NUR4050 Hemodynamics Exam 1 Questions
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Questions and Answers

What is a potential consequence of a myocardium that is too high or too low?

  • Increased cardiac output
  • Depressed myocardium (correct)
  • Enhanced diastolic filling
  • Elevated blood pressure

    • When a patient has a depressed myocardium, what type of medication might be considered?

  • Inotropes (correct)
  • Diuretics
  • Anticoagulants
  • Beta-blockers

    • What nursing course is likely associated with the 'hemodynamics' topic and 'exam 1' mentioned?

  • NUR4050 (correct)
  • NUR5050
  • NUR3050
  • NUR6050

    • What does the term 'diastolic filling volume' refer to?

    <p>The volume of blood in the heart at the end of diastole (C)</p> Signup and view all the answers

    According to the content, when will Exam 1 take place?

    <p>Week 5 (B)</p> Signup and view all the answers

    If a patient has a depressed myocardium, would inotropes always be used?

    <p>Inotropes may or may not be needed (A)</p> Signup and view all the answers

    What is the relationship between 'depressed myocardium' and 'diastolic filling volume'?

    <p>The relationship is variable and depends on other factors (B)</p> Signup and view all the answers

    What is the general subject matter being discussed in the context of 'week 3: hemodynamics'?

    <p>Cardiovascular dynamics (C)</p> Signup and view all the answers

    According to the provided information, what is the optimal value range targeted?

    <p>4-6 (B)</p> Signup and view all the answers

    If a student were studying 'NUR4050', which of these topics, in addition to hemodynamics, would they most likely be preparing for?

    <p>Exam 1 content (C)</p> Signup and view all the answers

    What does a low value indicate?

    <p>Threatened tissue perfusion (C)</p> Signup and view all the answers

    What can be deduced about the timing of the 'hemodynamics' lecture relative to 'exam 1'?

    <p>The hemodynamics lecture occurs two weeks before exam 1 (D)</p> Signup and view all the answers

    If a patient's value is outside the specified range, what is the most immediate concern?

    <p>Risk of impaired circulation or potential tissue damage (D)</p> Signup and view all the answers

    Which of the following best describes the relationship between the described value and tissue perfusion?

    <p>A value within the specified range indicates adequate tissue perfusion. (C)</p> Signup and view all the answers

    If a patient presented with a value of 1, which clinical intervention would be a priority?

    <p>Initiating measures to improve tissue perfusion. (B)</p> Signup and view all the answers

    Which of the following would not typically cause an increase in superior vena cava pressure?

    <p>Pulmonary vasodilation (A)</p> Signup and view all the answers

    A patient presents with signs of severe hypovolemia. What change in superior vena cava pressure would you expect?

    <p>A decrease (B)</p> Signup and view all the answers

    Which of these factors will directly increase pulmonary vascular resistance?

    <p>Hypoxia (D)</p> Signup and view all the answers

    A patient with a history of liver failure is showing signs of third-spacing. What effect does this have on superior vena cava pressure?

    <p>Decreases due to reduced intravascular volume (B)</p> Signup and view all the answers

    Which of the following is NOT part of a basic hemodynamic physical assessment?

    <p>Oxygen saturation (A)</p> Signup and view all the answers

    What does CO refer to when discussing a pulmonary artery catheter?

    <p>Cardiac output (C)</p> Signup and view all the answers

    Which of the following provides the most direct measurement of the balance between oxygen supply and demand in the body?

    <p>Mixed venous oxygen saturation (ScvO2) (B)</p> Signup and view all the answers

    What is the primary purpose of monitoring ScvO2 through a pulmonary artery catheter?

    <p>To assess the adequacy of oxygen supply relative to tissue demand (D)</p> Signup and view all the answers

    If a patient's ScvO2 levels are lower than normal, what might this suggest?

    <p>The patient's oxygen demand exceeds the supply (D)</p> Signup and view all the answers

    Where is ScvO2 typically measured on a pulmonary artery catheter?

    <p>Dedicated port for ScvO2 monitoring (B)</p> Signup and view all the answers

    What does an elevated ScvO2 reading typically suggest?

    <p>Oxygen supply exceeding tissue oxygen consumption needs. (C)</p> Signup and view all the answers

    Which of the following is a non-invasive method for monitoring cardiac output (CO) and related hemodynamic parameters?

    <p>ClearSight finger cuff system. (C)</p> Signup and view all the answers

    A patient's ScvO2 is 55%. Based on this, which condition is most likely?

    <p>Reduced cardiac output or hemoglobin level. (C)</p> Signup and view all the answers

    If a patient's cardiac output is measured at 7 L/min, what might be the interpretation?

    <p>May suggest that oxygen supply is exceeding the needs of the body. (C)</p> Signup and view all the answers

    What is the primary function of the EV1000 monitor in the context of hemodynamics?

    <p>To combine data from the arterial line and ScvO2 catheter when measuring cardiac output. (B)</p> Signup and view all the answers

    Flashcards

    Low Blood Pressure (4-6)

    A lower blood pressure reading, specifically between 4 and 6, may indicate a threat to tissue perfusion.

    Tissue Perfusion

    Tissue perfusion refers to the delivery of oxygen and nutrients to tissues and the removal of waste products.

    Hemodynamics

    The study of blood flow and its mechanics within the circulatory system.

    Blood pressure

    The force exerted by the blood against the vessel walls.

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    Cardiac Output

    The amount of blood pumped by the heart per minute.

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    Peripheral Vascular Resistance

    The resistance to blood flow in the vessels.

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    Blood Flow

    The amount of blood flowing through a vessel per unit of time.

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    Depressed Myocardium

    A condition where the heart muscle is weakened and cannot contract effectively, leading to reduced cardiac output.

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    Diastolic Filling Volume

    The volume of blood filling the ventricles during diastole (relaxation phase).

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    Inotropes

    Drugs that increase the force of contraction of the heart muscle.

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    Low Blood Flow to Myocardium

    A situation where the heart muscle is not receiving enough blood flow, resulting in weak contractions. This can be caused by a blockage in the coronary arteries, leading to a heart attack.

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    High Blood Flow to Myocardium

    A situation where the blood flow to the heart muscle is exceeding the normal range. This can be due to a variety of factors, including high blood pressure or an overactive heart.

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    Superior Vena Cava Pressure

    The pressure in the superior vena cava, which carries deoxygenated blood from the body to the heart, typically ranges from 0 to 10 mmHg.

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    Factors Increasing Superior Vena Cava Pressure

    Increased intravascular volume, such as fluid overload, can increase pressure in the superior vena cava.

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    Pulmonary Vascular Resistance and Superior Vena Cava Pressure

    Pulmonary vascular resistance, which measures how hard the right ventricle has to pump blood through the lungs, can increase pressure in the superior vena cava.

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    Factors Decreasing Superior Vena Cava Pressure

    Conditions like hypovolemia (low blood volume) and systemic vasodilation (as seen in septic or neurogenic shock) can decrease pressure in the superior vena cava.

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    Hemodynamic Status Assessment

    Assessing hemodynamic status means evaluating the function of the cardiovascular system, which can be done through physical exam and invasive monitoring.

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    What is a pulmonary artery catheter (PAC)?

    Pulmonary artery catheter (PAC) is a thin tube inserted into the pulmonary artery for monitoring blood pressure, heart function, and fluid status.

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    What does ScvO2 monitoring involve?

    A port on the PAC allows for measurement of ScvO2, which is a measure of the oxygen saturation in mixed venous blood returning to the right heart.

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    Why is ScvO2 monitoring important?

    ScvO2 monitoring helps assess the difference between oxygen supply (how much oxygen is delivered to the tissues) and oxygen demand (how much oxygen the tissues are using).

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    What does high versus low ScvO2 mean?

    High ScvO2 indicates a good balance between oxygen supply and demand, while low ScvO2 suggests inadequate oxygen delivery to tissues.

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    How can ScvO2 monitoring be used?

    This allows clinicians to adjust therapy and optimize oxygen delivery to the body's tissues.

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    ScvO2 (Central Venous Oxygen Saturation)

    The percentage of oxygenated hemoglobin in the blood returning to the heart. A normal value is around 70%.

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    Cardiac Output (CO)

    A measure of the amount of blood pumped by the heart each minute. A normal range is 4-6 liters per minute.

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    Elevated ScvO2

    Indicates how well the body is delivering oxygen to tissues. Elevated levels suggest excess oxygen supply, potentially due to conditions like carbon monoxide poisoning or early stages of shock. Low levels indicate inadequate oxygen delivery, possibly caused by decreased cardiac output, reduced hemoglobin levels, or low oxygen saturation.

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    Low ScvO2

    Indicates inadequate oxygen delivery to tissues, often due to decreased cardiac output, reduced hemoglobin levels, or low oxygen saturation.

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    EV1000 Monitor

    A medical device that combines data from an arterial line and ScvO2 catheter to measure cardiac output, stroke volume, systemic vascular resistance, and stroke volume variation, especially useful for managing ventilated patients.

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    Study Notes

    Hemodynamics Week 3

    • Labs for hemodynamic studies include: lactic acid, ABGs, ScvO2, troponin, BNP, and a comprehensive metabolic panel.
    • Stress affects hemodynamics by increasing contractility, heart rate, blood pressure, and respiratory rate/gas exchange.
    • Volume regulation cycle involves:
      • Increased extracellular fluid volume leads to elevated ventricular/atrial pressure, causing ventricular/atrial wall expansion.
      • Release of ANP and BNP, inhibiting the renin-angiotensin-aldosterone system (RAAS), resulting in decreased sodium and water excretion.
    • Heart failure (CHF) differences: patients with CHF may not recognize BNP, which can lead to RAAS activation. Treatment often involves ACE inhibitors.
    • Cardiac output is decreased due to reduced stroke volume.
      • Afterload, the pressure required to open the aortic valve during systole (ventricular contraction), is a primary variable influencing stroke volume.
      • Increased afterload: Hypertension, atherosclerosis, aortic stenosis, hypothermia, left ventricular failure, and stress. This can activate the RAAS system.
      • Decreased afterload: hyperthermia, septic and anaphylactic shock, neurogenic shock, and vasodilation.
    • Contractility is affected by:
      • Increased by shock, positive inotropes and the sympathetic nervous system (SNS).
      • Decreased by late sepsis, myocardial infarction (MI), negative inotropes, electrolyte imbalances, low oxygen levels, and acidosis.
    • Diastolic filling volume (preload) is influenced by, circulating blood volume, heart failure, bleeding, vomiting, diarrhea, and diuresis and other variables.
    • Frank-Starling curve predicts preload capacity, showing how cardiac output increases with volume until a maximum capacity, beyond which it starts declining due to increased ventricular load.
    • Heart rate (HR) is affected by atrial systole and sympathetic stimulation, as well as possible bradycardia or atrial fibrillation (AFib).
    • Decreased HR: loss of the atrial kick via bradycardia from symptomatic causes
    • Increased Afterload: aorta stenosis, low ef, volume overload
    • Desired HR: 4-6 bpm
    • Increased right-sided pressure can be caused by left-sided overload, AV septal defects, or severe chronic lung disease (e.g., COPD, pulmonary hypertension).
    • Central venous pressure (CVP) measures venous return and blood volume on the right side of the heart.
    • CVP range: 0-10
    • Factors increasing CVP include: intravascular volume and pulmonary vascular resistance.
    • Factors decreasing CVP include: vasodilators and correction of hypoxemia, acidosis, exercise
    • Monitoring hemodynamic status includes physical assessments and invasive measurements. Basic hemodynamic assessments involve pulse rate, blood pressure, heart sounds, mental status, and skin temperature. Invasive monitoring techniques include arterial lines, pulmonary artery catheters, and central venous catheters.
    • Complications related to invasive monitoring: possible thrombus formation and infection, air embolism (related to fluid overload or deficits), and assessment of fluids.
    • Invasive procedures need: -Thick cath and high-pressure tubing. -Transducer for electrical signal monitoring -Monitoring device for assessing heart beats into electrical signals.
      • Positioning to the 4th-5th intercostal space.
    • Perfusion pressure changes due to altered cardiac rhythm/pressure bag, or transducer placement.
    • PVC causes: ineffective ventricular contraction, longer filling period for the next beat resulting in increased systolic pressure for the next cardiac cycle
    • Abnormal arterial waveforms or "over/under dampened rhythm" can be caused by excessive pressure in the catheter or kinking of the tubing
    • Venous catheters are used for CVP monitoring.
    • Sites for catheter insertion include the femoral, jugular, subclavian, brachial, or percutaneous-catheter (picc) veins.
    • Central venous pressure (CVP) monitoring, ranges, cautions, and indications
    • Pulmonary artery catheter (PAC) monitoring, indications
    • Guidelines for fluid management post-op (e.g., cardiac surgery, CABG) and hemodynamic monitoring
    • Cooling procedures for post-cardiac arrest patients and reasons
    • Nursing interventions and complications related to post-cardiac arrest patients, including hemodynamic management
    • Short-term mechanical circulatory support (e.g., intra-aortic balloon pump, ECMO) indications

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    Related Documents

    Week 3 Hemodynamics - NUR4050 PDF

    Description

    This quiz covers key topics related to hemodynamics, particularly for the NUR4050 course. It addresses important concepts such as myocardium function, diastolic filling volume, and medication considerations. Prepare for Exam 1 with targeted questions related to these crucial nursing concepts.

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