Week 3 Hemodynamics - NUR4050 PDF

1/28/25, 8:50 PM week 3: hemodynamics 🧑‍⚕️ Nursing🧑... SMOL NUR4050 exam 1 (week 5... we Share week 3: hemodynamics labs for hemodynamics → lactic, abg, scvo2, trop, bnp, che...

1/28/25, 8:50 PM week 3: hemodynamics 🧑‍⚕️ Nursing🧑... SMOL NUR4050 exam 1 (week 5... we Share week 3: hemodynamics labs for hemodynamics → lactic, abg, scvo2, trop, bnp, chem panel stress effect on hemodynamics → +contractility, +hr, +bp, +rr/gas- exchange volume regulation cycle ↓  1. extracellular fluid increase vent/atrial pressure ⇒ vent/atrial wall expansion 2. release of anp + bnp (vent⇒brain) inhibits raas system ⇒ -na + h2o excretion 3. decreased extracellular fluid difference in chf → poor perfusion cause kidneys to not recognize bnp ⇒ does not inhibit raas system (treat with ace inhibitors cardiac output ↓  1. stroke volume A. systolic ejection volume ↓  I. afterload → pressure to open the aortic valve during systole (ventriclular systole) primary variable → systematic vascular resistance (svr) increased by → htn (atherosclerosis), aortic stenosis(so big it creates overload), hypothermia, left vent failure ⇒ raas activation, shock (hypovolemic + cardiogenic), stress decreased by → hyperthermia, shock (septic + anaphylactic + neurogenic), vasodialtion https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 1/11 1/28/25, 8:50 PM week 3: hemodynamics low svr treatment → vasopressors (levo + high dose dopamine via large-bore iv) this is aka afterload high svr treatment ↓ vasodilators ⇒ nitrates (nipride), hydralazine inotropes (if related to contractility) ⇒ dobutamine (w/ ace-1 for vasodilation) alpha and cc blockers ⇒ amlodipine, nifedipine, cardura surgery for av stenosis ⇒ valvuloplasty, avr, tavr II. contractility → squeeze of the heart increased by → shock, postive inotropes, sns decresed by → late sepsis, MI, passing the curve, neg inotropes, lytes, low O2, acidosis, myocardium doesnt work variables ↓ myocardial oxygenation (hypoxia, mi) myocardial function (dilated cardiomyopathy) septic shock (+early,-late) stress fluid balance (preload ⇒ starlings curve) electrolyte imbalance (ca, mg, k, ph balance)... too high or low = depressed myocardium inotropes (+/-) B. diastolic filling volume I. preload → volume after diastole, this is measured by CVP (left ventricular diasolte) altered by ↓ circulating volume variables → iv fluids, bleeding, vomiting, diarrhea, diuresis, "third spacing" https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 2/11 1/28/25, 8:50 PM week 3: hemodynamics franks-starling curve → predicts preload capacity (shows how volume increases co to certain point before dropping off) atrial systole (low hr + loss of atrial kick via symptomatic bradycardia + afib) ventricular compliance/relaxation (dilated cardiomyopathy), we wanna be in a sweet spot aortic stenosis/low ef (increased afterload ⇒ volume overload) 2. hr 3. want it at 4-6, low= threated tissue perfusion https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 3/11 1/28/25, 8:50 PM week 3: hemodynamics 4.   increased right-sided pressure caused by → left-side overload (backs into right), a/v septal defects, pulmonary htn, severe chronic lung dx central venous pressure (cvp) → measures volume depending on venous return on the right side of the heart.... Pressure and blood in the supeior vena cava basically range → 0-10 increased by ↓ +intravascular volume +pulmonary vascular resistance → how hard it is for the right side of the heart to pump blood through the lungs increased by → htn (vasoconstriction), hypoxia, obstruction, stenosis, -pulm compliance (pulm edema, ard, fluid overload), embolisms decreased by → vasodilators, correction of hyoxemia + acidosis, exercise decreased by ↓ hypovolemia https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 4/11 1/28/25, 8:50 PM week 3: hemodynamics systemic vasodilation (septic + neuogenic shock) third-spacing (liver failure, burns) interventions to +co → optimal hr + filling time + preload how do we monitior hemodynamic status → physical assesment and invasive assement basic hemodynamic physical assessment → bp, hr, loc, color/temp of skin (warm/pink)... esp in ER types of invasive montioring → art line, pul cath, central venous cath 4 things invasive montioring needs → thick ahh catheter, high pressure tubing/bag, transducer (makes heart beats into eletrical signals), and monitor phelobtic status → 4th-5th intercostal, needs to be here for good reading, high postion= will drop pressure which is bad for treating arterial line → for pressure and map allens test → occlude radial + ulnar artery ⇒ release ulnar side to confirm ulnar artery is sufficient (confirm with pulse ox) indications → frequent bp monitoring (multiple iv vasopressors + vasodilators or labile bp) nursing interventions → maintain map (60-65), monitor pulse pressure, compare to cuff (qh, should be similar) map formula → (sys + (2)dias)/3 dicrotic notch → aortic valve snapping shut (relaxing in diastole) perfusion pressure changes due to → change in rhythm, pressure bag, transducer location https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 5/11 1/28/25, 8:50 PM week 3: hemodynamics pvc causes → ineffective vent contraction ⇒ more filling time next beat ⇒ higher systolic pressure during the next beat  abnormal arterial pressure waveform → does not reflect the actual pressure... jsut know somehting can be wrong with the catheter AND ASSESSS “over shoot” rhythm → exaggerated peaks, false notch, possible too much pressure in bag or kinked tubing “under dampened” rhythm → flatter waves w/ no transition to dicrotic notch, possibly due to low volume in bag or open stop-cock (pressure is released) venous catheters → for CVP sites → fem, jug, subclavian, brachial, picc (via ac) https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 6/11 1/28/25, 8:50 PM week 3: hemodynamics central venous pressure monitoring → monitors volume via jug or subclavian vein ranges → 0-10 is normal, tricuspid causes dicrhotic notch cavets → not really good at micu, good for more so healthy pts indications → fluid overload/deficit, need for fluid resuscitation may cause → air embolisms (if left open), thrombus formation, infection pulmonary catheter → measures pressure of ra/rv/pa/paop  indications ↓ diagnose/evaluate heart disease, shock states, ards (pulm htn/copd/chf/pe/dvt), restrictive cardiomyopathy, pericardial or valve dx (disease compromising co) determine if there is a central venous issue or right-sided heart issue determining response to vasodilator therapy https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 7/11 1/28/25, 8:50 PM week 3: hemodynamics guided fluid management post op (mi + cabg) hemodynamics and CO may cause → bleeding, air embolisms, artery rupture (balloon), ischemia, catheter knots, clots, vent dysrthymias, infection when inserting → basically as they insert it, the wave forms change and they can figure out where they are at in terms of chamber of the hearrt paop → measures left side pressures of the heart when inflated thermodilution → heat substance to certain temperature before administration ⇒remeasure once it reach a certain point of the body (most common in icu if swan is present)... how we can see CO in pa cath scvo2 monitoring → its a port on the pa cath that measures difference between o2 supply + demand.... helps us to understand theruprtuic responses to o2 normal scvo2 → 70% high → o2 supply exceeds demands (+co, early sign of shock) low → o2 demand exceed supply (-co, -hgb, -spo2) normal co → 4-6l/m ev1000 monitor → combines data from art line + scvo2 cath to measure co/sv/svr/svv (vented patients) nursing interventions → input pt name + weight + age + sex, clear sight finger cuff system → noninvasive method of monitoring co/sv/svr/svv like the. EV1000 indications → surgical candidates with comorbidities preventing them from receiving art line, only good for 8 hours which is only really good for like surgies stroke volume variation (svv) → changes in sv related mechanical ventilation inspiration + expiration (used to determine if pt will benefit from fluid aka preload responsiveness) https://www.remnote.com/w/631b902ba607ddce9059f4a0/week-3-hemodynamics-ENHesN8BgylvfCQ7C 8/11 1/28/25, 8:50 PM week 3: hemodynamics not indicated in → arrhythmias higher svv → more responsive to fluid interventions → passive leg raising (returns volume to heart)... this allows us to see if they are preload responsive.... we can know this alos by the frank curve cooling protocol post cardiac arrest why do we do this → stop brain death post-ca guidelines (2015) ↓ return of rosc ⇒ cool to 32-36°c (89.5-96.8°f) if initial rhythm was vfib cool as early as possible using any cooling method (even during med administration + pci) don’t warm if mildly hypothermic nursing interventions/ complications ↓ hob 30° w/ seizure precautions glycemic control (central venous draw) infection prevention skincare q2-6h (thermal injuries) maintain map + perfusion monitor k/pt/ptt/cbc q6h manage shivering (paralytics) + fever (aka watch for hypothermia) no enteral nutrition inclusion criteria ↓ out-of-hospital ca or intubated pt within 6h of ca bp > 90 post-ca (with or without pressors or bolus) not following commands (gcs