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Terms in this set (94)
What is preload?
Passive stretching of muscle fibers of the ventricles
What is contractility?
Inherent ability for the myocardium to contract normally
What is afterload?
Refers to the pressure that the ventricular muscles must generate to overcome the higher pressure in the aorta to get the blood out of the heart
When is preload increased?
Regurgitation of the heart valves
When is afterload increased?
What is cardiac output?
The amount of blood the heart pumps through the circulatory system in one minute
What is stroke volume?
The amount of blood put out by the left ventricle of the heart in one contraction
What determines cardiac output?
Stroke volume and Heart rate
What is the normal adults cardiac output?
Stroke volumes for each ventricle are generally _____
Higher venous return or fluid volume overload will result in a ____ stoke volume
What are the normal values of preload?
Drugs such as nitrates that cause venous dilation __________ preload
Diuretics that eliminate excess fluid volume ________ preload
What is Starling's law of the heart?
If preload is increased...you will increase the stroke volume which will increase the force of the contractions
Overstretch of the cardiac muscles will ______ cardiac contractility and efficiency over time
If vasodilation is present afterload is _________
If vasoconstriction is present afterload is __________
Arterial vasodilatiors such as CA++ blockers, ACE inhibitors ________ afterload and decrease the workload of the heart
Contractility of the cardiac myocardium are __________ of the starling law
Contractility is influenced by calcium channel blockers. How do CCB effect contractility?
They decrease it and should be used with caution in those with heart failure
What is an ejection fraction?
fraction of blood pumped from ventricle with each heart beat
What is a normal ejection fraction?
What does the ejection fraction of 30-35% indicate?
Half normal cardiac output
What does the ejection fraction 10-15% indicate?
end stage heart failure
List some ACE Inhibitors:
What is the ACE Inhibitor Mechanism of action?
Blocks conversion of angiotensin I to angiotensin II
In Heart failure what is the first medication used?
What are ACE Inhibitors used for?
HTN, HF, CAD
What are the most common side effects of ACE Inhibitors?
Hypotension, cough, dizziness, ANGIOEDEMA
What are nursing considerations of ACE inhibitors?
Hold if SBP is less than 90
Change position of elderly slowly
Monitor for decreased WBC, Hyperkalemia as well as liver function, creatinine
List off some Beta Blockers
What is the mechanism of actions for Beta Blockers?
Selectively inhibits beta 1 in the heart
Increased contractility and O2 demand
ALL THESE EFFECTS INCREASE THE HEARTS WORKLOAD
What are Beta Blockers used to treat?
HF, HTN, acute MI, CAD, Ventricular dysrhythmias
What are the most common side effects of Beta Blockers?
Bradycardia, hypotension, fatigue, weakness
What are nursing considerations of Beta Blockers>
Hold if HR is less than 60 or BP less than 90
Change position slowly
Contraindicated in worsening HF, bradycardia, heart block, use with caution in diabetes and liver disease
List some calcium channel blockers:
What is the Mechanism of action for Calcium channel blockers?
Blocks calcium ions
What are calcium channel blockers used for?
Angina, HTN, controlling rapid heart rate in SVT or A-fib
What are common side effects of calcium channel blockers?
Peripheral edema, hypotension, constipation
What are nursing consideration of calcium channel blockers?
Change position slowly
Monitor I/O for Edema
Monitor liver and kidney function
Obtain BP and HR before administration
List some nitrates:
Isosorbide mononitrate IMDUR
Isosorbide dinitrate ISORDIL
Nitrodur topical patch
What is the mechanism of action for nitrates?
Relaxes and dilates coronary arterial vessels and systemic venous smooth muscle
What are nitrates used for?
What are common side effects of nitrates?
Hypotension, Tachycardia, Dizziness, headache
What are nursing considerations for nitrates?
Tolerance can occur with long acting. Remove patches at night and replace in morning
Contraindicated with in taking ED medication at same time as it can lead to hypotension.
List some diuretics:
What is the mechanism of action for a loop diuretic?
Used in acute HF exacerbation causes extreme diuresis and potassium loss, Prevents sodium absorption
What is the mechanism of a thiazide diuretic?
Increases excretion of sodium and water. Used more for long term. Potassium loss needs to be monitored
What is the mechanism of pottassium sparing diuretic?
The weakest it is used on those with risk of hypokalemia. Must also assess for development of hyperkalemia
What are diuretics used for?
HTN, HF, renal insufficiency/acute renal failure
What are common side effects?
Dehydration, orthostatic hypotension, hypokalemia, hyponatremia, hypomagnemia, hyperkalemia
What are nursing considerations for diuretics?
Change position slowly
Obtain BP before administering
Monitor potassium, sodium and GFR and creatinine
Aldactone and ACE inhibitors can lead to hyperkalemia
If on Aldactone make sure no potassium rich foods are taken in
-The study of forces involved in blood circulation. Used to assess cardiac function in critically ill.
State primary indications for invasive hemodynamic monitoring
used in critical care setting to monitor cardiac function and evaluate effectiveness of therapy. It is indicated for patients who have insufficient cardiac output (preload), alterations in vascular resistance (afterload) or alterations in myocardial contractility.
What are common indications for Hemodynamic monitoring?
Severe Heart failure
Sepsis or septic shock
Multiple organ system dysfunction
Acute respiratory distress syndrome
How are pressure measurements taken?
With the patient lying in supine position with head of bed up to 60 degrees up.
What are indications for arterial blood pressure monitoring?
Vasoactive IV infusions
Fluctuating unstable blood pressures
Frequent blood draws
What artery is usually used for arterial pressure monitoring?
What is the mean arterial pressure used for?
To evaluate per-fusion of vital body organs
What is the normal range for mean arterial pressure?
70 to 105 mm Hg
What does the formula for Mean arterial pressure look like?
Systolic pressure plus diastolic pressure multiplied by 2
divided by 3
What are complications of arterial pressure monitoring?
Accidental blood loss to avoid this keep limb immobile
Infection to avoid this use proper care and sterile fields
Impaired circulation to avoid this the nurse should check the limb often for circulation
How is central venous pressure monitored?
Measured in the superior vena cava near the right atrium via a PICC line or central line catheter placed in the jugular or subclavian vein.
What does central venous pressure monitor?
Intravascular blood volume
Right ventricular end diastolic pressure
Right ventricular volume
What is a normal central venous pressure?
2 to 8 mmHg
What causes low central venous pressure?
What causes a high central venous pressure?
Right ventricular failure
Left Ventricular heart failure
What are complications of central venous pressure?
What is the primary goal of invasive monitoring?
Evaluate cardiac and circulatory function and the response to interventions.
You are outside the room and notice that the patients CVP is negative what should you do first?
Assess the patient and check the equipment as the patients state and the equipment should match.
Where is the phlebostatic axis on the body?
in the 4th intercostal space, Mid clavicular.
When taking pressure measurements how should the patient be laying?
Supine no more that a 60 degree angle.
If the transducer is higher than the phlebostatic axis than the CVP will be....
If the transducer is lower than the phlebostatic axis than the CVP will be...
What does the CVP tell us?
The patients volume status
How is the CVP measured?
Via a central line
What arteries are used to measure CVP?
Subclavian or Jugular
What does CVP measure?
Right Arterial pressure
List conditions that elevate CVP:
Intra abdominal HTN
Mechanical Ventalation with positive ended expiratory pressure
What are signs and symptoms of high CVP
What are signs and symptoms of low CVP?
Low Urine Output
What are complications of central venous catheters?
What is arterial pressure monitoring?
Allows direct and continuous monitoring of systolic diastolic and mean arterial pressure
Where can arterial pressures be monitored from?
Radial, brachial, Femoral
What are nursing interventions for arterial pressure monitoring?
Be able to visualize site by taking off restraints. Be vigilante with checking the site.
If the Mean Arterial Pressure is less than 50 it means that...
There is a severe lack of perfusion to vital organs
If the Mean Arterial Pressure is greater than 105 that means that...
There is possible hypertension or vasocontriction
How much higher is arterial pressure monitoring in comparison to normal blood pressure?
5 to 10 mmHg
What does the dicrotic notch represent?
Aortic valve closing and blood being pumped into the body
What does preload indicate?
Volume Status of the Patient
What does afterload indicate?
What is normal cardiac output?
4 to 8 Liters a minute
What is normal cardiac index?
2.5 to 4L a minute
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