NURS 4550 - Cardiac, Heart Failure, CVPS, and Hemodynamics

Vocabulary practice flashcards covering cardiac concepts, heart failure classification, hemodynamic parameters, and diagnostic monitoring based on NURS 4550 lecture notes.

Nitroglycerine

A vasodilator that causes relaxation of the vasculature in smooth muscle, decreasing left and right ventricular filling pressures and afterload.

Preload

The pressure created by the volume of blood in the ventricles at the end of diastole; ex: filling like a balloon

increased in hypervolemia, valve regurgitation, and heart failure

decreased in hypovolemia and dehydration, and measured by CVP (normal $2-5\,\text{mm Hg}$).

Afterload

The resistance the left ventricle must overcome to circulate blood, which is affected by systemic vascular resistance (normal $800-1200\,\text{dynes-sec-cm}$).

ex: pushing a door against a hard wind

Right afterload is affected by pulmonary vascular resistance.

Stroke Volume

The amount of blood ejected from the ventricles at the end of each heartbeat (approximately $60-70\,\text{ml}$), which is affected by preload, afterload, and contractility.

PAOP (Wedge Pressure)

A measurement assessed through a PA catheter by inflating and wedging a balloon to determine the LV preload volume created in the left ventricle at the end of diastole. This measurement reflects left atrial pressure and helps evaluate cardiac function and fluid status. Normal is 8-12

Frank-Starling Law of the Heart

A model indicating that the ventricle will stretch to attempt to increase cardiac output, but overstretching causes the ventricle to become less effective, resulting in decreased cardiac output.

Cardiac Output

The mathematical product of heart rate multiplied by stroke volume, influenced by multiple factors affecting heart rate and stroke volume.

Heart Failure

A response to cardiac dysfunction in which the heart cannot pump at a volume required to meet the body's needs; coronary artery disease with resulting necrotic damage to the left ventricle is the underlying cause in most patients.

others include: cardiomyopathy, MI, infections, HTN, and valve disorders that can lead to heart failure symptoms such as fatigue, dyspnea, and fluid retention.

B-type Natriuretic Peptide (BNP)

A diagnostic blood test primary used to assess heart failure; elevated levels over $100\,\text{pg/ml}$ are used to diagnose heart failure in patients with shortness of breath and fluid overload.

Hemodynamic Calibration

Nursing tasks completed each shift consisting of zeroing the transducer to atmospheric pressure (used as a baseline) and leveling the transducer. Used during arterial line monitoring

Arterial Lines

Lines utilized in major medical and surgical conditions to provide continuous measurement of systole, diastole, and mean arterial pressure, requiring an arterial catheter, transducer, pressure tubing, flush line, and a pressure bag on flush.

• accurate ABGs

• never give meds through a line

• assess the site for infection and patency, and monitor for complications.

• Allen test used to assess collateral circulation before arterial line placement; tests for adequacy of blood flow in the hand.

Left Sided Heart Failure

A clinical condition manifested by cough (worse at night), dyspnea, crackles or wheezes/pink frothy sputum, tachypnea, decreased peripheral perfusion with weak pulses, peripheral cyanosis, pallor, and cool extremities.

Right Sided Heart Failure

A clinical condition manifested by JVD, weight gain, ascites, polyuria, peripheral edema, hepatomegaly, and GI symptoms.

Diastolic Heart Failure

An abnormality of the heart that makes it unable to relax, stretch, or fill during diastole, presenting with an ejection fraction $>40-50\%$.

Systolic Heart Failure

An abnormality of the heart that decreases the ability to contract during systole, presenting with an ejection fraction $<40-50\%$ and typically higher BNP. It is characterized by reduced cardiac output and may lead to symptoms of heart failure.

Transesophageal Echocardiography (TEE)

A less invasive diagnostic tool used to perform a real-time assessment of left ventricular cardiac contractility.

Femoral Site

A insertion site for an arterial or central venous catheter that should be used as a last resort due to a very high risk for infection despite having very large vessels.

SVO2

A measurement obtained via a PA line that determines the amount of tissue oxygen consumption, influenced by cardiac output, hemoglobin, arterial oxygen saturation ($SaO_2$), and tissue oxygen metabolism ($VO_2$).

How to get a wedge pressure on a PA line

• The balloon at the end of the catheter is inflated and wedged.

  • Caution needed to make sure the balloon not left inflated as this can

  cause ischemia in the pulmonary area

  
  

CVP

• . It measures pressure near the right atrium and helps assess right-sided heart filling/venous return.

• low CVP: dehydration, hypovolemia, blood loss, vasodilation

• High CVP; fluid overload, heart failure, or pulmonary hypertension.

• usually 2-6

Complications of CVC

Infection-

• utilize appropriate infection control practices with insertion

and maintenance of the line

• Heparin coated catheters

• Risk of developing HIT-monitor coagulation studies

removal of a CVC

• Bleeding-hold pressure after removal until bleeding has

  stopped

  • Air embolism-lay patient flat and ask patient to take deep

  breath when removing

  • Occlusive dressing after removed