Crit Care exam 3

What are the clinical manifestations of left-sided heart failure related to preload?

Pulmonary edema, dyspnea, pink frothy sputum, crackles

What does CO stand for in hemodynamics?

CO stands for Cardiac Output

How is Cardiac Output (CO) calculated?

CO = Heart Rate (HR) x Stroke Volume (SV)

What can cause increased preload?

Heart failure, fluid overload, valve disease

What are the clinical manifestations of right-sided heart failure related to preload?

Edema, JVD, ascites

What is a common treatment for increased preload?

Diuretics (e.g., furosemide), Veno dilator (e.g., nitroglycerin)

What is preload in hemodynamics?

Preload = Volume

What is the formula for Mean Arterial Pressure (MAP)?

MAP = (systolic BP + 2 x diastolic BP) / 3

What is the adequate MAP for general patients?

Adequate MAP > 60

What is the adequate MAP for cardiac/ICU patients?

Adequate MAP > 70

What can decrease preload?

Dehydration, hemorrhage

What are the clinical manifestations of decreased preload?

Hypotension (HoTN), tachycardia, pale cool skin, weak pulses, cap refill > 2 seconds

What is a common treatment for decreased preload?

Fluids, oxygen (O2), blood

What is afterload?

Afterload is how hard the heart is working to eject blood.

What is the relationship between afterload and blood vessel lumen sizes?

Afterload is directly related to the lumen sizes of blood vessels.

What does increased afterload resemble?

Increased afterload resembles a little straw.

What are common causes of increased afterload?

Vasocontraction, hypertension (HTN), sympathetic nervous system (SNS) activation, and hypothermia.

What are clinical manifestations of increased afterload?

Decreased perfusion, pale cool skin, weak pulses, decreased urine output, and decreased bowel sounds.

What is a common treatment for increased afterload?

Vasodilators such as nitroglycerin and nitroprusside.

What does decreased afterload resemble?

Decreased afterload resembles a big straw.

What are common causes of decreased afterload?

Vasodilation and shock.

What are clinical manifestations of decreased afterload?

Hypotension (HoTN), warm skin, and strong/bounding pulses.

What is a common treatment for decreased afterload?

Vasopressors such as dopamine, norepinephrine, and vasopressin.

What factors can increase contractility?

Exercise and stimulants.

What are clinical manifestations of increased contractility?

Tachycardia, heart palpitations, and flushed skin.

When should increased contractility be treated?

Do not treat unless there is a hypertensive crisis.

What factors can decrease contractility?

Myocardial infarction (MI), heart failure (HF), electrolyte imbalance, hyperkalemia, and hypoxia.

What are clinical manifestations of decreased contractility?

Decreased cardiac output and decreased perfusion.

What is a common treatment for decreased contractility?

Positive inotropic medications such as milrinone, dobutamine, and digoxin.

What are noninvasive modalities for blood pressure assessment?

Noninvasive blood pressure assessment includes assessment of jugular venous pressure and assessment of serum lactate.

What does lactate/lactic acid indicate in the body?

Lactate/lactic acid is produced because of anaerobic metabolism and indicates how well the body is being perfused.

What is the most accurate and continuous method for blood pressure monitoring?

Arterial pressure monitoring is the most accurate and continuous method for blood pressure monitoring.

When is arterial pressure monitoring used?

Arterial pressure monitoring is used for hemodynamically unstable patients or those on vasopressor or vasodilator medication.

What are the common sites for arterial pressure monitoring placement?

Common sites for arterial pressure monitoring placement include brachial, femoral, and radial arteries.

What is the risk associated with femoral artery placement for arterial pressure monitoring?

Femoral artery placement has a high infection risk and should be changed every 24 hours.

What is Allen's test used for?

Allen's test is used to assess blood supply to the hand by occluding both the radial and ulnar arteries.

What indicates a positive result in Allen's test?

A positive result in Allen's test occurs when blood supply is restored after releasing the ulnar artery.

What are key nursing management practices for arterial pressure monitoring?

Key nursing management practices include positioning the patient flat, performing CMS checks hourly, preventing infection, and assessing hourly or more.

What does the dicrotic notch represent in arterial pressure waveforms?

The dicrotic notch represents the closure of the aortic valve in arterial pressure waveforms.

What are potential complications of arterial pressure monitoring?

Potential complications include blood clots and hemorrhage.

What is the square wave test used for in arterial pressure monitoring?

The square wave test is used to assess the accuracy of the arterial pressure monitoring system by checking for a nice square waveform.

What does a central venous pressure monitor measure?

Right sided preload only

How is central venous pressure measured?

Through any kind of central line

What are the nursing implications for a central venous pressure monitor?

Position, monitor waveforms, prevent infection

What are signs of high central venous pressure (CVP)?

Peripheral edema, jugular venous distention (JVD)

Why is a central venous pressure monitor used?

To administer medications that are harmful in other lines, when IV access is not possible, or for rapid infusion

What is the proper placement technique for a central venous catheter?

Place in Trendelenburg position, have the patient take a deep breath and hold it during insertion, and obtain a chest x-ray after placement

What does a pulmonary artery pressure monitor measure?

Left sided preload only

What is a key nursing management task for pulmonary artery pressure monitoring?

Routinely measure pulmonary artery wedge pressure (PAWP/PAOP)

What is the maximum duration for continuous pulmonary artery wedge pressure measurement?

No more than 10-15 seconds

What is the maximum amount of air to inflate the balloon in pulmonary artery monitoring?

No more than 1.5 mL

What are potential complications of pulmonary artery pressure monitoring?

Infection, dysrhythmias, hemorrhage

What are the 5 components for invasive modalities?

Catheter, pressure tubing, transducer, pressure bag with saline and pressure gauge, monitor.

What is the role of the transducer in invasive modalities?

The transducer takes pressures and turns them into numbers.

What position should a patient be in for invasive modalities?

The patient should be flat.

Where must the transducer be leveled for accurate readings?

At the phlebostatic axis (4th intercostal space midaxillary line).

What is the purpose of zeroing the transducer?

To obtain the most accurate data.

What are some infection control measures for invasive modalities?

Hand washing, sterile technique, monitoring for CLABSI, and removing once no longer needed.

What does continuous cardiac output monitoring measure?

It measures systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR).

What does SVR measure?

Left sided afterload.

What does PVR measure?

Right sided afterload.

What is the normal value for Mixed Venous Oxygen Saturation (SvO2)?

60 - 80%.

What does a high SvO2 indicate?

Tissue did not take oxygen; may indicate end stage shock, severe tissue damage, or burns.

What does a low SvO2 indicate?

Tissue is taking more/too much oxygen; may indicate hypoxia, hypo/hyperthermia, pain, early states of shock, or anemia.

What is the treatment for low SvO2?

Treat the cause, give oxygen, and give blood.

What are the 6 types of shock?

Hypovolemic, Cardiogenic, Distributive, Obstructive, Neurogenic, Septic

What does CVP stand for and what does it measure?

CVP (Central Venous Pressure): Measures right atrial pressure/preload.

What does PA stand for and what does it measure?

PA (Pulmonary Artery Pressure/Wedge): Measures left-sided filling pressure/preload

What does SVR stand for and what does it measure?

SVR (Systemic Vascular Resistance, left side): Measures peripheral vasoconstriction/afterload.

What does PVR stand for and what does it measure?

PVR (Pulmonary Vascular Resistance, right side): Resistance in the pulmonary vessels.

What is hypovolemic shock?

A type of shock caused by significant fluid loss, such as from hemorrhage, burns, or vomiting/diarrhea.

What happens to cardiac output in hypovolemic shock?

Cardiac output decreases.

What happens to blood pressure in hypovolemic shock?

Blood pressure decreases.

What happens to heart rate in hypovolemic shock?

Heart rate increases.

What happens to central venous pressure in hypovolemic shock?

Central venous pressure decreases.

What happens to pulmonary artery pressure in hypovolemic shock?

Pulmonary artery pressure decreases.

What happens to pulmonary vascular resistance in hypovolemic shock?

Pulmonary vascular resistance increases.

What happens to systemic vascular resistance in hypovolemic shock?

Systemic vascular resistance increases.

What are the clinical manifestations of hypovolemic shock?

Hypotension, pale and cool skin, weak pulses.

What is the treatment for hypovolemic shock?

Fluids, blood, and oxygen.

What is cardiogenic shock?

A type of shock where the heart fails to act as an effective pump.

What is a common cause of cardiogenic shock?

Acute myocardial infarction (MI).

What happens to cardiac output in cardiogenic shock?

Cardiac output decreases.

What happens to blood pressure in cardiogenic shock?

Blood pressure decreases.

What happens to heart rate in cardiogenic shock?

Heart rate increases.

What happens to central venous pressure in cardiogenic shock?

Central venous pressure increases.

What happens to pulmonary artery pressure in cardiogenic shock?

Pulmonary artery pressure increases.

What happens to pulmonary vascular resistance in cardiogenic shock?

Pulmonary vascular resistance increases.

What happens to systemic vascular resistance in cardiogenic shock?

Systemic vascular resistance increases.

What are the clinical manifestations of cardiogenic shock?

Pulmonary edema, weak pulses, cool and pale skin.

What is one treatment for cardiogenic shock?

Positive inotropic agents (e.g., dobutamine, milrinone).

What is another treatment for cardiogenic shock?

Diuretics (e.g., furosemide; caution with blood pressure).

What is a third treatment for cardiogenic shock?

Vasodilators (e.g., nitroglycerin).

What is an intra-aortic balloon pump?

A circulatory assist device.

Where is the intra-aortic balloon pump placed?

In the femoral artery.

When does the intra-aortic balloon pump deflate?

During systole.

When does the intra-aortic balloon pump inflate?

During diastole.

What are the effects of using an intra-aortic balloon pump?

Increases blood supply to coronary arteries, moves blood forward, increases cardiac output (CO) and mean arterial pressure (MAP), and decreases pulmonary artery occlusion pressure (PAOP).

What are some nursing considerations for an intra-aortic balloon pump?

Assess timing, pedal pulses, keep head of bed (HOB) < 30 degrees, monitor organ function, and monitor for bleeding.

What is obstructive shock?

A type of shock caused by obstruction of blood flow, such as pulmonary embolism, tension pneumothorax, or cardiac tamponade.