jsamuels12313's version from 2015-11-08 04:50

Section 1

Question Answer
What diseases increase preloadpericardial tamponade & constrictive pericarditis
What medications/complications decrease preload?nitroglycerin, trauma, hemmorhage, GI bleed, A fib, pt with decreased circulating blood volume
Increases left side preloadleft sided heart failure, volume overload, mitral stenosis
Increases right side preloadvolume overload, tricuspid stenosis or insufficiency, pulmonary HTN, & right ventricular infarction
What increases PVR? (afterload)Pulmonary HTN, PE, pulmonary stenosis
What increases SVR? (afterload) HTN, vasopressors, aortic stenosis, hypothermia
What meds/ complications decreases afterload?septic shock, anaphylactic, neurogenic shock, vasodilators, and ADR of some meds (narcotics)
What decreases contractility? hyperkalemia, hypocalcemia, myocardial ischemia, negative inotropic meds, hypercapnea, hypoxia, and acidosis
What increases contractility? hypercalcemia, positive inotropic meds, or sympathetic stimulation
Normal SVR900-1400dynes/s/cm-5
Normal PVR100-250 dynes/s/cm-5
Normal mean arterial pressure70-105 mmHg
Medical Management (preload) volume deficitIV fluids, IV fluid challenge & fluid resuscitation, PRBC's
Medical Management (preload) volume overloaddiuretics, nitroglycerin, improve contractility
Medical Management to decrease afterloadNa+ nitroprusside (Nipride given 2nd) IV drip, Nitroglycerin IV drip (given 1st), ACE-I, dobutamine IV drip (5mcg/kg/min)
Medical management to increase afterloadvolume fluid challenge (bolus), 30ml/kg NS, vasopressors (NE, Vasopressin, epinephrine)

Section 2

Question Answer
Where is the phlebostatic axis located? 4th intercostal space half way between the anterior-posterior diameter of the chest
When do you re-level the pressure monitoring system? Anytime the patient's position is changed
When do you zero the pressure monitoring system? During the initial setup, beginning of each shift (when values do not fit the clinical picture), when the monitoring cable is disconnected from the flush
What is the square wave test? use a fast flush which causes a square to appear on the monitor and subsequent waveforms to occur
When is the square wave test performed? at the initial setup, after opening the system (draw blood), or when the values are suspected to be inaccurate
What can cause the overdampened values? catheter patency (clot in the line), air bubbles, or blood or kinks in the tubing
What can cause underdampened values? excessive tubing, use of multiple stop cocks

Section 3

Question Answer
Normal values CVP/RAP2-6 mmHg
What causes decreased CVP? volume deficit or venodilation
What causes increased CVP? volume excess, right ventricular failure, pulmonary HTN, tricuspid stenosis or insufficiency, pulmonic stenosis or insufficiency, PE
Normal RV pressure (systolic & diastolic)15-25 mmHg systolic, 0-8 mmHg diastolic
Normal PA pressure (systolic & diastolic)15-25 mmHg systolic, 5-15 mmHg diastolic
What does PAWP values indicate? an estimate of the preload of the left ventricle
Normal PAWP values4-12 mmHg
Normal PA mean pressure9-16 mmHg
How long can the balloon be inflated for when obtaining PAWP? 15 seconds
Normal CO4-8 L/min
Normal Cardiac index2.8-4.2 L/min/m2
Normal stroke volume60-100mL/beat
Normal ScvO260-80
Normal CPP>50-60
How to calculate normal CPPCPP= MAP-ICP
Normal ICP5-15mmHg

Section 4

Question Answer
What are some age related changes in myocardial structure? increase myocardial collagen --> decreased compliance, increased O2 consumption, higher risk for MI, hypertrophy, myocardial infarct
What are some age related changes in HR and EKG? resting HR decreases, decreased R & S wave amplitude, increased QT interval, increased incidence of asymptomatic dysrhythmias