CC Exam 3

  1. What 3 things affect stroke volume (not CO or HR)
    • Preload
    • Afterload
    • Contractility
  2. What is the degree of ventricular stretch before the next contraction
  3. What impacts preload
    volume present in ventricles at end of diastole, vasoconstriction
  4. What is the amount of resistance the ventricles must overcome to deliver the stroke volume into receiving vasculature
  5. What impacts afterload (4 things)
    • Arterial systemic tone
    • Blood viscosity
    • Flow patterns
    • Valve competency
  6. What is the strength of myocardial muscle fiber shortening during systole
  7. What affects contractility
  8. What system is a high pressure, low volume, high-resistant circuit responsible for delivering O2 and nutrients to the capillary system
  9. How many liters are in blood? How much plasma makes up the blood
    • 5
    • 60%
  10. What are high capacity, low resistance vessels
  11. amount of blood pumped out of ventricle every minute
  12. What does CVP measure?
    Pressure created by volume of blood in right side of heart
  13. What is the amount of blood ejected from the ventricle with each contraction? What is normal?
    Stroke volume
  14. resistance that the left ventricle must overcome to eject a volume of blood
  15. What happens to CO if SVR increases
  16. resistance that the right ventricle must overcome to eject a volume of blood
  17. What is JVP an indirect measure of
  18. What is considered an elevated JVP
    >3 cm above angle of louis
  19. What are the 5 components of the hemodynamic monitoring system
    • invasive catheter
    • high-pressure non-compliant tubing
    • Transducer (stopcocks)
    • Pressurized flush system
    • bedside monitoring system
  20. Where is Central venous catheter most commonly placed
    subclavian or internal jugular
  21. What translates intravascular pressure changes into waveforms andnumerical data
  22. What are 4 major components for validating accuracy of hemodynamic monitoring systems
    • Patient positioning
    • Zeroing the transducer
    • Leveling the air-fluid interface (zero stopcock to phlebostatic axis)
    • Assessing dynamic responsiveness (square wave test)
  23. Where should transducer system be positioned when zeroing stopcock
    phlebostatic axis
  24. Where is phlebostatic axis located
    4th intercostal space, midway point of the anterior-posterior diameter of the chest wall
  25. What can an overdamped system indicate when doing square wave test
    systolic pressure falsely low and diastolic pressure falsely high
  26. What can an underdamped system indicate when doing square wave test
    falsely high systolic and low diastolic
  27. Causes of overdamped system during dynamic response test
    • Blood clots/air bubbles
    • Loose connections
    • kink in tubing
    • compliant tubing
  28. Causes of underdamped system during dynamic response test
    • Excessive tubing length
    • Small bore tubing
    • possible artifact
  29. What site has the highest rate of complications (pneumothorax and phrenic nerve damage) when picked for the measurement of CVP
  30. How often should tubing and flush bag be changed during hemodynamic monitoring to prevent infection of CRBSI
    72-96 hrs
  31. What pressure of flush solution should be used during hemodynamic monitoring
  32. What are some indications or arterial pressure monitoring
    • risk of compromised tissue perfusion & volume status
    • frequent labs
    • hypo/HTN
  33. Whats the site of choice for arterial pressure monitoring
  34. What should be done EVERY time before cannulation of radial artery
    allens test
  35. What is the most accurate method of obtaining systemic blood pressure
    arterial pressure monitoring
  36. How do you do the Allen's test
    • make tight fist
    • occlude artery for 10 sec
    • should blanch within 5 sec after release while hand is open
  37. What is the reference point between the systolic and diastolic phases of the cardiac system
    dicrotic notch (aortic valve close, beginning of diastole)
  38. 4 major complications of arterial pressure monitoring
    • thrombosis
    • embolus
    • infection
    • blood loss
  39. What should be suspected if noninvasive BP is higher than invasive BP
    • equipment malfunction
    • technical error
  40. Name interventions for pt with intrarterial catheter
    • assess q 2 hrs
    • keep wrist neutral
    • pressure on insertion site after removal (5 min if radial)
  41. What measurement assesses the preload of the right side of the heart
  42. What does it mean if RAP and SI are both low? High?
    • Low: hypovolemia
    • High: RV dysfunction
  43. When should RAP be measured
    end expiration and end of ventricle diastole
  44. What causes high RAP
    • hypervolemia
    • severe vasoconstriction
    • mechanical ventilation
  45. What causes low RAP
    • hypovolemia
    • vasodilation
    • sepsis
  46. What does PAOP tell us
    function of Left side of heart
  47. pt positioning for PA catheter insertion
    trendelendburg or blanket roll places between pt's should blades
  48. how do u measure PAOP
    inflate balloon no more than 1.5 mL for no longer than 8-10 sec
  49. causes of decreased preload
    • hemorrhage
    • hypovolemia
    • vasodilation
    • fluid shifts outside intravascular space
  50. causes of increased afterload
    • vasoconstriction
    • increased blood viscosity
  51. causes of decreased contractility
    • MI or ischemia
    • HF
    • Cardiomyopathy
    • cardiogenic shock
    • cardiac tamponade
  52. causes of increased preload
    • fluid resuscitation
    • alteration in ventricular compliance
  53. causes of decreased afterload
    • Vasodilation in sepsis
    • Decreased blood viscosity (anemia)
    • Increased contractility
    • hypermetabolic states
    • medication therapy
  54. 4 causes of high SVO2
    • shunting
    • increased affinity of hgb for O2
    • Increased distance between capillaries and cells
    • Inability to take up/use O2 (sepsis)
  55. 3 components of respiratory system
    • Upper
    • Lower
    • Lungs
  56. Which bronchus is shorter, wider and straighter
    right mainstem
  57. Lobes of the lungs
    • 2 on left
    • 3 on right
  58. Top of each lung called? lower part?
    • apex
    • base
  59. What pleura covers the lung surfaces
  60. what pleura covers internal surface of thoracic cage
  61. normal pressure of pleural space
  62. Describe what occurs during inspiration
    • diaphragm lowers and flattens
    • intercostal muscles contract
    • chest wall lifts up and out
    • intrapleural and intraalveolar negative
  63. Describe what occurs during expiration
    • Diaphragm and intercostal muscles relax
    • Lungs recoil
    • Positive intraalveolar pressure
  64. 4 steps of gas exchange
    • ventilation
    • diffusion at pulmonary capillary
    • Perfusion
    • Diffusion to cells
  65. Movement of gases in and out of alveoli
  66. Where is oxygen pressure higher? CO2?
    • O2: alveoli
    • CO2: Capillaries
  67. Where is oxygenated blood transported from the pulmonary capillary
    to the left side of heart from pulmonary vein
  68. Where is Carbon dioxide transported
    to right side of heart via vena cava into pulmonary capillaries to diffuse into alveoli for elimination
  69. What regulates rate, rhythm, and depth of ventilation
    medulla and pons
  70. What happens when CO2 is high or O2 is low
    chemoreceptors are stimulated and send message to medulla
  71. In normal lung function, what stimulates respirations? In people with chronic obstructive lung disease?
    • high levels of CO2
    • Hypoxemia
  72. What is lung compliance
    stretchability of lung and chest wall
  73. What refers to how easily the lungs are stretched when the respiratory muscles work and expand the thoracic cavity
  74. What conditions lead to low lung compliance
    • pulmonary fibrosis
    • ARDS
    • Pulmonary edema
    • Obesity
    • mechanical ventilation
  75. How does emphysema cause lungs to lose their elasticity, thereby increasing compliance
    destruction of lung tissue and enlarged air spaces
  76. What two things does dynamic compliance measure
    • lung compliance
    • airway resistance to gas flow
  77. 3 things that affect airway resistance
    • airway length (long-increased)
    • airway diameter (narrow-increased)
    • flow rate of gases (broncoconstriction, mucus, edema-increased)
  78. volume of normal breathing (Vt)
    Tidal volume
  79. amount of remaining air in the lungs after maximal expiration
    Residual volume
  80. volume of gas that can be inspired at normal resting expiration
    Inspiratory capacity
  81. Maximal volume of gas that can be forcefully expired after maximum inspiration
    Vital capacity
  82. During inspiration, what can cause asymmetrical excursion of chest
    unilateral ventilation
  83. What can a tracheal shift indicate
    tension pneumothorax
  84. What is a cyanosis a late sign of
  85. Normal inspiratory/expiratory ratio
  86. 2 disease processes Cheynes Stokes is seen
    • CNS disorder
    • CHF
  87. deep, increasingly shallow respirations followed by progressive periods of apnea (last at least 20 sec)
  88. What is cluster breathing in which there are variations in depth and periods of apnea?
  89. Where do u see Biots respirations
    Brainstem injury
  90. deep, regular, and rapid respirations
  91. Where is kussmaul breathing seen
  92. Gasping inspirations followed by short, ineffective expirations
  93. Where do u see Apneustic respirations
    lesions to the pons
  94. presence of air beneath skin surface that has escaped from the airway of lungs
    Subcutaneous crepitus/emphysema
  95. 5 sounds of audible percussion from pt chest
    • resonance (normal)
    • dullness (consolidation)
    • flatness (lung collapse)
    • hyperrosonance (emphysema)
    • tympany (pneumothorax)
  96. bubbling sounds from air bubbling through fluid or mucus
  97. possible indications from crackles
    • bronchitis
    • pneumonia
    • atelectasis
  98. sonorous, rattling sound caused by air movement through excessive mucus, fluid, inflamed airway
  99. causes of rhonchi
    • pneumonia
    • bronchitis
    • pulmonary edema
  100. whistling, musical sound caused by narrowing of the airway
  101. causes of wheezes
    • Bronchospasms
    • Partial obstruction
    • Inflammation
    • Stenosis
  102. high pitched crowing sound caused by total constriction of larynx or trachea
  103. causes of stridor
    • laryngeal edema
    • choking
    • epiglottitis
  104. coarse, grating sound caused by inflamed pleura rubbing against each other
    pleural friction rub
  105. causes of pleural friction rub
    • Pleuritis
    • Pneumonia
    • TB
    • Chest tube insertion
    • Pulmonary infarction
  106. How to tell the difference between pleural friction rub and pericardial friction rub
    hold breath, if it goes away it is pleural
  107. Partially compensated resp acid
    • <7.35
    • >45
    • >26
  108. Partially compensated resp alka
    • >7.45
    • <7.35
    • <22
  109. Fully compensated resp acid
    • normal pH
    • >45
    • >26
  110. Fully compensated resp alka
    • normal pH
    • <35
    • <22
  111. Partially compensated met alka
    • >7.45
    • >45
    • >26
  112. Fully compensated met alka
    • normal pH
    • >45
    • >26
  113. Partially compensated met acid
    • <7.35
    • <35
    • <22
  114. fully compensated met acid
    • normal pH
    • <35
    • <22
  115. combined resp and met acidosis
    • <7.35
    • >45
    • <22
    • -2 BE
  116. combined resp and met alka
    • >7.45
    • <35
    • >26
    • +2 BE
  117. BE of Met acidosis and Resp alkalosis
  118. BE or met alka and resp acid
  119. What is critical zone of oxyhemoglobin dissociation curve
    PaO2 <60
  120. oxy hgb right shift
    <hgb affinity to O2, O2 more readily released to tissues
  121. causes of oxy hgb right shift
    • acidemia
    • inc temp
    • anemia
    • chronic hypoxemia
    • low CO
  122. What is PaO2 when there is a right oxy hgb shift
    higher than expected
  123. oxy hgb left shift
    hgb affinity for o2 increases and hgb clings to o2
  124. causes of oxy hgb left shift
    • alkalemia
    • dec temp
    • high altitude
    • carbon monoxide poisoning
    • Administration of stored bank blood
    • Septic shock
    • hypophosphatemia
  125. PaO2 when there is left oxy hgb shift
    lower (<92, hypoxemia)
  126. Causes of Resp Acidosis
    • COPD
    • CNS depression
  127. causes of resp alkalosis
    • Hyperventilation
    • Pain, fever
    • Mechanical ventilation
  128. Causes of Metabolic acidosis r/t increased acid
    • DKA
    • Renal Failure
    • Lactic Acid
  129. Causes of Metabolic acidosis r/t loss of base
  130. causes of metabolic alkalosis r/t gain of base
    • antacids
    • sodium bicarb
  131. causes of meta alka r/t loss of acids
    • vomit
    • NG suction
    • <K
    • diuretics
  132. Most important buffering system
  133. How long does it take for renal system to secrete bicarb enough to compensate
    2 days
  134. 4 critical ABG lab values
    • PaO2 <60
    • PaCO2 >50
    • pH <7.25 or >7.60
    • SaO2 <90
  135. What can affect accuracy of SpO2
    • artifact
    • limb ischemia
    • inflated BP cuff
    • sun/fluorescent light
    • nail polish
  136. Name low-flow O2 systems
    • nasal cannula
    • simple face mask
    • partial rebreather
    • non-rebreather
  137. Name high-flow O2 systems
    • venturi
    • high flow nasal cannula
    • air entrainment
  138. when is humidification recommended for pts receiving O2 flow
  139. Two types of ARF classifications
    • hypoxemic
    • hypercapnia
  140. What is considered hypercapnic ventilatory failure
    pH <7.30 and PaCO2 >50
  141. 5 generally accepted mechanisms of failure to oxygenate (<PaO2) creating a state of hypoxemia
    • hypoventilation
    • intrapulmonary shunting
    • Ventilation-Perfusion mismatch
    • diffusion defect
    • decreased barometric pressure
  142. What is intrapulmonary shunting
    When a large amount of blood bypasses gas exchange to the left side of the heart
  143. 4 things that can cause shunting
    • septal defects
    • pneumonia
    • atelectasis
    • pulmonary edema
  144. What is the most common cause of hypoxemia in respiratory failure
    V/Q mismatch
  145. 6 barriers to diffusion of O2
    • surfactant
    • alveolar epithelium
    • interstitial fluid
    • capillary endothelium
    • plasma
    • RBC membrane
Card Set
CC Exam 3