Cardiovascular Physiology Overview

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Questions and Answers

What is the purpose of positioning the stopcock of the transducer at the phlebostatic axis?

To reduce the required head elevation during readings

To decrease the risk of pneumothorax during insertion

To ensure accurate measurement of blood pressure (correct)

To calibrate the monitor to a higher pressure reading

What complication should a nurse be vigilant for during the catheter insertion using a central venous approach?

Cardiac arrest due to rapid blood loss

Pneumothorax resulting from needle insertion (correct)

Severe allergic reaction from the catheter material

Thrombosis in the peripheral veins

How long can a catheter be safely left in place to minimize the risk of infection?

72 to 96 hours (correct)

Less than 12 hours

Up to a week

Indefinitely if monitored

What is the recommended head elevation for making accurate measurements of CVP, BP, and pulmonary artery pressures?

60° Signup and view all the answers

What immediate action should be taken after establishing the zero reference point in a hemodynamic monitoring setup?

Open the transducer to air Signup and view all the answers

What occurs to the force of contraction when heart muscle fibers are overly stretched?

It is reduced. Signup and view all the answers

Which scenario would lead to an increase in afterload?

Hypertension. Signup and view all the answers

How does an excessively high heart rate affect cardiac output?

It leads to decreased diastolic filling time. Signup and view all the answers

What is the impact of excessive preload on stroke volume?

It reduces stroke volume. Signup and view all the answers

Which factor describes the resistance against which the ventricle must pump?

Afterload. Signup and view all the answers

Which physiological response would lead to decreased afterload?

Vasodilation. Signup and view all the answers

What happens to cardiac output when heart rate is increased without a proper stroke volume adjustment?

Cardiac output may decrease. Signup and view all the answers

What is the relationship between contractility and the strength of heart muscle contraction?

Higher contractility leads to stronger contractions. Signup and view all the answers

Which medication listed can serve as an alternative to ACE inhibitors in heart failure treatment?

Hydralazine and Isosorbide Dinitrate Signup and view all the answers

What is the primary goal of nursing planning when caring for a heart failure patient?

Promote drug compliance Signup and view all the answers

How should daily weights be monitored for heart failure patients to ensure accuracy?

At the same time each day wearing the same clothing Signup and view all the answers

What is a critical intervention to improve the quality of life in heart failure patients?

Conservation of physical/emotional energy Signup and view all the answers

What condition is indicated by the use of an implantable cardioverter defibrillator (ICD) in heart-failure treatment?

High risk of sudden cardiac death due to abnormal heart rhythm Signup and view all the answers

What component is NOT commonly prescribed for managing nutritional therapy in heart failure?

Fluids restrictions Signup and view all the answers

Which nursing diagnosis is related to a heart failure patient's inability to maintain adequate physical activity?

Activity intolerance Signup and view all the answers

What is the primary focus of hemodynamic monitoring in critically ill patients?

To continuously assess cardiovascular conditions Signup and view all the answers

What is the primary goal when managing acute congestive heart failure?

Improving left ventricular function Signup and view all the answers

Which symptom is most characteristic of acute congestive heart failure?

Pink, frothy sputum Signup and view all the answers

Which diagnostic study would provide information about the underlying cause of heart failure?

Echocardiogram Signup and view all the answers

What is the effect of using loop diuretics in acute heart failure?

Decrease venous return Signup and view all the answers

Which stage of heart failure includes structural heart disease without symptoms?

Stage B Signup and view all the answers

What common behavioral change may be experienced by patients with chronic congestive heart failure?

Restlessness Signup and view all the answers

Which medication class is primarily used to alleviate symptoms in chronic heart failure?

Diuretics Signup and view all the answers

Which of the following describes Stage D heart failure?

Refractory heart failure requiring specialized interventions Signup and view all the answers

What is a major symptom of paroxysmal nocturnal dyspnea (PND) in heart failure patients?

Difficulty breathing while lying flat Signup and view all the answers

Which class of drugs would be used to improve cardiac function in acute heart failure?

Positive inotropes Signup and view all the answers

What is the maximum duration before components of the pressure monitoring system need to be replaced?

96 hours Signup and view all the answers

Which of the following statements regarding patient education is true?

Patients can shower as long as the catheter is covered with an impermeable cover. Signup and view all the answers

Which is the preferred site for inserting a pulmonary artery catheter?

Subclavian vein Signup and view all the answers

What must be monitored during the use of a pulmonary artery catheter?

Inflation of the balloon tip Signup and view all the answers

What is an essential requirement for maintaining sterility in the pressure monitoring system?

Keeping all components of the system sterile Signup and view all the answers

Which cardiovascular structure is entered first during catheter placement?

Vena cava Signup and view all the answers

What complication should the nurse monitor for during and after the insertion of a pulmonary artery catheter?

Local complications at the catheter site Signup and view all the answers

What is the unit of pressure measurement taken by a transducer during catheterization?

Millimeters of mercury (mm Hg) Signup and view all the answers

Study Notes

### Heart Muscle Fibers Stretch

Increased stretch of heart fibers leads to stronger contraction, but only up to a point
Overstretching leads to reduced contraction and subsequently reduced stroke volume (SV) and cardiac output (CO)

Afterload

The pressure the heart must overcome to pump blood
Increased afterload makes it harder for the heart to pump
Afterload increases with hypertension and vasoconstriction
Afterload decreases with vasodilation

Heart Rate

Higher heart rate generally increases CO
Reduced diastolic filling time with excessively high heart rates results in decreased SV and CO

Contractility

Refers to the heart muscle's ability to contract
Increased contractility = Stronger contractions

Stages of Heart Failure

Stage A: At high risk for heart failure without structural heart disease or symptoms
Stage B: Has structural heart disease but no symptoms
Stage C: Structural heart disease with current or past symptoms
Stage D: Refractory heart failure requiring specialized interventions

### Acute Congestive Heart Failure

Clinical Manifestations: pulmonary edema, agitation, pale or cyanotic skin, cold, clammy skin, severe dyspnea, tachypnea
Primary goal is to improve left ventricular (LV) function by decreasing intravascular volume, venous return, afterload, improving gas exchange, and reducing anxiety
Nursing intervention: Administer diuretics, oxygen, and inotropes, place patient in high Fowlers position, and administer morphine

Chronic Congestive Heart Failure

Clinical Manifestations: fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), tachycardia, edema, nocturia, restlessness
Treatment aims to treat the underlying cause, maximize CO, alleviate symptoms, and ensure appropriate rest.

Cardiac Resynchronization Therapy (CRT)

Used in patients with chronic heart failure
Improves heart's electrical rhythm and coordination

Hemodynamic Monitoring

Continuous assessment of cardiovascular system for critically ill patients
Uses direct pressure monitoring systems
Establishment of a zero reference point during setup to ensure proper function

Hemodynamic Monitoring Complications

Pneumothorax is possible during insertion of central venous catheters
Infection risk increases with prolonged catheter use (after 72-96 hours)
Follow proper aseptic techniques and practice meticulous hand hygiene

Pulmonary Artery Catheter Insertion

Catheter is inserted into a large vein, typically the subclavian vein
The catheter is advanced to the right atrium, where the balloon tip is inflated and guided through the tricuspid valve into the right ventricle and the pulmonary artery

### Hemodynamic Monitoring Nursing Considerations

Monitor frequently for complications like infection and pneumothorax
Educate patients about catheter care and potential complications
Maintain aseptic technique during insertion and ongoing care of the catheter
Replace transducers, tubing, and flush solution every 96 hours
Discontinue dextrose-containing solutions from the monitoring system
Do not submerge catheters in water
Encourage patients to report any new discomfort from the catheter site

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Description

This quiz covers essential concepts of cardiovascular physiology, including heart muscle fiber stretch, afterload, heart rate, and contractility. Additionally, stages of heart failure are discussed, highlighting the progression from high-risk to symptomatic conditions. Test your understanding of how these factors influence cardiac output and heart function.