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Hardin CH 9 Hemodynamics
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14
Nursing
Graduate
02/21/2016

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Cards

Term
Initial Post Op Assessment
Definition
Connect to bedside monitor EKG, BP, HR, SpO2; assess rhythm and VS.

CI, CO. Hypovolemia, pain levels. Dysrhytmias, SV (preload, afterload, contractility). Bleeding, CTOP (notify MD is more than 100/hr for 3 hours, 200 ml/hr for 2 hrs, or 300 ml/hr for 1 hr).

Level transducers at phebostatic axis (4ICS), zero balance to establish
atmospheric pressure (guns up, caps off).

Square wave test to ensure responsiveness.
Term
Square wave test
Definition
TO test Arterial line pressure waveform reflects the true pressure

overdampened: sluggish, exagerated or falsely high. Underestimates SBP. Causes are large bubbles, no or low fluid in flush bag, loose connections, kink in tubing

Underdamped: overresponse, narrow, artificial peak; overestimates SBP. Causes: small bubbles, tubing too long, defective transducer
SE:
Term
Assessment of chest drainage system
Definition
Connect to suction
Note and record the amount of drainage from the OR. Correlate thses findings with the patients baseline hemodynamic profile.
Term
Assessment of fluid status
Definition
compare intraoperative intake and output with baseline hemodynamics and VS
Term
Complications of invasive monitoring arterial
Definition
Bleeding, infection, thrombosis, ischemia, nerve damage
Term
WHy monitor CVP in post CPB patients?
Definition
CPB have systemic inflammatory responses for first 24-48 hours: fluid leak, vasodilation, and hypovolemia.

Decreased CVP = low volume/pressure, or decreased CO

Increased CVP = hypervolemia, vasoconstriction, ventricular dysfunction, pulmonary HTN, A Fib, tamponade, pneumothorax...any situation where blood flow backs up into the right side of the heart, increasing pressure at the end of filling (diastole)
Term
Parts of CVP waveform: A, C, X, V
Definition
A: Atrial contraction (p wave); follows p wave on EKG, reflects the physical contraction folowing the electrical stimulus of the P wave. (Will be large in tricuspid stenosis)

C: bulging of the tricuspid into RA at start of ventricular systole. This physical action follows the electrical stimulus of the QRS wave.

X: Atrial relaxation

V: Filling of the atrium, follows the T wave; closed tricuspid, and so pressure begins to rise again.
Term
complications of CVP catheters
Definition
pneumothorax
thrombus
ingfection
air embolism
vessel perforation
extravasation into pericardium, endocardium, pleural cavity
hemothorax
hematoma
uncontrollable venous bleeding
Term
Pulmonary Artery Pressure measures what?
Definition
Hardin Page 151

with no impediment to blood flow, a PAC indirectly measures LA pressure and appx LV end diastolic pressure function (left sided preload)
Term
PAS
Pulmonary Artery Systolic Pressure
Definition
mesaure from tricuspid to the mitral valve, and is a good indicator of PAP.

Conditions such as COPD, ARDS, Pulm HTM are likely to increase PAS.
Term
PAD
Pulmonary Artery Diastolic Pressure
Definition
Reflects pressure in the area between pulmonic and aortic valves. If no obstruction, is a good indicator of LV function
Term
Rsks of pulmonary arery Wedge pressure
Definition
PA rupture, embolism, infarction, hemorrhage
Term
THermodilution
Definition
Bolus of NS is injected into RA (proximal port), fluid mixes with blood flow. As it passes the thermistor, the CO is calculated using the amount of time it took for the coolor liquid to reach the probe.

Less time to travel to probe = high CO
More time to travel to probe - low CO
Term
Mixed Venous
Definition
65-75 Ideal

Amount of oxgyen remaining in blood as it returns to the right side of teh heart to be reoxygenated

More = less oxygen demand or increased supply

Less = more oxygen demand or less supply

Determined by
1. CO (how quickly the train moves)
2. Hgb (how many cars on the train)
3. SaO2 (how many passengers on the train)

If any decreased, SVO2 will be decreased
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