Term
| Cardiodynamics/Hemodynamics |
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Definition
| Demonstrates the forces the heart needs in order to circulate blood. |
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Term
|
Definition
| Blood pressure and blood flow. |
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Term
| How do you calculate pulse pressure? |
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Definition
| Systolic bp - diastolic bp |
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Term
| How do you calculate mean arterial pressure (MAP)? |
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Definition
(Sbp) + (dbp x 2)
-----------------
3 |
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Term
|
Definition
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Term
| How do you calculate cardiac output (CO)? |
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Definition
Heart rate x stroke volume
(HR x SV) |
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Term
|
Definition
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Term
| How do you calculate cardiac index (CI)? |
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Definition
Cardiac output ÷ body surface area
(CO ÷ BSA) |
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Term
|
Definition
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Term
| How do you calculate stroke volume (SV)? |
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Definition
Cardiac output x 1000 / heart rate
(CO x 1000 / HR) |
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Term
|
Definition
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Term
|
Definition
Stretch on the ventricular mycardium at end diastole.
It is determined by volume. |
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Term
| What is the main cause of elevated preload? |
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Definition
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Term
| What causes right ventricular elevated preload? |
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Definition
fluid overload
tricuspid stenosis
pulmonary stenosis
pulmonary insufficiency
pericardial tamponade
constrictive pericarditis
right ventricular infarction
pulmonary hypertension |
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Term
| What causes left ventricular elevated preload? |
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Definition
Left sided heart failure
Volume overload
Mitral stenosis
Cardiomyopathy
Myocarditis
Pericardial tamponade
Constrictive pericarditis |
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Term
| What is the main cause of decreased preload? |
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Definition
|
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Term
| What causes left ventricular decreased preload? |
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Definition
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Term
| What causes right ventricular decreased preload? |
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Definition
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Term
| How do you treat elevated preload? |
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Definition
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Term
| How do you treat decreased preload? |
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Definition
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Term
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Definition
| Pressure (resistance) against the ventricles has to pump to eject blood |
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Term
| What is the main cause of elevated afterload? |
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Definition
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Term
| What causes elevated systemic vascular resistance? |
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Definition
Hypertension
Vasopressor use
Aortic stenosis
Hypothermia |
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Term
| What causes elevated pulmonary vascular resistance? |
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Definition
Pulmonary hypertension
Hypoxia
Pulmonary embolism
Pulmonary stenosis |
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Term
| What is the main cause of decreased afterload? |
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Definition
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Term
| What causes decreased systemic vascular resistance? |
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Definition
Septic shock
Anaphylactic shock
Neurogenic shock
Use of vasodilators
Medication side effects |
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Term
| What causes decreased pulmonary vascular resistance? |
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Definition
use of vasodilators
Medication side effects (Viagra) |
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Term
| How do you treat elevated afterload? |
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Definition
Vasodilators
Calcium channel blockers
ACE inibitors |
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Term
| How do you treat decreased afterload? |
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Definition
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Term
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Definition
| the ability of the myocardium to shorten the muscle fibers (how well the heart contracts) |
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Term
| What things influence contractility? |
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Definition
| Electrolytes (K+), acid-base balance, myocardial oxygen supply/demand (MVO2) |
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Term
| What causes elevated contractility? |
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Definition
Hypercalcemia
Administration of positive inotropic medications
Sympathetic stimulation |
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Term
| What causes decreased contractility? |
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Definition
Hyperkalemia
Hypocalcemia
Myocardial ischemia
Administration of negative inotropic medications
Hypercapnea
Hypoxia
Acidosis |
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Term
| How do you treat decreased contractility? |
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Definition
|
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Term
| How do you treat elevated contractility? |
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Definition
Beta blockers
Calcum channel blockers
Cardioversion |
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Term
| What are some clinical manifestations of elevated preload? |
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Definition
JVD
edema
SOB
crackles
pink, frothy sputum |
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Term
| What are some clinical manifestations of decreased preload? |
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Definition
tented skin
sunken eyes
hypotension
dry mucous membranes |
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Term
| What are some clinical manifestations of elevated afterload? |
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Definition
HTN
decreased urine output
pale, cool extremities
slow cap refill |
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Term
| What are some clinical manifestations of decreased afterload? |
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Definition
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Term
| What are some clinical manifestations of decreased contractility? |
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Definition
hypotension
fatigue
SOB
dizziness
low urine output |
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Term
| What are some clinical manifestations of increased contractility? |
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Definition
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Term
| Nursing management with PA cath insertion |
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Definition
Prime the system
Zero and level
Place pt in Trendelenberg
Monitor pt status, pressures and waveforms during insertion
Set alarms |
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Term
| Nursing management after PA cath insertion |
|
Definition
Apply sterile occlusive dressing
CXR to verify placement
Monitor vitals and waveforms
Assess respiratory and cardiovascular status |
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Term
| Continued care for PA cath |
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Definition
Record values at least hourly
Monitor trends
Ensure tight connections
Sterile, non-vented capps
Pressure bag at 300 mmHg
Alarm active at all times
Monitor placement via waveforms
Observe for infection |
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Term
|
Definition
Ventricular dysrhythmmias
Pulmonary artey/capillary rupture
Pulmonary infarction
Pneumo/hemothorax
Infection
Hematoma
Valvular damage
PA catheter knotting |
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Term
| What does Mixed Venous Oxygen Saturation (SVO2) reflect? |
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Definition
|
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Term
|
Definition
O2 sat
Hgb
CO
oxygen use by the tissues |
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Term
|
Definition
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Term
|
Definition
| From central venous catheter |
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Term
|
Definition
Low CO/CI (hypovolemia, left ventricular failure)
Low Hgb (Bleeding, dyshemoglobinemia- carbon monoxide poisoning)
Low SaO2 (pulmonary disease, low inspired oxygen)
High O2 demand (elevated metabolic rate - fever, hyperthyroidism, shivering, seizures, stressful states -surgery, pain, trauma. |
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Term
|
Definition
High oxygen delivery - high FiO2
Low oxygen demand - hypothermia, anesthesia, paralysis, sepsis |
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Term
| What are the early signs of shock? |
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Definition
MAP down 10 mmg from baseline
Effective compensation
Elevated heart rate |
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Term
| What are the compensatory signs of shock? |
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Definition
MAP down 10-15 mmHg from baseline
Elevated renin
Elevated ADH
Vasoconstriction
Low Pulse Pressure
High Heart Rate
Low pH
Restless
Apprehensive |
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Term
| What are the progressive signs of shock? |
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Definition
MAP down 20 mmHg from baseline
Tissue/Organ hypoxia
Oliguria
Weak Rapid Pulse
Low pH
Sensory Neural Changes |
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Term
| What are the refractory signs of shock? |
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Definition
Excessive cell/organ damage
Multisystem Organ Failure
low pH |
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Term
| What causes hypovolemic shock? |
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Definition
Results from decreased circulating volume.
Caused by hemorrhage (trauma, surgery, GI bleed, rupture aneurysm) or fluid loss (vomiting, diarrhea, ascites, third spacing)
Loss of 15-30% or more of normal blood volume. |
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Term
| What are the diagnostic criteria for hypovolemic shock |
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Definition
Hypernatremia
Elevated Hct
Metabolic acidosis
Elevated serum lactate
Decreased SVO2 |
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Term
| How do you treat hypovolemic shock? |
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Definition
Fluid bolus of isotonic crystalloids (0.9 NS or LR)
Blood products (PRBC's, plasma, platelets) |
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Term
| What happens if you rapid infuse blood products and why? |
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Definition
Hypocalcemia.
The preservative in the blood binds to calcium in the blood and lowers the levels too much. |
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Term
| If the sodium level in your hypovolemic pt is too high, what fluid can you give instead of 0.9 NS? |
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Definition
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Term
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Definition
| Systemic Inflammatory Response Syndrome |
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Term
|
Definition
| SIRS + presence of (or presumed) systemic infection |
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Term
| What happens when you have dysfunction of 2 or more organ systems? |
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Definition
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Term
| What are the clinical manifestations of SIRS? |
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Definition
Fever
Pulse >90 bpm
MAP <70 mmHg
RR >20 breaths/min
PaCO2 <32
WBC >12,000 mm3 or <4000 mm3 |
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Term
| How can we prevent sepsis? |
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Definition
Prevent nosocomial infections such as VAP, CAUTI, Surgical Site infections.
Identify signs of infection early. |
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Term
| What are two of the clinical manifestations of sepsis? |
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Definition
Fever, chills
Hypotension
Decreased skin perfusion
Decreased urine output
Significant edema or positive fluid balance
Hyperglycemia
Decreased cap refill or mottling |
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Term
| What are some signs of organ dysfunction? |
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Definition
Tachypnea/hypoxia - lungs
Coagulation abnormalities/thrombocytopenia
Mental status changes - neuro
Decreased urine output/increase in serum creatinine - renal
Jaundice/coagulopathy/decreased protein C levels/increased D-dimer levels - liver
Stress ulceration/ileus/malabsorption - GI
tachycardia/dysrhythmias/hypotension with decreased CVP or PA pressures/high or low cardiac output - cardiac |
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Term
| How do you treat septic shock? |
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Definition
Early recognition
Antibiotics
Fluid resuscitation
Vasopressors
Blood products |
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Term
| What are the steps of the sepsis resuscitation bundle? |
|
Definition
1. Measure serum lactate.
2. Obtain cultures.
3. Start broad spectrum antibiotic (w/in 3 hrs of ED admission, w/in 1 hr of non-ED admission)
4. Administer min of 20 mL/kg of crystalloid or colloid equivalent
5. Use vasopressors for hypotension not responding to fluid resuscitation
a. Norepinephrine (Levophed)
b. Vasopressin
c. Dopamine |
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Term
| What is the most common cause of DIC? |
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Definition
|
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Term
| What does the breakdown of fibrin result in? |
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Definition
| Fibrin degradation products |
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Term
| How would you recognize a pt is developing DIC? |
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Definition
| Pt presents with either signs of bleeding or symptoms from systemic microemboli. |
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Term
| What signs of bleeding suggest DIC? |
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Definition
Oozing from IV sites, art lines, urinary catheters, surgical sites, GI tract, and mucous membranes.
Ecchymosis on the palate, gums, and skin.
Hemoptysis
Hemorrhage
Hematochezia |
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Term
| What symptoms of systemic microemboli might you see in a pt with DIC? |
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Definition
Cyanosis +/or gangrene (especially of the digits)
Pain
Diminished pulses
Change in LOC - stroke
Signs of renal failure
Pain at costo-vertebral angle
Abdominal pain
Diminished or absent bowel sounds - ileus |
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Term
| What lab findings would you see in DIC? |
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Definition
Low Platelet count - 50,000 or less
High FDP - 40 mcg/mL or greater
High D-Dimer - > 250 ng/mL
Low Fibrinogen - < 100
High PT - >12.5 sec
High aPTT - >40 sec (critical >70 sec) |
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Term
|
Definition
Identify and treat the underlying disorder or trigger.
Restore depleted clotting factors.
Platelet replacement.
Cryoprecipitate
FFP
Heparin - if trigger is thrombosis |
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Term
| What causes anaphylactic shock? |
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Definition
| Exposure to an allergen that releases massive amounts of histamine. |
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Term
| What happens during anaphylactic shock? |
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Definition
Massive vasodilation and increased capillary permeability.
Lead to hypotension.
Massive airway obstruction (angioedema) |
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Term
| How do you treat anaphylactic shock? |
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Definition
AIRWAY
fluid resuscitation
Epinephrine (epi-pen)
Bronchodilators
Antihistamines
Corticosteroids |
|
|
Term
| Why do we give corticosteroids for anaphylactic shock? |
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Definition
| To preven the 2nd wave reaction from occuring. |
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Term
| What triggers neurogenic shock? |
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Definition
| Injury to the brain +/or spinal cord. |
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Term
| What happens during neurogenic shock? |
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Definition
Loss of sympathetic nervous system function below level of injury.
Massive vasodilation - decreased preload and afterload
Hypotension
Bradycardia |
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Term
| How do you treat Neurogenic shock? |
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Definition
SPINAL STABILITY/AIRWAY
Vasopressors
Atropine
Monitor for hypothermia |
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Term
| Why should fluids be used cautiously in neurogenic shock? |
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Definition
| Hypotension is not typically related to fluid loss. |
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Term
| What causes obstructive shock? |
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Definition
Reduced blood flow preventing it from entering the heart.
Can be caused by cardiac tamponade, PE, pneumothorax or tumor. |
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Term
| How do you treat obstructive shock? |
|
Definition
|
|
Term
| How do you treat cardiac tamponade? |
|
Definition
|
|
Term
|
Definition
| thrombolytics, surgery to retrieve the clot |
|
|
Term
| How do you treat pneumothorax? |
|
Definition
Needle decompression
Chest tubes |
|
|
Term
| How do you treat a tumor? |
|
Definition
| Have it removed (surgery) |
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