Term
|
Definition
| STROKE VOLUME:amount of blood pumped by left ventricle in one contraction. |
|
|
Term
|
Definition
|
|
Term
| What is the best indicator of overall heart status? |
|
Definition
| Cardiac Index because it takes body size into account |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Four determinants of cardiac output? |
|
Definition
heart rate
preload (stretch) amount of blood in ventricle at end of diastole
afterload - resistance ventricle must overcome to eject blood
contractility - force of contraction |
|
|
Term
| Two factors that affect preload |
|
Definition
Volume ( coming from venous return, or the total blood volume)
Compliance (stiffness and thickness of ventricular wall) |
|
|
Term
| five sighs of decreased preload |
|
Definition
tachycardia
decreased urinary output
increased specific gravity
dry mucous membranes
orthostatic hypotension. |
|
|
Term
| what is a late sign of a decreased preload |
|
Definition
|
|
Term
| six signs of an increased preload |
|
Definition
-Jugular vein distention
-pedal edema
-S3 S4
-Crackles
-Dyspnea
-Ascities (hepatic engorgement) |
|
|
Term
| What is JVD a reliable indicator of? |
|
Definition
| volume/pressure in the right side of the heart. this tells us about the patients central venous pressure. |
|
|
Term
| How should patient be positioned that you are monitoring for JVD? |
|
Definition
HOB needs to be at 45 degrees
head turned to the right
Identify sternal angle
locate superior sternal notch
measure distance between top pulsation and sternum in centimeters |
|
|
Term
| What is a normal measurement when you suspect patient of JVD? |
|
Definition
|
|
Term
| Two kinds of medications that affect preload |
|
Definition
Diuretics
Venodilators (nitrates, morphine, ace inhibitors) |
|
|
Term
| Change in heart rate causes an immediate change in the? |
|
Definition
| cardiac output. severe increase in heart rate all cause the stroke volume to decreased due to decreased filling time, causing decreases in cardiac output. |
|
|
Term
|
Definition
| volume of blood pumped with each heart beet. |
|
|
Term
|
Definition
| 60-70ml with each ventricular contraction |
|
|
Term
|
Definition
| ventricular pressure at the end of systole., resistance at which the heart pumps blood. |
|
|
Term
| four factors affecting afterload |
|
Definition
| aortic impedance, blood viscosity, blood volume, vascular tone. |
|
|
Term
| Systemic vascular resisitance |
|
Definition
| resistance to ejection from left side of the heart. |
|
|
Term
| normal systemic vascular resistance? |
|
Definition
|
|
Term
| pulmonary vascular resisitance |
|
Definition
| resistance to ejection from right side of th heart |
|
|
Term
| normal pulmonary vascular resisitance? |
|
Definition
|
|
Term
| four signs of increased afterload |
|
Definition
cool, clammy hands,
hypertension
non healing wounds
thick brittle nails. |
|
|
Term
| two signs of decreased afterload |
|
Definition
warm flushed skin
increased cardiac output.
(this is a GOOD things, means that your heart is in great shape) |
|
|
Term
|
Definition
| the ability of a muscle to shorten when stimulated, the force of myocardial contraction |
|
|
Term
| is contractility independent of pre-load and after load? |
|
Definition
|
|
Term
| normal contractility (measured in EF) |
|
Definition
|
|
Term
| Three indications that wold call for hemodynamic monitoring |
|
Definition
alterations in CO
alterations in fluid volume
alterations in tissue perfusion |
|
|
Term
| Central Venous Pressure Central LIne |
|
Definition
| can tell us volume and pressure on the right side of the heart and guides overall fluid balance. |
|
|
Term
| two reasons to give someone an arterial line? |
|
Definition
| monitoring blood pressure and ABG's frequently |
|
|
Term
| five locations to put arterial line |
|
Definition
| radial, DP, femoral, axillary, brachial. |
|
|
Term
| how is blood pressure different from arterial line vs. cuff |
|
Definition
| usually 5-10mmHg difference, more accurate, |
|
|
Term
| When does perfusion occur? |
|
Definition
|
|
Term
| When are gases being exchanged |
|
Definition
|
|
Term
| Vigileo Flo Trac monitoring device? |
|
Definition
| transducer that gives cardiac output readings and connects to existing lines. much easier than a swan gang catheter |
|
|
Term
| four benefits of Vigileo flo trac machine? |
|
Definition
minimally invasive because it connects to existing arterial line
requires no manual calibration
accurate when validated against swan catheter
automatically calculates hemodynamic values every 20 seconds. |
|
|
Term
| vigileo hemodynamic data: tells us |
|
Definition
CO
CI
Central venous oxygen saturation (determine oxygen extraction vs. demand. oxygen utiliation)
Stroke Volume
Stroke volume variation (variation in stroke volume given as percentage. > 15% may indicate hypovolemia)
Systemic Vascular Resistance- Indiactor of after load |
|
|
Term
| Where does swan gang catheter sit? |
|
Definition
|
|
Term
| Advantages of PA catheter (3) |
|
Definition
real time data
simultaneously measures a variety of hemodynamic parameters
able to rapidly asses pt. responses to interventions. |
|
|
Term
| disadvantages of PA catheter |
|
Definition
infection
Insertion complications (dmage to vlood vessles (ect))
Air emboli (loose connections)
Balloon Rupture
Pulmonary artery Rupture |
|
|
Term
| Pulmonary artery Wedge Pressure? What is it and what is normal reading? |
|
Definition
| reflects left atria preload 6-12 mmHg |
|
|
Term
| Pulmonary Artery Pressure? What is it and what is normal reading? |
|
Definition
| 20-30/ 10's mmHg blood pressure in the lungs |
|
|
Term
| CO / CI what is it? Normal reading? |
|
Definition
volume ejected/minte with each beat
4-6/2.5-4.5 liters min |
|
|
Term
| Central Venous Pressure? What is it? What is normal? |
|
Definition
reflects right sided preload
normal: 2-6mmHg |
|
|
Term
| Pulmonary vascular resistance? what is it? normal values? |
|
Definition
reflects right sided after load
50-250 dynes/sec/cm |
|
|
Term
| systemic vascular resistance? What is it? Normal values? |
|
Definition
800-1200 dynes/sec/cm
reflects left sided after load |
|
|
Term
| Pulmonic valve stenosis what is it? what causes it? |
|
Definition
| insidious process that happens over time, increased after load on right ventricle |
|
|
Term
|
Definition
| increased after load on right ventricle, which impacts right ventricular emptying (incomplete emptying) |
|
|
Term
| three interventions for elevated pulmonary artery pressures |
|
Definition
reduce preload (circulating volume to decrease venous return to right side)
increase/improve contractility
na and fluid restrictions |
|
|
Term
| 2 Meds that can be given for elevated pulmonary artery pressures |
|
Definition
vasodilators (viagra)
diuretics |
|
|
Term
| Four Phases of an action potential |
|
Definition
Phase 0: depolarization: systeole: Na moves into cells
Phase 1: Early re-polarization: closure of fast Na channels
Phase 2: Plateau : ca moves in to ells Na leaves
Phase 3: Re-polarization: diastole: k moves back into cell: Na out
Phase 4: resting membrane potential: electrochemical gradient returns to normal. |
|
|
Term
|
Definition
| affects the rate of ventricular depolarization helps to confine pacing activity to the sinus node |
|
|
Term
| normal values of potassium? |
|
Definition
|
|
Term
| Hyperkalemia (Cardiac) ECG changes |
|
Definition
decreased rate of ventricular depolarization
shortened depolarization period depressed atrial ventricular conduction. |
|
|
Term
| what does hyperkklemia look like on an ECG? |
|
Definition
|
|
Term
| Hypokalemia this causes what changes with cardiac functioning |
|
Definition
| prolongation of ventricular depolarization. |
|
|
Term
|
Definition
frequent PVC's which can progress to ventricular tachycardia and ventricular fibrillation.
sometimes you can see flat t wave or have u wave depression after t wave. |
|
|
Term
|
Definition
| reflects level of water balance, direct effect of heart rate and blood pressure effect on cardiac preload/afterload. |
|
|
Term
|
Definition
|
|
Term
| BUN/creatnine are indicators of? |
|
Definition
| renal function, if elevated may have increased intravascular volume and edema formation, which will increase myocardial workload |
|
|
Term
|
Definition
|
|
Term
|
Definition
| myocardial contractility and myocardial excitability. |
|
|
Term
| what is the percent that calcium is bound to proteins and what percent is biological active |
|
Definition
55% bound to proteins (albumin) and found in the blood stream
the other 45% is biologically active and called ionized CA |
|
|
Term
| 6 effects of hypercalcemia |
|
Definition
causes smooth muscle relaxation
will strengthen mycardial contractility
shorten ventricular repolarization
bradycardia
first, second, third degree heart block
bundle branch block |
|
|
Term
| what does hypercalcemia look like on ECG |
|
Definition
|
|
Term
|
Definition
decreased myocardial contractility
decreased cardiac output
hypotension
torsades
ventricular tachycardia
asystole |
|
|
Term
| what does hypocalcemia look like on ECG? |
|
Definition
|
|
Term
| Three kinds of drugs that you can take to decrease heart rate? |
|
Definition
| beta blockers calcium channel blockers and digoxin. |
|
|
Term
| drug to increase heart rate |
|
Definition
|
|
Term
| With beta blockers, by blocking beta1 receptors you are doing two things... what can you cause as an effect as well (3 things) ? |
|
Definition
slowing heart rate
lowering blood pressure
you can cause AV node blocks |
|
|
Term
| with beta blockers, by blocking beta 2 receptors you are causing |
|
Definition
bronchoconstriction
inhibition of glycogenolysis |
|
|
Term
| Betal blocker drugs (6 drugs) |
|
Definition
metoprolol
esmolol
labetalol
atenolol
propranolol
carvedilol |
|
|
Term
| Calcium channel blocks inhibit calcium influx to do three things.... |
|
Definition
decrease contractility
decrease heart rate
vasodilation |
|
|
Term
| 4 times to use calcium channel blockers |
|
Definition
SVT
vasospams
increased preload
hypertension |
|
|
Term
|
Definition
Diltiazem
verapamil
nifedipine |
|
|
Term
| two adverse reactions for calcium channel blockers |
|
Definition
|
|
