure?
What are the SVR & SVRI normal values? |
Afterload: the muscle tension within the arteries in the left ventricle
SVR= 800-1400/sec SVRI= SVR/BSA (2000-2400/sec) |
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What does PVR Measure
What is the normal value of PVR |
Afterload: R side
The muscle tension within the Right ventrical/ Pulmonary Vein. PVR= 100-250 |
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The MD wants to decrease SVR. Which of the following drugs would you as a nurse question giving her.
Select all that apply. a. Dopamine b. Primacor c. Dobutamine d. Digoxin b a. |
Answer: ABD
Rational: Dopamine, Primacor, and Digoxin increase SVR r/t vasoconstriction. Dobutamine causes vasodilation decreasing SVR +inotrophic and vasodilation *dobutamine cause vasodilation before increasing contractility** |
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The MD wants to increase SVR. Which of the following drugs would you as a nurse question giving her.
Select all that apply. a. Dopamine b. Nitro paste c. Dobutamine d. Digoxin |
Answer: BC
Rational: Dobutamine and Nitro paste decrease SVR r/t the Vasodiliation effect. Dopamine and digoxin causes vasoconsrtiction increasing tension. |
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Afterload is increase by what?
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1. Hypertension
2. Fluid volume overload r/t increased viscosity. (too much PRBC in surgery) or sickle cell 3. Fluid volume deficit r/t dehydration causing increased viscosity in the ICF. 4. Vasoconstriction r/t increased blood volume. 5. Drug effects of dopamine and Levophed |
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Afterload is decreased by what?
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1.Vasodilators (Dobutamine, Nitro) &
ACE inhibitors 2. Sepsis r/t massive vasodilation effect r/t hypotensive effect of blood being spread out. |
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Contractility is what
How is Contractility measured |
1. The squeeze of the heart muscles
2. Ejection Fraction |
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What is the normal Ejection Fraction
What happens if it is low. What conditions could cause a low EF |
1. 55-60%
2. If EF is below 50% = CHF ***Any other condition that increases CVP lowers EF*** *** SVR increases EF** Fluid volume deficit r/t dehydration that increases ICF viscosity such a |
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Which of the following drugs and fluid would you use to help a CHF patient increase an EF of 45%
a. Digoxin & 500ml of 5% Albumin b. Primacor & Hetastarch c. Cardizem & 500ml of LR d. Dobutamine & 500ml of LR |
Answer: D
Rational: CHF causes fluid volume overload r/t to increased viscosity of the contents in the ICF. Dobutamine acts to increase the contractility, and the 500ml of LR helps dilute the ICF. Together these two collectively improve Contractility and decrease CVP. A,B are wrong r/t the Albumin and Hetastarch increasing the CVP or increasing the viscosity of the ICF C is wrong because Cardizem decreases contractility. |
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Which drugs will increase contractility?
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+ inotrophic drugs
1 Digoxin, 2. Natracor 3. Primacor 4. Dobutamine |
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Which drugs will decrease contractility?
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- Inotrophic drugs
1. Cardizem 2. Beta blockers (olol) |
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What conditions can decrease contractility.
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1. CHF
2. Hypoxia 3. Hypercapina 4. metabolic acidosis (kidneys attempt to compensate for H+ ions by releasing bicarb HCO3 |
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What is MAP
What is the formula for MAP |
1. Mean arterial pressure. The average pressure in the blood vessels. It is more accurate than looking at SBP.
** MAP of at least 60 is needed to perfuse the kidneys** ** just because SBP is 90 it doesn't mean that organs are perfusing.** 2. SBP+ DBP+DBP/ 3 = MAP |
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The nurse is reviewing the drugs in the chart of a patient. Which nursing intervention will decrease the preload of this client.
a. Bed rest with HOB less than 30 degrees b. Admin Lasix 40mg IVP c. Application of SCD d. Clustering of the nursing activities to promote rest. |
Answer: B
Rational: Lasix decreases the viscosity of the ICF and decreases the fluid volume overload. This decreases preload. |
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Indications for
Bedside Hemodynamic Monitoring |
Decreased CO
Fluid volume excess/deficit (CHF), (dehydration) Ineffective tissue perfusion (hypovolemia r/t blood loss) |
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If a person is hypotensive with a CVP 7mmhg do you give them:
Dopamine, or fluid |
Answer: A pt. that is hypotensive that has a CVP of 7 means Fluid volume overload
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If a person is hypotensive with a CVP of 2mmhg do you give them:
Dopamine or fluid? |
Answer: A pt. that is hypotensive that has a CVP of 2 means Fluid volume deficit.
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If a person is hypotensive with a unknown CVP what do you do?
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Give the Fluid first.
If dehydrated r/t unbalanced electrolytes give NaCL, LR, or D5W If hypovolemia is suspected give Albumin like fluids. |
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Calibration of Hemodynamic monitoring
How frequent to you perform this task? |
1. At least once Q shift (8hr)
2. Every time you disconnect and reconnect. 3. Funky numbers that do not make sense. |
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Amy is 3 days postop kidney transplant. Her CVP during your shift has been 6mmhg. Within 15 mins. you check on you her, and notice her CVP is 1mmhg. What might be a cause of this?
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Answer: The transducer might me higher than the mid axillary line.
Higher than level with give you a false low reading |
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Amy is 3 days post op kidney transplant. her CVP during your shift has been 2mmhg. If 15min you check on your pt. and notice her CVP is 8mmhg. What might be a cause for this?
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Answer: The transducer might be LOWER than the mid axillary line.
LOWER than level gives a false high Reading reading r/t having to overcome gravity |
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How do you Zero Hemo Equipment
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1. Open the line to room air and open the cap.
2. zero (tear) scale 3. Replace cap and close to room air. |
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indications for Arterial line
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1. Major surgical complications
a) CABG, heart surgery 2. Compromised Cardiac output tissue perfusion or fluid volume status |
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What does a Arterial line do
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Monitors SBP DBP and MAP along with drawing ABG, one touches.
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What are the pros and cons of having an arterial line placed in the subclavian artery?
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Pros: Decreased risk for infection
Cons: High risk for Pneumothroax |
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What are the pros and cons of having an arterial line placed in the femoral artery?
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Pros:
1.can be done in emergent situations 2. can be used as a central and arterial line. Cons: 1. Decreased accuracy of CVP 2. Higher risk of infection r/t proxmity to genital area 3. Limits mobility of pt. *pt can shear femoral artery by moving can cause hematoma* |
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What are the pros and cons of having an arterial line placed in the Interjuggular
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Pros:
Big area and easy to stick Cons: 1. If pt. turns head it can occlude line. 2. Higher rate of infections if on vent r/t secretions running down toward central line |
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what are the proper positions of the following Arterial lines:
1. Femoral 2. Interjuggular or subclavian |
1. Flat
2. head down feet up before stick then head up feet down after stick |
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If a physician is using an IJ or SC what are your nursing responsibilites related to monitoring and use
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1. Monitor the ekg for PVC
When PVC occurs you know you are in the Right ventrical. When this happens the physician pulls back 2. Obtain a Chest Xray for placement 3. Wait for order to use. |
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CVC Central venous Catheter complications include
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1. **Air embolism**
2. Thrombus formation 3. Infection |
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Signs and symptoms for Air Embolism
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1. Loud continous Murmur middle of chest
2. Tachypena (RR > 20), SOB 3. Impending sense of doom |
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Treatment for an Air embolism
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100% Non Rebreather Fo2
Left lateral trendelenburg r/t trapping the embolism from going through circulation. |
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signs and symptoms of a thrombus in the CVC line
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1. Line that has high resistance to flushing
2. Damping wave form 3. Alarm says distal occlusion |
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Interventions and Treatment of a thrombus r/t CVC complication
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1. Tape occluded line and lable
2. Aspirate blood and discard (this may get rid of the thrombus |
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Complications of Removing a Central venous catheter include
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1. Embolism
2. Bleeding |
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How do you remove a CVC catheter?
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1. Wash hands and put on gloves
2. Pull back 10ml of fluid from each port r/t possible thrombus. 3. Remove Sutures 4. Remove line (if IJ or SC have pt breath, then remove line when breaths out.) 5. Hold pressure for at least 5mins 6. monitor site for REED frequently |
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What does a (Swan) PA catheter measure?
What do the lines represent? |
1. Measures preload on the left side of the heart.
2. light lines represent 10cm 3. Dark lines represent 50cm |
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What is the correlation between CVP and RA wave form
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The both equal 2-5mmhg
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In the Pulmonary Artery Catheters what are the following ports used for?
1. Proximal injectate (blue) 2. Baloon inflation (red) 3. Distal lumen (yellow) |
1. injectate (blue) measures Cardiac output and CVP
2. To inflate between RA Wave form and the Right ventricular Wave form 3. Distal lumen (yellow) flushing and meds |
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When the Pulmonary Artery Catheter is advanced past the Pulmonary artery what Wave form changes occur?
What do you do when this occurs |
1. The RA wave form will change to Right ventricular Wave.
2. Notify the MD 3. Deflate the balloon 4. Physician will pull back line to place between RA and RV wave |
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What are the wave form changes that correspond with the insertion of a PA catheter?
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1. RA Wave
2. Right ventricular Wave 3. Pulmonary Wave (looks identical to aorta Wave) 4. Left Ventricular Wave form |
