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NUR 340 > W8: Cardio Mgmt & Hemodynamic > Flashcards

W8: Cardio Mgmt & Hemodynamic Flashcards

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1
Q

Heart Rate x Stroke Volume =

A

Cardiac Output

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2
Q

What is preload?

A

Volume of blood in ventricles at end of diastole (end of diastolic pressure)

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3
Q

How do we increase preload?

A

administration of IV fluid - will drip fluids into the venous system and will increase blood volume returning to the heart

sympathetic nervous system - stimulating with a vasopressor - will increase venous return to the heart

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4
Q

What is afterload?

A

Resistance left ventricle must overcome to circulate blood

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5
Q

What is afterload increased in?

A

Hypertension
Vasoconstriction

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6
Q

Increased afterload results in

A

Increased cardiac workload

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7
Q

What is the resistance the heart has to pump against?

A

Afterload is the force or load against which the heart has to contract to eject the blood

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8
Q

How does tachycardia impact cardiac output and coronary artery filling?

A

Tachycardia of atrial or ventricular origin reduces stroke volume and cardiac output, particularly when the ventricular rate is greater than 160 beats/min.

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9
Q

Frank Starling Principle

A

The Frank-Starling Law states that the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction.

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10
Q

Intrinsic rate

A

The patients own heart beat

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11
Q

Extrinsic rate

A

A rate that is set by an artificial source

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12
Q

Temporary Pacemakers Indications

A

Dysrhythmias that are unresponsive to drug therapy and that compromise hemodynamic status

Usual application symptomatic bradycardia or progressive heart block secondary to ACS or drug toxicity

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13
Q

When are temporary pacemakers used?

A

Usual application symptomatic bradycardia or progressive heart block secondary to ACS or drug toxicity

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14
Q

What do temporary pacemakers require?

A

Requires pulse generator and pacing leads

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15
Q

Synchronous pacing modes (demand) pacers

A

DDD

VVI

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16
Q

Describe DDD Pacing

A

most physiologic- enhances atrial contribution to ventricular filling

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17
Q

Describe VVI Pacing

A

designed to pace ventricle; demand pacing; used in atrial fibrillation

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18
Q

Asynchronous Pacer

A

Emergency DOO

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19
Q

Describe DOO Pacer

A

Emergency DOO (both atrium and ventricles) or VOO(ventricles) used is asystole or operating room if EMI(electric magnet interference) is an issue

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20
Q

Ventricular pacing

A

–Ventricular pacing spikes followed by wide, bizarre QRS complexes

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21
Q

A-V Pacing

A

Atrial & Ventricular pacing spikes followed by atrial & ventricular complexes

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22
Q

Modes of Pacing

A

Atrial pacing
*Intact AV node conduction system required

Ventricular pacing
•Loss of atrial kic

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23
Q

Patient Education - Temporary Pacer

A

➢Exposed lead wires
➢Soiled or dislodged dressings
➢Electrical devices from home
➢Movement of affected extremity

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24
Q

Patient Education - Permanent

A

➢Remote monitoring can be transtelephonic or Internet-based-status of the pacemaker will be regularly checked or “interrogated”
➢Avoiding electromagnetic interference
➢Activity
➢Pacemaker ID card

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25
What is an ICD?
The implantable cardioverter defibrillator (ICD) system
26
Describe ( Implantable Cardioverter-Defibrillator) ICD
●Electronic device used in treatment of life-threatening tachy dysrhythmias and: ●Sudden cardiac arrest ●Spontaneous sustained VT ●Familial or inherited condition (long QT syndrome) ●Recurrent syncope of undetermined etiology ●Capable of identifying and terminating lethal ventricular arrhythmias
27
Postoperative Nursing Management - Cardiac Surgery
•Postoperative Nursing Management –Normalize cardiac output –Rewarming –Maintaining chest tube patency –Control bleeding including early detection of tamponade –Promoting early extubation and preventing respiratory complications –Assessing for neurologic complications –Preventing infection –Preserving renal function
28
Valvular Disease - Stenosis
Stenosis Mitral stenosis ●Rheumatic heart disease Aortic stenosis ●Rheumatic fever, calcification with age
29
Valvular Disease - insufficiency
Insufficiency Mitral insufficiency ●Rheumatic heart disease, age, LV dilation Aortic insufficiency ●Rheumatic disease, aneurysm of ascending aorta
30
During cardiopulmonary bypass surgery what temperature is the body temperature lowered to?
To 28C from 32C
31
Complications of Cardiopulmonary Bypass
Increased capillary permeability ●Hemodilution ●Altered coagulation ●Damage to blood cells ●Microembolization
32
What does a cardiopulmonary bypass do?
Moves oxygenated blood around the body during open heart surgery
33
Describe Intraaortic Balloon Pump IABP
Used to treat heart failure when conventional pharmacologic therapy has proved ineffective or as a bridge to definitive therapy for ACS Decrease myocardial workload and maintain adequate perfusion to vital organs
34
Diastolic balloon ____ augments coronary ____ and systolic deflation ____ afterload
Diastolic balloon INFLATION augments coronary BLOOD FLOW and systolic deflation DECREASES afterload
35
Carotid Endarterectomy 70% to 90% stenosis Postoperative
Postoperative Management ●Control of blood pressure ●Assessment of cranial nerves: VII, X, XI, XII Bleeding ●Note neck size ●Check for swelling – possible hematoma formation ●Difficulty in swallowing or breathing - Airway
36
BEDSIDE HEMODYNAMIC MONITORING Indications
processes that alter preload, afterload, contractility and heart rate
37
Bedside Hemodynamic Monitoring can lead to:
Decreased cardiac output •Deficient fluid volume or excess fluid volume •Ineffective tissue perfusion
38
What does stroke volume consist of?
Preload Contractility Afterload
39
PULMONARY ARTERY PRESSURE MONITORING Indications
Hypovolemic shock •Early septic shock •Advanced septic shock or multisystem failure •Cardiogenic shock •Acute respiratory distress syndrome (non-cardiogenic shock) •Cardiac output indications
40
ACCURACY OF PRESSURE SYSTEMS DEPEND ON ACCURATE USE OF:
High pressure tubing Transducer Flush system including manual flush Beside monitor
41
Pulmonary Artery Pressure Monitoring - Nursing Mgmt Priorities
Preventing pulmonary artery catheter-related complications - Cardiac - Pulmonary -Infection
42
NON-INVASIVE SURROGATES TO EVALUATE CARDIAC OUTPUT
Inferior vena cava measurements Passive leg raise The FloTrac sensor
43
How do you perform a passive leg raise?
To perform a passive leg raise, a patient is placed in a semi-recumbent position at 45°. The patient’s legs are then elevated to 45° and the hemodynamic variable of interest evaluated after 30−60 seconds.
44
What is stroke volume?
the amount of blood pumped by a ventricle with each beat
45
What is contractility?
strength of cardiac cells to contract/shorten
46
How can be decrease preload?
Administration of diuretic - to remove extra fluid from the blood volume Vasodilation - nitroglycerin - the vessels will widen and increase blood pooling and decrease the amount of blood coming to the heart
47
What is cardiac afterload affected by?
vascular resistance
48
What is preload increased in?
Hypervolemia Regurgitation of cardiac valves Heart Failure
49
What decreases afterload?
Vasodilators - to decrease vascular resistance - due to widening of the vessels - decrease afterload
50
What increases afterload?
Aortic stenosis - Valve problems - narrowing of the valves cause for a greater resistance to work against
51
Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole. C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.
The answer is B. Cardiac preload is the amount the ventricles stretch at the end of diastole (the filling or relaxation phase of the heart).
52
Select the statement below that best describes cardiac afterload: A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.
The answer is D. Cardiac afterload is the pressure the ventricles must work against to pump blood out of the heart by opening up through the semilunar valves. So, it’s the pressure the ventricles must overcome to open the semilunar valves to push blood out of the heart.
53
What two factors are used to calculate cardiac output? Select all that apply: A. Heart rate B. Blood pressure C. Stroke volume D. Mean arterial pressure
The answers are A and C. Cardiac output is calculated by taking the heart rate and multiplying it by stroke volume. CO = HR x SV
54
A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility
The answer is B. IV fluids will increase venous return to the heart. This will increase the amount of fluid that will fill the ventricles at the end of diastole...hence increasing preload and increasing cardiac output.
55
__________ is the amount of blood pumped by the left ventricle with each beat. A. Cardiac output B. Preload C. Afterload D. Stroke volume
The answer is D. Stroke volume is the amount of blood pumped by the left ventricle with each beat.
56
Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume: A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure
The answers are B, C, and D. Preload, afterload, and contractility all have a role with influencing stroke volume
57
Which treatments below would decrease cardiac preload? Select all that apply: A. IV fluid bolus B. Norepinephrine C. Nitroglycerin D. Furosemide
The answers are C and D. Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys. This will decrease venous return to the heart and decrease preload. An IV fluid bolus and Norepinephrine (a vasoconstrictor) will increase venous return to the heart and increase preload.
58
A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will? A. Decrease the patient’s blood pressure and increase cardiac afterload B. Decrease the patient’s blood pressure and decrease cardiac afterload C. Decrease the patient’s blood pressure and increase cardiac preload D. Increase the patient’s blood pressure but decrease cardiac output.
The answer is B. The patient has a high systemic vascular resistance…as evidence by the patient’s blood blood….there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now, the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will go down (hence the systemic vascular resistance).
59
What conditions below can result in an increased cardiac afterload? Select all that apply: A. Vasoconstriction B. Aortic stenosis C. Vasodilation D. Dehydration E. Pulmonary Hypertension
The answers are A, B, and E. Vasoconstriction increases systemic vascular resistance which will increase cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve to get blood out of the heart….all of this increase cardiac afterload.
60
True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload. True False
The answer is True. If pulmonary vascular resistance or systemic vascular resistance is high, it will create an increased cardiac afterload. If pulmonary vascular resistance or systemic vascular resistance is low, it will create a decreased cardiac afterload.
61
Capture
Heart responds to the pacer to see stimulation There will be a P or QRS after the pacer spike
62
Sense
The ability of the pacer to "se" the intrinsic activity of the heart
63
Inhibited
An intrinsic event causes the pacer "turned off" because some activity is seen QRS comes faster the pacer rate set
64
Asynchronous (fixed) pacing
set at a fixed rate, a non sensing mode. Pacer paces regardless of the intrinsic activity
65
Synchronous pacing
pacer delivers a stimuli in response to what it senses
66
Trigger
An intrinsic event causes a stimuli to be delivered Long AV delay
67
What degree blockage requires a pacemaker
Third degree heart block

NUR 340 (4 decks)

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