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N244 Cardiac Questions
Terms in this set (57)
What basic measurements can be use to evaluate hemodynamic status?
How is cardiac index best defined?
The amount of blood pumped by the heart each minute corrected for body size. (Think a fat person and a skinny person same height and age, and sex)
Stoke volume is heavily influenced by? (3things)
What is the one term to represent after load?
resistance (think vessel dilated or constricted)
What do doppler ultrasound hemodynamic monitors measure?
Blood flow vilocity
Using pulse contour analysis, PA line, homonymic monitors, how is stroke volume measured?
Beat to beat changes in pulse amplitude
What is the normal range for mean arterial pressure (MAP)?
Where should the tip of the venous catheter pressure line be positioned?
Vena cave near the entrance of the right atrium.
What is the correct range for normal central venous pressure?
Placement of arterial line for direct management of arterial blood pressure has what advantages? (3)
*It measures minute-by-minute fluctuations in blood pressure.
*it facilitates obtaining frequent blood samples
*it enables arterial pulse contour analysis
Which port of the PA catheter is used to obtain RAP?
The pressure reading from which lumen is constantly measured?
Why should vasoactive drugs never be infused through the port used for thermodilution CO determinations?
A bolus injection of a potent drug will occur every time CO is obtained.
What is the best way to delete the balloon on the PA catheter?
Allow the balloon to passively deflate. (this is so damage doesn't occur to the heart)
What is the focus of the national standards regarding a major preventable complication of the CVP?
The thermodilution method of CO is based on which factor?
A change is blood temperature over time.
Which technique is used to increase the accuracy of CO determinations?
Inject normal saline (cooler than blood) smoothly within a four second interval.
What disadvantages are associated with bolus thermodilution CO measurements? (3)
*They are time consuming
*multiple measurements may subject patients to fluid overload
*accuracy is affected by user technique
What statement correct regarding CO measurements?
They agree with bolus theromdilation measurements.
The right arterial pressure is measured through what port on PA catheter?
The RAP is a reflection of what factor?
What is the normal range for Right ventricle systolic pressure?
What is the most accurate description of the RV waveform?
*A steep upstroke follow by a sharp downstroke
The greatest potential for abnormal cardiac rhythms when the PA catheter is located where?
*Right ventricle (causes V tach or PVC's)
The normal range for PAS pressure is which set of values?
The normal pressure for PAD pressure is what?
So normal pressures using a Pulmonary Artery catheter would range from?
A PAD is 2mmHg the nurse should anticipate doing what?
Volume replacement/pressure is too low.
After load to the right ventricle can be estimated by which hemodynamic measurement?
Pulmonary vascular resistance
When assessing left ventricular function, The LVSW1 should be used instead of the PAWP in the presence of which condition?
To measure Left atrium pressure we inflate the PAWP and then deflate. What happens if this is left inflated?
cardiac muscle death
If resistance is felt in inflating ballon for PAWP?
stop!!! Do not continue
The patient with cirrhosis of the liver has significant ascites. The patient is cold, clammy and confused. The nurse interrupts this findings as indicating which physiological condition?
decreased preload from venous return to the heart.. Rationale: Ascites results in third spacing of fluid derived from the circulatory system. The patient fluid is not in the vascular system which means decrease preload which would cause decrease in cardiac output and the patient would have: cold clammy skin, confusion due to not enough oxygen to body organs.
A patient has an arterial line inserted into the radial artery. What nursing interventions should the nurse add to the patients plan of care?
*Regularly asses the color of the pt hand/to make sure it is getting blood profusion
*Measure pulses distal to the site/tissue profusion pt can lose a hand
*Observe insertion site for: warmth , redness, and edema.
*secure all line connections
*make sure all ports are capped if not being using to prevent infection.
*The nurse has just changed the bed linens and turned the patient. Which intervention should the nurse perform?
*wait 5-15 minutes following a position change to allow pt to regain stability.
*The nurse assesses that the dicrotic notch of a PA wave form has disappeared is this normal . If not what can she do?
*This means the catheter has moved backwards probably in the right ventricle and needs to be advanced to the pulmonary artery. The doctor must move the catheter, not the nurse. Notify the doctor immediately because this can irritate the ventricles and cause V tach which is a lethal arrhythmia. Lack of dicrotic notch is not a normal finding.
A nurse has to give the patient IV fluids through which port of the 4 lumens on the catheter?
*proximal port is used for IV fluids
A nurse notices an RV , right ventricle wave form on the beside monitor during routine hemodyamic monitoring what should she do?
*notify the doctor immediately because this waveform should only be seen on insertion. The patient is in V tach.
During hemodyamic monitoring the nurse notices an elevation of the pulmonary artery systolic pressure PAS the nurse would assess for which findings?
*Tenderness over the right costal margins indicating enlarged liver posssibly
*S3 and S4 heart sounds /too much fluid in the heart
**(Think of symptoms of right sided heart failure)
A patient is in septic shock and has a low systemic vascular resistance (SVR). The nurse would anticipate participating in which interventions?
*vasopressors are needed to increase input to the heart (carefully)
*fluid resuscitation to increase fluid in the vascular system and profusion to heart and organs(carefully)
*Keep the bed of head supine when patient has low volume or they will lose consciousness due to lack of profusion to the brain.
*oral fluids would be encouraged
Normal pressure on a PAC systolic and diastolic are?
*diastolic is 6-12 this is RAP: right arterial pressure
-*Systolic is 20-30 this is RV : right ventricle pressure
What is a normal PAWP and what is this monitoring and where is it located?
Normal PAWP is 4-12
*it is measuring an accurate measurement of the left ventricle preload
*located in the pulmonary artery
***You patient blood pressure is too high on the PAWP what medications will you anticipate the patient will need?
****interventions are directed at reducing preload by administer
*restricting sodium and fluids
*nitrates (nipride) (lower preload)
*Ace inhibitors (capoten) (dilate peripheral arteries)
*digoxin or dobutamine
Your pt PAWP is too low. What does this indicate and what as the nurse do you anticipate?
*we need to increase circulating blood volume
*these pt always get daily wts
S/S that your patient blood pressure is too low would be?
*flat neck veins
*decreased Urine output
S/S of that your patient blood pressure is to high?
*paroxysmal nocturnal dyspnea
*neck vein distention
What can cause a elevated Stroke volume?
*hypothermia (vasoconstriction the body is trying to compensate) we just warm up patient
*hypovolemia (too little fluid) increase fluids
*hypotension (compensatory mechanism peripheral vasoconstriction to increase fluids to the heart) The patient will need (cautiously) :
ace inhibitor /captopril
milrinone (positive inotropic ) that increases vasodilation to reduce both afterload and preload. Reducing after load makes it easier for the heart to eject Stoke volume lessens cardiac work and myocardial oxygen demand and improves cardiac output
Decreased stroke volume we give?
Remember in a heart attack we want to give?
Beta blocker and CCB do decrease the workload of the heart.
MAP normal pressure is?
If a patient is on warfarin what lab value guides their therapeutic goal?
Normal 2.0-3.5 for therapeutic range
Which pathology is associated with narrowing of the orifice of the mitral vale and obstructed blood flow during diastole?
Mitral valve stenosis
What patients are susceptible to endocarditis?
*pre-existing heart disease
Patient with mitral valve regurgitation which abnormal heart sound will you hear?
Weight gain of >3 pound might dictate an increase in which of the follow drug categories?
Pt blood pressure of 75/45 . You are the nurse and its time to administer the ace inhibitor. What do you do?
hold the medication and notify the doctor
Pt with cardiogenic shock , second to MI what medications do we anticipate?
*weak thready pulse
*shock is occurring
*vasopressors such as levophed, epinephrine
*positive inotropes (dopamine dobutamine and milrinone( Primacor)
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