Cardiovascular Assessment (Josh) Flashcards
(93 cards)
1
Q
Which valves are the AV valves?
Which valves are the Semilunar Valves?
A
AV = Tricuspid and Mitral
Semilunar = Pulmonica and Aortic
2
Q
What does the “LUB” sound coincide with?
A
closure of AV valves
3
Q
What does the “DUB” sound coincide with?
A
closure of Semilunar valves
4
Q
How many phases of the Cardiac Cycle?
A
7
5
Q
MAP:
Mean Arterial Pressure must be at least — to maintain adequate blood flow through coronary arteries.
A
60 mmHg
6
Q
MAP:
Mean Arterial Pressure must be — to maintain perfusion through major body organs like kidneys and brain.
A
60-70 mmHg
7
Q
When does coronary artery blood flow to the myocardium?
A
during DIASTOLE
8
Q
Cardiac Cycle:
When does the “Lub” sound happen?
When does the “Dub” sound happen?
A
Lub = MITRAL (AV) Valve closes
Dub = AORTIC (Semilunar) valve closes
9
Q
Diastole and Systole:
— consists of relaxation and filling of atria and ventricles and accounts for two-thirds of cardiac cycle.
A
Diastole
10
Q
Diastole and Systole:
— consists of the contraction and emptying of of atria and ventricles and accounts for one-third of cardiac cycle.
A
Systole
11
Q
How is Cardiac Output calculated?
A
CO = HR x SV
12
Q
What is Stroke Volume?
A
amount of blood ejected by left ventricle during each contraction
13
Q
Normal HR for adult is —
A
60-100
14
Q
How is BP calculated?
A
BP = SV x Systemic Vascular Resistence (SVR)
15
Q
How is MAP calculated?
A
SBP + DBP *2 / 3
16
Q
What is a Normal MAP?
A
70-100
17
Q
What is Systolic BP?
What is Diastolic BP?
A
SBP = pressure generated by left ventricle to distribute blood into aorta
DBP = pressure against arterial walls during relaxation phase of heart
18
Q
What is Central Venous Pressure?
A
reflects filling pressures of the right side of the heart
Normal value is 2-5 mmHg
19
Q
What is normal CO?
A
4-6 L/min
20
Q
What is Cardiac Index (CI)?
A
adjusts CO for body size
Normal Value is 2.2-4.0 L/min/meters squared
21
Q
How is SV calculated?
A
(CO / HR) x 1000 = SV
22
Q
What is normal SV?
A
60-70 mL
23
Q
What is Systemic Vascular Resistence (SVR)?
A
the resistence against which the left ventricle must pump to eject its volume
ie: Afterload
normal value is 800-1400 dynes/sec/cm
24
Q
What is normal SVR?
A
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
