lecture #1 - hemodynamic monitoring

Question 1

what is systole?

Answer 1

contraction; when two ventricles contract causing blood to be ejected into aorta and pulmonary artery

Question 2

what is diastole?

Answer 2

relaxation; blood vessels return blood to the heart in preparation for the next ventricular contraction

Question 3

what are the properties of myocardial cell?

Answer 3

automaticity, conductivity, contractility, excitability

Question 4

what is chronotropy?

Answer 4

the rate of contractions; positive chronotropic inc HR; negative chronotropic dec HR

Question 5

what type of medications do you give when the heart is inc contracting (HF, HTN)?

Answer 5

beta-blockers (-“lol”) - metoprolol or atenolol
calcium channel blockers (-“pine” or “-zem”) - amlodipine or cadizem
antiarrhythmic drugs - amiodarone

Question 6

what do inotropes do?

Answer 6

inc or dec force of contractions

Question 7

what do positive inotropes do?

Answer 7

strengthen the heart’s contraction, pump more blood w/ fewer heartbeats (used in CHF, cardiomyopathy, recent MI, cardiogenic shock)

Question 8

what do negative inotropes do?

Answer 8

weaken the heart’s contraction + slow the HR
tx CHF, HTN, arrythmias, chest pain + MI pt to red stress

Question 9

what do dromotropy agents do?

Answer 9

affect the conduction speed in the AV node + subsequently the rate of electrical impulse
(+) pos inc conduction velocity (epi)
(-) neg dec velocity (vagal stim)

**important in tx cardiac arrythmias

Question 10

what is cardiac output (CO)?

Answer 10

the amount of blood pumped by heart in one minute

Question 11

what is preload?

Answer 11

the stretch of the ventricle when the heart is at the end of diastole (LVEDP) just before contraction

inc pre load - HF, valve disease, inc O2 demand
dec pre load - ACE, ARBS, diuretics, nitrates, CCB
dec pre load - shock, hemorrhage, dec blood return to heart

Question 12

what is afterload?

Answer 12

the pressure the the heart must work against to eject blood during systole

inc afterload = inc BP + aortic stenosis

Question 13

what is stroke volume?

Answer 13

the volume of blood pumped out of the left ventricle to the heart during each systolic cardiac contraction

norm (50 - 100 mL)

Question 14

what is venous return?

Answer 14

the flow of blood back to the heart, the vol of blood that returns from the veins to the atria each minute

Question 15

what is systemic vascular resistance (SVR)?

Answer 15

total peripheral resistance, amount of force exerted on circulating blood by the vasculature of the body

Question 16

what is pulmonary vascular resistance?

Answer 16

the resistance against blood flow from the pul artery to the left atrium

Question 17

what is the goal of hemodynamic monitoring?

Answer 17

to maintain adequate tissue perfusion

Question 18

what factors affect HR?

Answer 18

autonomic innervation, hormones, fitness levels, age

Question 19

what factors affect SV?

Answer 19

heart size, fitness levels, gender, contractility, duration of contraction, preload (EDV), afterload (resistance)

Question 20

what does hemodynamic tell us?

Answer 20

the numbers can change before s/s
an inc in PAP means early indicator of: LV failure, pulmonary edema, fluid overload (hypervolemia)

*needs early tx

Question 21

indications of hemodynamic monitoring?

Answer 21

critical illness, shock, hemodynamic instability, HF, unstable post op pt, ARDS, acute kidney injury, severe burn injury, trauma

Question 22

expected reference ranges

Answer 22

Central venous pressure (CVP) = 2-6 mmHg
Pulmonary artery systolic (PAS) = 15-28 mmHg
Pulmonary artery diastolic (PAD) = 5-16 mmHg
Pulmonary artery wedge pressure (PAWP) = 6-15 mmHg
Cardiac output = 3-6 L/min
mixed venous (SVO2) = 60-80%

Question 23

what are the pre-procedure nursing actions?

Answer 23

ensure pt’s understanding of procedure
assemble the pressure monitoring system
place pt in supine or trendelenburg position
level transducer w/ phlebostatic axis

Question 24

what is the phlebostatic axis?

Answer 24

the anatomical point that corresponds to the RA and most accurately reflect’s a pt hemodynamic status

Question 25

what are the post procedure nursing actions?

Answer 25

obtain CXR to confirm cath placement continually mon respiratory + cardiac status maintain line placement + integrity observe + document waveforms; report changes as this can indicate catheter migration or displacement place in supine position; HOB can be elevated 15-30 degrees zero system to atmospheric pressure;monitor trends **secure that PA catheter

Question 26

nursing actions for infection/sepsis?

Answer 26

change dressings per protocol/document use surgical aseptic technique (mask, sterile gloves, maintain sterile field) mon for evidence of infection (fever, inc WBC) collect specimens as ordered admin antibiotics; IVFs; vasopressors

Question 27

nursing actions for embolism?

Answer 27

use 0.9% sodium chloride for flushing system (heparin) avoid introduction of air to prev embolism recognize risk of pneumothorax w/ line insertion recognize risk of arrythmias w/ insertion or line movement

Question 28

what is hemodynamic instability?

Answer 28

systolic BO <= 90 mmHg sustained low BP + dropping GOAL: MAP > 60 mmHg

Question 29

s/s of altered hemodynamic (preload)?

Answer 29

elevated: crackles in lungs, jugular vein distention, hepatomegaly, peripheral edema, taut skin turgor dec: poor skin turgor, dry mucous membranes R heart: CVP L heart: PCWP

Question 30

s/s of altered hemodynamics (afterload)?

Answer 30

elevated: cool extremities, weak pulses decreased: warm extremities, bounding pulses R heart: pulmonary vascular resistance L heart: systemic vascular resistance

Question 31

what drugs used to treat hemodynamic instability?

Answer 31

vasopressors inotropic drugs vasodilators anti htn loop diuretic morphine

Question 32

what do vasopressors do?

Answer 32

inc SVR + inc BP; induce vasoconstriction inc MAP Phenylephrine, Norepinephrine, Epinephrine, Dopamine, Vasopressin Vasopressors = vasoconstriction

Question 33

what do inotropic drugs do?

Answer 33

inc CO, inc BP pos (+) = Epinephrine, Norepinephrine, Dopamine, Dobutamine, Milrinone, Digoxin neg (-) = Flecainide, Verapamil, Cardizem, Clonidine, Atenolol

Question 34

what do vasodilators/anti htn do?

Answer 34

dec afterload + BP

Question 35

what do loop diuretics do?

Answer 35

dec preload + BP *if taken long term will dec afterload

Question 36

what does morphine do?

Answer 36

dec VR + preload

Question 37

why is cardiac output important?

Answer 37

it affects PERFUSION tissue perfusion is dependent on blood flow 3 factors = circulating vol, cardiac pump function, vasomotor tone *any inc in CO will inc BP = better blood flow

Question 38

nursing actions for arterial line?

Answer 38

assess for signs of bleeding, dislodgement, hematoma, infection assess for 5 P's: pain, pallor, pulses, paresthesia, paralysis if line gets dislodged = PRESSURE!