Perfusion

Question 1

perfusion

Answer 1

the process of nutrient delivery of arterial blood to a capillary bed
(supplying an organ or tissue with oxygen and nutrients)

Question 2

noninvasive assessment of perfusion

Answer 2

LOC
skin
urine output
color, BP, HR
capillary refill time

Question 3

perfusion scanning methods

Answer 3

CT perfusion
MRI perfusion
nuclear medicine perfusion

Question 4

cardiac output

Answer 4

the amount of volume/blood ejected/pumped from the heart in one minute
CO=HR*SV

Question 5

normal CO

Answer 5

4-8L/min

Question 6

normal cardiac index

Answer 6

2.4-4 L/min

Question 7

stroke volume

Answer 7

volume of blood pumped with each heartbeat

Question 8

normal SV

Answer 8

60-70mL with each ventricular contraction

Question 9

impact of HR on CO

Answer 9

severe increase in HR decreases SV due to decreased filling time, and therefore decreased CO

Question 10

four determinants of CO

Answer 10

heart rate
contractility
preload
afterload

Question 11

preload

Answer 11

amount of blood in ventricle at end of diastole
the degree of stretch in myocardial fibers at the end of diastole
the end diastolic ventricular volume
a function of volume and ventricular compliance

Question 12

factors affecting preload

Answer 12

volume: venous return, total blood volume, atrial kick
compliance: stiffness and thickness of ventricular wall

Question 13

manifestations of decreased preload

Answer 13

tachycardia
decreased urine output
increased specific gravity
dry mucous membranes
tented skin
sunken eyes
orthostatic hypotension

Question 14

increased preload

Answer 14

JVD
pedal edema
S3, S4
crackles
dyspnea
pink frothy sputum
ascities, hepatic engorgement

Question 15

medications affecting preload

Answer 15

fluids
diuretics
venodilators: nitrates, morphine, ACE inhibitors

Question 16

frank starling law of heart

Answer 16

increasing venous return, increases filling pressure of the ventricle will lead to increased force of contraction and stroke volume

Question 17

afterload

Answer 17

ventricular pressure at the end of systole, the resistance against which the heart pumps blood

Question 18

factors affecting afterload

Answer 18

aortic impedance
blood viscosity
blood volume
vascular tone

Question 19

systemic vascular resistance

Answer 19

resistance to ejection from left side of heart
normal 800-1200

Question 20

pulmonary vascular resistance

Answer 20

resistance to ejection from right side of heart
normal 50-250

Question 21

increased afterload

Answer 21

pale, cool, clammy skin
HTN
non-healing wounds
thick, brittle nails
slow cap refill
decreased urine output

Question 22

decreased afterload

Answer 22

warm, flushed skin
increased CO
decreased BP

Question 23

contractility

Answer 23

the ability of a muscle to shorten when stimulated
the force of myocardial contraction
independent of preload & afterload
SNS and PNS innervation
measured as EF

Question 24

decreased contracility

Answer 24

hypotension
fatigue
SOB
dizziness
low urine output

Question 25

increased contractility

Answer 25

increased blood pressure

Question 26

indications for hemodynamic monitoring

Answer 26

alterations in cardiac output alterations in fluid volume alterations in tissue perfusion

Question 27

central venous pressure

Answer 27

volume/pressure on the right side of the heart reflects filling pressures in the right ventricle guides overall fluid balance

Question 28

noninvasive hemodynamic technologies

Answer 28

impedance cardiography doppler ultrasound

Question 29

minimally hemodynamic technologies

Answer 29

CVP arterial access line MAP

Question 30

arterial line indications

Answer 30

monitoring blood pressure frequent ABGs

Question 31

pulmonary artery catheter advantages

Answer 31

real-time data measure a variety of hemodynamic parameters able to rapidly assess pts response to interventions

Question 32

PA catheters disadvantages

Answer 32

infection insertion complications air emboli, exsanguination balloon rupture pulmonary artery rupture

Question 33

pulmonary artery wedge pressure

Answer 33

4-12mmHg reflects left side preload

Question 34

pulmonary artery pressure

Answer 34

20-30/10s mmHg blood pressure

Question 35

central venous pressure

Answer 35

2-6mmHg reflects right sided preload

Question 36

pulmonary vascular resistance

Answer 36

50-250 dynes/sec/cm-5 reflects right sided afterload

Question 37

systemic vascular resistance

Answer 37

800-1200 dynes/sec/cm-5

Question 38

pulmonic valve stenosis/calcification

Answer 38

insidious process that happens over time increased afterload on right ventricle

Question 39

pulmonary hypertension

Answer 39

increased afterload on right ventricle, which impacts right ventricular emptying

Question 40

interventions for elevated PA pressures

Answer 40

find cause/root of problem reduction in preload (circulating volume) decrease venous return to the right side increase/improve contractility meds: vasodilators, diuretics, Na and fluid restriction, valve replacement/repair