Hemodynamic Monitoring Flashcards
1
Q
What is Hemodynamic Monitoring?
A
refers to the CONTINUOUS assessment of the CARDIOVASCULAR system to evaluate the HEART’S function and BLOOD flow throughout the body
2
Q
the total amount of blood ejected from the heart per minute
A
Cardiac Output (CO)
3
Q
What is the normal range for cardiac output?
A
4-8 Liters of blood each minute
4
Q
Why is cardiac output important?
A
It indicates adequate blood flow and oxygen delivery to tissues, which is crucial for overall health.
- aka ‘perfussion’
5
Q
amount of blood pumped by the VENTRICLE with each contraction
A
Stroke volume (SV)
6
Q
What is the normal range for stroke volume?
A
A: Each contraction should move between 60 to 100 ml of blood.
7
Q
Q: Why is stroke volume important?
A
A: It helps assess heart function and influences overall cardiac output.
8
Q
What is the cardiac output formula
A
CO = SV x HR
9
Q
What are the 2 determinantes of cardiac output
A
- Stroke volume
- heart rate
10
Q
- The determinant that can go up and down.
- Most easiest of the equation
A
Heart Rate
11
Q
The determinant of the equation that is more trickier bc it is influenced by MULTIPLE variables
A
Stroke Volume
12
Q
What 3 variables can influence Stroke Volume (SV)
A
Preload, Contractility, and Afterload
13
Q
Determinants of Stroke volume:
- Fill & stretch
- The VOLUME within the ventricles at the end of diastole
is called
A
Preload
14
Q
Determinants of Stroke volume:
- “Squeeze”
- How strong the heart squeezes
is called
A
Contractility
15
Q
- “Resistance”
- the resistance the LEFT ventricle must overcome to eject blood during contraction.
- The higher the resistance, the harder the heart must work
is called
A
Afterload
16
Q
Review:
Helps us to determine the volume status of our patient
A
Preload
17
Q
- Preload is measured on the RIGHT side of the heart as ___.
- “RIGHT ATRIAL PRESSURE”
A
CVP (CENTRAL VENOUS PRESSURE)
18
Q
Preload can be measured on the LEFT side of the heart as ___.
A
PCWP/PAWP
(Pulmonary Capillary/Artery Wedge Pressure)
19
Q
What is Central Venous Pressure (CVP)
A
- CVP is the pressure in the thoracic vena cava, near the right atrium & ventricle of the heart.
- It reflects the amount of blood returning to the right side of the heart and the heart’s ability to manage that blood volume.
- “RIGHT ATRIAL PRESSURE”
20
Q
What is the normal levels of Central Venous Pressure (CVP)
A
2-8 mmHg
21
Q
HIGH CVP the patient will present with
A
fluid OVERLOAD- HYPERvolemia
22
Q
LOW CVP, the patient will present with
A
DEHYDRATION- HYPOvolemia
23
Q
Review:
How do you treat Hypervolemia?
A
Diuretics- classes include
* Loop diuretics: ‘furosemide’
* Thiazides: end in -thiazide
* Potassium-sparing: end in -one (Spironolactone, Amiloride, Triamterene)
know these
24
Q
How would you treat DEHYDRATION
A
- IV FLUIDS
- ALBUMIN
- BLOOD TRANSFUSSION
ETC
25
Most “vasodilators” dilate ___.
ARTERIES (systemic or pulmonary).
26
Which drug is the one of the drug classes you know that dilate arteries, but also cause the VEINS to dilate as well.
nitrates
27
This effectively shows you the **preload for the left side** of the heart.
“Wedge Pressure”
**Pulmonary** Capillary/Artery Wedge Pressure (PCWP or PAWP)
28
What is the normal "Wedge Pressure"
Normal 6-12 mmHg
29
HIGH Wedge Pressure in pt's means ___.
Fluid OVERLOAD
30
LOW Wedge Pressure in pt's means ___.
HYPOvolemia.
31
Can you determine if a heart issue exists with just **one** measurement?
No
32
A **simple** calculation which **measures CO relative to the patient’s size**.
Cardiac Index
*on test, number will provided for you- no formula needed*
33
**medications** or substances that **increase the strength of heart muscle contractions**, enhancing the heart's ability to pump blood.
Positive Inotropes
34
Normal Cardiac Index
**2.2 - 4.0 L/min/m2**
*know normal levels- no calculations needed on test*
35
Q: Which drugs are considered **positive inotropes** that **increase** CONTRACTILITY?
List 6
* dopam**ine**
* dobutam**ine**
* epinephr**ine**
* norepinephr**ine**
* milrin**one** **
* **digoxin** **
**know**
36
**Positive** Inotropes also **increase** ___.
Cardiac workload
*increasing the heart’s O2 demands*
37
Medications or substances that **decrease the strength of heart muscle contractions**, leading to a **reduction** in CONTRACTILITY.
Negative Inotropes
38
Q: Which drugs are considered **negative inotropes** that **decrease** CONTRACTILITY?
* calcium channel blockers
* beta blockers
*They reduce the force of contraction, reducing cardiac workload and O2 demands of heart*
39
*Going back to Afterload:*
**Afterload** can be measured using what **2** measurements?
SVR and MAP.
40
Measures the **RESISTANCE** of blood flow **out of the LEFT ventricle into the AORTA.**
Systemic **Vascular** Resistance (SVR)
- *refers to the resistance that the body's blood vessels provide against the flow of blood from the heart through the systemic circulation.*
41
Systemic Vascular Resistance (SVR) **normal value** is
**800 -1200 dynes/sec/cm-5**
42
**Increased** SVR indicates
Vaso**constriction**
43
**Decreased** SVR indicates
Vaso**dilation**
44
Drugs that cause VASO**CONSTRICTION**
List 4
* Epinepherine
* norepinephrine
* phenylephrine
* vasopressin - "*press in*"
*think meds that increase BP*
**KNOW**
45
Drugs that cause VASO**DILATION**
List 4
* Calcium channel blockers
-*verapamil, nifedipine, diltiazem*
* ace-inhibitors- "*pril*
* nitrates- *NTG*
* direct vasodilators (ex: *hydralazine*)
**KNOW**
46
* CRITICAL measure of blood pressure that represents the **average pressure in a person's arteries AFTER blood leaves LEFT side of heart.**
* It is an important indicator of **perfusion** to vital organs.
**MAP** = Mean Arterial Pressure
47
Normal MAP is
**70 - 105 mmHg**
*(>60 necessary to sustain vital organs)*
48
What is the **MAP formula**
MAP = **(SBP + DBP x 2) ÷ 3**
(*diastolic is added 2x*)
**know**
49
To calculate **Preload** (both sides of heart), what 2 parameters are needed
* **CVP** (right side of heart)
* **Wedge pressure** (left side of heart)
50
To calculate **Contractility**, what 2 parameters are needed
* Cardiac Output
* Cardiac Index
51
3 **Non-Invasive** methods for hemodynamic monitoring
1. Central Lines
2. Arterial Lines
3. Swan Catheters **
52
Arterial lines give us CONTINUOUS
BP & MAP readings
53
What should we assess if a patient has an ART- line and how often?
* Assess **neurovascular status** distal to the arterial insertion site - **6 P's**
* Q 1 hr **
54
List the 6 P's
(review)
55
Can you use ARt- lines as an extra lumen for **administering medications**?
No! The only thing running should be NS
56
If your'e arterial pressure monitor alarms are going off... what will you assess FIRST!?
ALWAYS ASSESS PT FIRST!!!
57
What risks follow a Pulmonary Artery Pressure Monitoring (PA catheters) -"**SWANS**"
**List 3**
* Blocks blood flow through PULMONARY artery
* Balloon can rupture
* Tear of pulmonary artery
58
For testing purposes, if the question states 'The patient is wedged..', OR 'Patient has a SWAN/PA catheter and is in distress' OR 'Pt turns and accidentaly inserts air into the ballon' .... what would most likely be the answer you would choose?
DEFLATE THE BALLOON
59
When a **PA Catheter/SWAN** is being **removed**, theres a posibility that patients can go into __.
VTACH or VFIB
60
VTACH can be both
with PULSE or PULSELESS
61
HOW TO TREAT VTACH
* **With Pulse**: antidysrhythmics or cardioversion (if rx ineffective
* **Pulseless**: IMMEDIATELY START CPR, SHOCK, CPR 2 mins, SHOCK, CPR 2 mins, **Epi (1mg) Q3-5 mins**, SHOCK, CPR 2 mins, **Amiodarone (1st: 300mg, wait 3-5mins, 2nd: 150mg) or lidocaine (1st: 1mg, 2nd: 0.5)**
62
Q: What is **referencing** in the context of a PA-Art line?
It means positioning the transducer of the PA catheter so that the **zero reference point is at the level of the atria of the heart.**
63
Where is the **reference point** that ensures **correct pressure readings from the PA catheter**
Is the **phlebostatic axis**,
* located at the 4th intercostal space at the midaxillary line (*approximately at the level of the right atrium*).
64
Confirms that when pressure **within the system is zero**, the **monitor reads zero**
Zeroing
65
When should you Zero?
With initial setup, periodically thereafter, or when questioning measurements.
* *for this- dont zero when patient moves around*
66
What should you check FIRST before troubleshooting a system?
Assess your patient!!!!
- treat the pt not the monitor
67
Q: Why should clinicians **avoid** relying on a s**ingle hemodynamic measurement**?
A **single** hemodynamic value is **rarely** significant; evaluating multiple values provides a clearer picture of the patient's cardiovascular status.
68
**Increased blood pressures** in the **pulmonary arteries**
What am I?
Pulmonary Hypertension
68
What happens to the pulmonary arteries in Pulmonary Hypertension?
thicken, narrow, and stiffen
69
What can Pulmonary Hypertesion cause in the HEART?
right-sided heart failure (RS HF)
* *if untreated RS HF occurs and death within a few years*
69
Pulmonary Vascular Resistance (PVR) will be ___ in Pulmonary Hypertension
elevated
70
What is the word that means Right Side heart failure that is NOT caused by true heart failure
“Cor pulmonale”
71
How essential are medications for patients with pulmonary hypertension?
* Medications are considered the **lifeline** for these patients
* NEVER stop taking them.
72
3 Levels of Pulmonary HTN
1. Mild
2. Moderate
3. Severe
73
What meds are used for **MILD** Pulmonary HTN?
Calcium Channel Blockers
1. **Dihydropyridines**: End in "-dipine."
2. **Non-Dihydropyridines**: "VD" for Verapamil and Diltiazem.
74
CCB for MILD Pulmonary HTN are used in patients **WITHOUT**
RIGHT-sided heart failure
75
In MODERTE Pulmonary HTN, what meds are used?
**Phosphodiesterase Enzyme Inhibitors**
* *prolonged vasodilation, increased blood flow, and enhanced smooth muscle relaxation.*
76
What are the 2 Phosphodiesterase Enzyme Inhibitors (PEI) meds we need to know?
1. silden**afil** (Viagra)
2. tadal**afil** (Cialis)
End in *-afil*
**know**
77
**Phosphodiesterase Enzyme Inhibitors (PEI)** should **NOT** be given to patients who are already taking ___.
**NTG**- may cause **refractory hypotension** (*persistent low blood pressure that does not respond to standard treatments or interventions*)
78
What meds will we give to a pt with **SEVERE** pulmonary HTN
Vasodilators (**inhaled**)
*Teach pt how to use nebulizer*
79
2 Vasodilators (**inhaled**) meds we need to know
1. ilo**prost** (Ventavis)
2. tre**prostinil** (Tyvaso
**-prost** in the name
80
How many times a day will **INHALED** Vasodilators be administerd?
6-9 times /day
81
Main side effect of Vasodilators
orthostatic hypotension
82
What are the **3 Vasodilator meds** used for **SEVERE** Pulmonary HTN that we give via **PARENTERAL**.
* treprostinil (Remodulin)
* epoprostenol (Flolan)
* epoprostenol (Veletri)
end in **-prostinil/prostenol**
83
Strategies to Manage Hemodynamic Alterations: Overall
84
*Pulmonary HTN:*
Vasodilator **Parenteral** meds are given what 2 routes?
* IV - central line
* SubQ
