Hemodynamic Monitoring Flashcards
What is ejection fraction?
Ratio of stroke volume to end-diastolic volume
What two things does preload impact the most?
Ventricular contractile response (Starling) and organ perfusion
What measurement tells you about the right ventricular preload?
CVP/RAP
What measurements tell you about left ventricular preload?
PAD/PAP and PAOP/PCWP
What assessment findings would you expect to see with increased left ventricular preload?
Lung issues: crackles, dyspnea, cough, etc
What assessment findings would you expect to see with increased right ventricular preload?
JVD, edema, HJR (assessed by pressing on the liver)
What would you administer if you wanted to reduce preload?
Diuretics, nitrates, beta and calcium channel blockers
What assessment findings would you expect to see with decreased preload?
Altered LOC, decreased urine output, tachycardia, hypotension, dry mucous membranes, poor skin turgor
What would you administer if you wanted to enhance preload?
Volume (crystalloids, colloids, blood) and norepinephrine (LEVOPHED)
What must you check before administering norepinephrine (LEVOPHED)?
That the patient has adequate volume
What is the most critical factor in determining after load?
Vascular resistance
Which assessment readings will give you information about after load?
MAP, SVR, PVR
What would you administer to reduce after load?
Vasodilators; nitroprusside, calcium channel blockers (NICARDIPINE), ACE-inhibitors, ARBs
What would you administer to enhance after load?
Vasopressors for vasoconstriction; norepinephrine (LEVOPHED), dopamine
What factors influence contractility?
coronary artery perfusion (HR), coronary oxygen supply, blood pressure, valve competence, intracellular calcium and ATP availability
Which measurements give you information about contractility?
CO, CI, EF
What findings are associated with low cardiac output?
dry, cool skin, decreased urine output, mental status changes, tachycardia, poor peripheral circulation
What would you administer to reduced contractility?
Negative inotropic agents; beta and calcium channel blockers
What would you administer to enhance contractility?
Volume to increase preload, positive inotropic agents; dobutamine, digoxin, dopamine
Stimulation of the beta one receptors produces what effect?
altered ventricular function, positive chronotropic and inotropic effects; faster heart rate and stronger force of contraction
Stimulation of the beta two receptors produces what effect?
bronchodilation and vasoconstriction
The parasympathetic system releases what NT? What effect does it have on the body?
Acetylcholine; negative dromotropic and chronotropic effects; slower conduction and heart rate
Stimulating the vagus nerve by bearing down on the glottis produces what effect?
Slows conduction and heart rate
A patient with invasive hemodynamic monitoring can have their head of bed no higher than what?
60 degrees
