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The volume coming into the heart is the?
preload
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What hemodynamic parameters measure the PRELOAD?
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What is the normal range for CVP/RAP?
2-6 mm Hg
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What is the ultimate goal of hemodynamics?
make the Cardiac Output (CO) happy (stable)
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the pressure against which the heart must work to eject blood during systole?
afterload
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Used to determine volume status and right ventricular function, reflects the right hearts preload?
CVP / RAP
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Used to determine state of resistance in pulmonary vasculature and right ventricular function?
PAP
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What are the normal parameters of PAP?
- Systolic: 15-25 mm Hg
- Diastolic: 8-15 mm Hg
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Used to determine left ventricular function; reflects left hearts preload?
PCWP (pulmonary artery wedge pressure)
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What are the normal parameters of PCWP?
6-12 mm Hg
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Amount of blood ejected by the heart per minute; a product of SV x HR
cardiac output (CO)
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Cardiac output adjusted for patient's body surface area?
cardiac index (CI)
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Describes the state of stystemic vasculature; reflects the left heart's afterload
systemic vascular resistance (SVR)
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What are the normal parameters of cardiac output (CO)?
4-8 L/min
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What are the normal parameters of cardiac index?
2.5-4 L/min
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What are the normal parameters of systemic vascular resistance (SVR)?
900-1400 dyne/s/cm-5
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If the BP is <90/60 what do we treat first?
- + inotrope (dobutamine, milirinone)
- then treat preload
- then treat afterload
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If the BP is >90/60 what do we do first?
- treat preload
- then treat afterload
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If preload is high what do we do?
too much volume - give diurectics
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If preload is low what do we do?
tank is low - give fluids
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If afterload is high what do we do, once preload is treated?
Give vasodilator - nitro/nipride
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With hemodynamics what are 4 items to initially pay attention to to treat quickly?
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Why give an ACE-I for life with EF <40%?
prevents ventricular remodeling
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What does a beta-blocker do to the heart?
- slows heart down - to prevent more damage to the heart
- decreases force of contraction
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A study of the forces involved in circulating blood through the body?
hemodynamic parameters
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What is the catheter used to monitor hemodynamics?
Pulmonary artery catheter (Swan-Ganz)
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What is the formula for cardiac output (CO)?
SV x HR = CO
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The amount of blood pumped by the left ventricle of the heart per minute?
stroke volume
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What factors affect cardiac output (CO)?
- preload
- afterload
- contractility
- muscular synchrony (we cannot manipulate this)
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Which ventricle does the CVP (central venous pressure) measure?
right ventricle
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Which ventricle does the PCWP (pulmonary artery wedge pressure) measure?
Left ventricle
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Sum of all forces against which the ventricle muscle must contract to eject blood into the pulmonary and systemic circulation?
systemic vascular resistance (SVR) - measures afterload
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what factors affect afterload?
- size of the heart
- how much resistance the heart must overcome to eject blood
- how much disease is present
- whether the tank is full or dry
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when afterload is high what happens to O2 demand?
increased myocardial O2 consumption
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what factors affect contractility?
- metabolic states - acidosis
- depressant drugs - tricyclic antidepressants (too much/OD)
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What is the normal ejection fraction (EF)?
55-70%
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What is the normal mean arterial pressure (MAP)?
>60 mm gH - for tissues to get profused
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If NIBP >90/60 what do we do first?
treat preload and see if it positively affects afterload
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If NIBP >90/60 and we treated preload and afterload remains elevated then do what?
add afterload reducer (NTG)
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If NIBP is <90/60 what do we do first?
- start a positive inotrope (dobutamine, milrinone)
- then deal with elevated or low preload, then afterload
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What is IABP and why is it used?
- IABP = intra-aortic balloon pump
- used in cardiogenic shock (HF) that cannot be corrected by any other means
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When does the IABP inflate?
onset of diastole
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When does the IABP deflate?
onset of systole - acts as a suction to help eject blood from left ventricle
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What are the HF core measures/GWTG at discharge?
- Lipid management
- Weight management
- Smoking cessation
- Antiplatelet therapy
- Beta-blockers
- ACEI/ARB especially in pts with EF of 40% or less
- Blood pressure control
- Diabetes management
- Physical activity 30 minutes 7 days a week (5 minimum)
- Post-discharge appointment
- Influenza during flu
- Pneumococcal vaccination
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What are some health promotion nursing interventions for a patient with CAD?
- Assist to set realistic goals
- Educate about diet: low salt, trans fat, minimum sugar
- Physical activity: low to moderate intensity, 30 min/day
- take statins - there are some risks
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