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Flashcards in Cardiovascular Assessment (Josh) Deck (93):
1

Which valves are the AV valves?

Which valves are the Semilunar Valves?

AV = Tricuspid and Mitral

Semilunar = Pulmonica and Aortic

2

What does the "LUB" sound coincide with?

closure of AV valves

3

What does the "DUB" sound coincide with?

closure of Semilunar valves

4

How many phases of the Cardiac Cycle?

7

5

MAP:

Mean Arterial Pressure must be at least --- to maintain adequate blood flow through coronary arteries.

60 mmHg

6

MAP:

Mean Arterial Pressure must be --- to maintain perfusion through major body organs like kidneys and brain.

60-70 mmHg

7

When does coronary artery blood flow to the myocardium?

during DIASTOLE

8

Cardiac Cycle:

When does the "Lub" sound happen?

When does the "Dub" sound happen?

Lub = MITRAL (AV) Valve closes

Dub = AORTIC (Semilunar) valve closes

9

Diastole and Systole:

--- consists of relaxation and filling of atria and ventricles and accounts for two-thirds of cardiac cycle.

Diastole

10

Diastole and Systole:

--- consists of the contraction and emptying of of atria and ventricles and accounts for one-third of cardiac cycle.

Systole

11

How is Cardiac Output calculated?

CO = HR x SV

12

What is Stroke Volume?

amount of blood ejected by left ventricle during each contraction

13

Normal HR for adult is ---

60-100

14

How is BP calculated?

BP = SV x Systemic Vascular Resistence (SVR)

15

How is MAP calculated?

SBP + DBP *2 / 3

16

What is a Normal MAP?

70-100

17

What is Systolic BP?

What is Diastolic BP?

SBP = pressure generated by left ventricle to distribute blood into aorta

DBP = pressure against arterial walls during relaxation phase of heart

18

What is Central Venous Pressure?

reflects filling pressures of the right side of the heart

Normal value is 2-5 mmHg

19

What is normal CO?

4-6 L/min

20

What is Cardiac Index (CI)?

adjusts CO for body size

Normal Value is 2.2-4.0 L/min/meters squared

21

How is SV calculated?

(CO / HR) x 1000 = SV

22

What is normal SV?

60-70 mL

23

What is Systemic Vascular Resistence (SVR)?

the resistence against which the left ventricle must pump to eject its volume

ie: Afterload

normal value is 800-1400 dynes/sec/cm

24

What is normal SVR?

800-1400 dynes/sec/cm

25

What is the best indicator of fluid balance?

weight

2.2 lb = 1 kg = 1 L

26

How much does one liter of fluid weigh?

1 L = 1 kg = 2.2 lb

27

--- are located in arch of aorta and respond when walls are stretched by increased BP

Baroreceptors

***they in turn inhibit the vasomotor center in the Pons and Medulla which leads to drop in BP

28

Heart Cath:

Which side is typically done first and goes through the femoral vein into the IVC?

Right Sided Cath

***Left Sided Cath goes through femoral artery against blood flow

29

When performing Hemydynamic Monitoring, what do we set the Pressure Bag to?

300 mmHg

30

What is Positioning for Hemodynamic Monitoring?

HOB can be 0-60 degrees if patient is supine

31

Hemodynamic Monitoring:

What is the Phlebostatic Axis?

4th ICS and midway of the AP diameter of the chest

32

What should we do prior to any access to Radial or Ulnar artery?

Allen's Test

33

When removing any catheter from an artery, how much pressure?

manual pressure for 10 mins

34

What is a Pulsus Paradoxus?

when SBP declines more than 10 mmHg during inspiration

***Normal fall should be less than 10

35

Why are Central Lines useful?

Rapid infusion of large volumes of fluid/blood

Safer for infusion of caustic meds

Allows measurement of filling pressures of right side of heart

Can be used to measure mixed venous blood

36

What are common locations for Central Lines?

Internal Jugular

Subclavian

Femoral

Peripheral

37

Complications associated with Central Lines?

Infection

Pneumothorax (with Subclavian sites)

Bleeding

Thrombus

Air Embolus

38

What is nursing action with an Air Embolus?

Trendelenburg

Left Side

100% oxygen

Call Doc

39

What is normal Central Venous Pressure?

2-5 mmHg

40

Pulmonary Artery Pressure (PAP):

What is normal Systolic Pressure of PA (PAS)?

20-30 mmHg

41

Pulmonary Artery Pressure (PAP):

What is normal Diastolic Pressure of PA (PAD)?

5-10 mmHg

42

Pulmonary Artery Pressure (PAP):

What is normal Mean Pressure of PA (PAPm)?

10-15 mmHg

43

Pulmonary Artery Pressure (PAP):

What is Pulmonary Artery Wedge Pressure (PAWP)?

aka Pulmonary Artery Occlusive Pressure (PAOP)

reflects the filling pressures in the pulmonary vasculature LEFT sided pressures

44

What is normal PAWP?

4-12 mmHg

45

Normal Preload for the right side and left side of the heart?

Right Side = 2-5 mmHg

Left Side = 5-12 mmHg

46

For the right side of the heart, --- reflects the filling pressure

For the left side of the heart, --- reflects the filling pressure.

CVP (Central Venous Pressure)

PAWP (Pulmonary Artery Wedge Pressure)

47

What meds can increase SVR?

What meds can decrease SVR?

DA, NE

Nitroprusside, NTG, Hydralazine

48

What is Pulmonary Vascular Resistance (PVR)?

resistance of ejection of blood from right side of heart

49

PVR normal range?

1/6 of SVR

100-250 dynes/sec/cm to the 5th

50

SVR:

Vasoconstriction --- SVR

Vasodilation --- SVR

increases

decreases

51

What is Stroke Volume Variation?

naturally occurring phenomenon in which the arterial pulse pressure falls during inspiration and rises during expiration due to changes in intrathoracic pressure secondary to negative pressure ventilation.

variations over 10 mmHg are referred to as Pulsus Paradoxus

52

What is a normal Stroke Vol. Variation (SVV)?

less than 10-15%

53

What do SVV values below 10-15 % indicate?

patient is not likely to increase CO through fluid infusion

54

Lactate Levels:

Anaerobic metabolism of glucose results in lactate formation.

Serum Lactate greater than --- indicates tissue hypoxia.

4 mmol/L

55

Why should we measure Venous Oxygen Saturation?

shows the balance achieved b/t the arterial oxygen supply and the oxygen demand at the tissue level

56

What is a normal Mixed Venous Oxygen Saturation?

60-80%

57

What are the 4 contributing factors for Venous Oxygen Saturation (SvO2)?

CO

Hgb

SaO2

Tissue Metabolism (VO2)

58

What doe high values (80-90%) of SvO2 indicate?

Hyperoxygenation

Anesthesia

Sepsis

False Reading

59

What do low values (less than 60%) of SvO2 indicate?

Anemia, Bleeding

Cardiogenic Shock

Hyperthermia, Seizures, Activity

Hyoxemia

60

Difference between SaO2 and SpO2?

When arterial oxyhemoglobin saturation is measured by an arterial blood gas it is called SaO2.

When arterial oxyhemoglobin saturation is measured non-invasively by pulse oximetry, it is called SpO2.

61

The lub dub sounds are caused by what?

closure of valves

Lub = AV valve closure
Dub = SL valve closure

62

What does a P Wave represent?

T Wave?

P Wave = Atrial Depolarization

T Wave = Ventricular Repolarization

63

Heart Sounds:

What is S1?

Closure of AV Valves and beginning of Ventricular Systole

64

Heart Sounds:

What is S2?

Closure of Semilunar Valves and beginning of Ventricular Diastole

65

Heart Sounds:

What is S3?

extra sound during Diastole

***can signify ventricle filling too fast

***Fluid Volume Overload

66

Heart Sounds:

What is S4?

extra sound during Diastole

before S1

67

Can you see Atrial Repolarization on telemetry?

NO

because if happens during QRS

68

When does the SA Node contract?

during diastole

***allows atria to fill the ventricles

69

When do the Ventricles receive impulses from Purkunjie Fibers?

during Systole

*** SQUEEZE

70

Why is Proteinurea a lab taken to determine HF?

one of first signs of HF is spilling over of protein into urine

71

What is purpose of Hemodynamic Monitoring?

gives you a continuous reading of BP

72

Where do we place the transducer for hemodynamic monitoring?

Phlebostatic Axis

***important because improper placement can cause to be inaccurate

73

How do you determine the accuracy of Hemodynamic Monitoring device?

Fast Flush Waveform Test

***rapidly flushing saline into artery will cause a square wave on ECG

74

Arterial Pressure Tracing:

What is the Dicrotic Notch on the pressure tracing?

where Aortic Valve closes

75

Arterial Pressure Tracing:

If they have a blank spot on tracing, what does this indicate?

decreased perfusion (there would be a lack of a pulse during this time)

76

SVV:

What type of waveform for Inhalation?

Exhalation?

Inhalation = lower wave form

Exhalation = higher wave form

***greater than 10 is a Pulsus Paradoxus

77

When would we see a Pulsus Paradoxus?

Cardiac Tamponade

78

What does a Pulsus Arterans indicate?

poorly functioning heart

Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.

79

When is the only time that Trendelenberg will be correct choice on a Langston test?

Air Embolus from Central Line

80

How does a Pulmonary Artery Catheter measure PAWP?

deflated baloon sits in pulmonary artery

inflated to give back pressure

this reveals the filling pressure of the Left Side of Heart

81

Pulmonary Artery Catheters:

What do waves look like in Right Atrium?

less than 10 mmHg

82

Pulmonary Artery Catheters:

What do waves look like in Right Ventricle?

rise to less than 30 mmHg

***More pressure than atrium

83

Pulmonary Artery Catheters:

What do waves look like in Pulmonary Artery?

as high as Right Ventricle but doesn't drop all the way to 0 mmHg like right ventricle

84

Pulmonary Artery Catheters:

Why is it important to know what waves look like?

so that you can tell if it is in correct spot by looking at Waveform

85

What are factors that effect Contractility?

Preload

Aftrerload

Positive Inotropic Effects

Negative Inotropic Effects

86

What does Inotropic mean?

any agent that alters the force of muscular contraction

87

What are positive Inotropic Factors?

Dopamin

Dobutamine

88

What are negative Inotropic Factors?

Beta Blockers

Ca Channel Blockers

Hypoxemia

89

What factors determine SV?

Preload

Afterload

Contractility

90

Why would Sepsis lead to High SvO2?

cellular tissue is damaged and unable to take up oxygen

91

The nurse caring for a patient with an arterial line notes the reading of 182/130. The priority action at this time will be:

1) Notify the MD
2) Increase the nitroprusside IV gtt
3) Verify the transducer level
4) Verify the flush solution

3) Verify the transducer level

92

The patient with a FloTrac monitor is noted to have a SVV of 19%. The nurse can anticipate which treatment ordered?

1) Fluid bolus
2) Dopamine IV gtt
3) Nitroglycerine IV gtt
4) Lasix per IV

1) Fluid bolus


***high values (greater than 15) indicate HYPOvolemia

93

The nurse notes a SVR of 550 dynes/sec/cm-5. This is an indicator of:

1) Vasoconstriction
2) Increased right heart preload
3) Increased left heart preload
4) Vasodilation

4) Vasodilation


***Normal values are 800-1400