Hemodynamic monitoring Exam Review 100%

Hemodynamic monitoring Exam Review 100% Which of the following is used to guide fluid balance and responsiveness and provides information about the pressure created by volume in the R side of the heart? A. pulmonary artery pressure B. pulmonary artery occlusion pressure C. stroke volume D. central venous pressure - Answer- D SvO2 is a measure of ? A. pressure in the left side of the heart B. pressure created by resistance in the systemic vasculature C. percent of oxygen in mixed venous blood D. measured in the distal portion of the subclavian vein - Answer- C (A- this is measured by pulmonary artery occlusion (wedge) pressure , B- this is measured by systemic vascular resistance, D- Central venous oxygen saturation ScvO2 is measured here. Mixed venous oxygen saturation is measured in the pulmonary artery.) Which of the following is the normal range for right atrial (aka central venous) pressure? A. 8-12 mm Hg B. 4-8 L/min C. 4-8 mm Hg D. 15-30 mm Hg - Answer- C (A- this is normal range for pulmonary artery occlusion (wedge) pressure, B- this is normal range for cardiac output, D- this is normal range for pulmonary artery systolic pressure) Amount of blood ejected from the ventricle with each contraction is the? - Answer- stroke volume What is the normal range for stroke volume? - Answer- 60-100 ml/beat What is the range for the typical cardiac index? A. 2.5-4.0 L/min/m^2 B. 4.0-8.0 L/min C. 33-47 ml/beat/m^2 D. 10-15% - Answer- A (B- this is normal cardiac output range, C- this is normal stroke volume index range, D- this is normal stroke volume variation) Which of the following is true regarding the normal ranges for pulmonary artery pressures? (select all) A. Pulmonary artery systolic pressure ranges from 15-30 mm Hg B. Pulmonary artery diastolic pressure ranges from 8-15 mm Hg C. Pulmonary artery systolic pressure ranges from 4-8 mm Hg D. Pulmonary artery diastolic pressure ranges from 15-30 mm Hg - Answer- A, B (C- right atrial pressure (central venous pressure) ranges from 4-8 mm Hg) What is the normal range for pulmonary artery occlusion pressure? - Answer- 8-12 mm Hg Which of the following can be obtained from a pulmonary artery catheter (PAC) ? (select all) A. Stroke volume variation B. Pressure created by volume in left side of the heart C. Pressure created by volume in right side of the heart D. Mixed venous oxygen saturation E. Cardiac output - Answer- A, B, C, D, E Which of the following may cause a decrease in pulmonary artery occlusion pressure? (select all) A. dehydration B. myocardial infarction C. hemorrhage D. fluid volume excess - Answer- A, C (B- more likely that heart failure from MI may cause an increase in pulmonary artery occlusion pressure. D- Fluid volume excess would cause an increase in PAOP.) Which of the following is correct regarding use of pulmonary artery wedge pressures? (select all) A. Pressure should be obtained at end expiration B. Balloon is inflated with greater than or equal to 1.5 mL air C. Rhythm strip, plethysmograph, and PAOP waveform are printed simultaneously during the procedure for obtaining a PAOP D. The balloon should be inflated no longer than 1 second - Answer- A, C (B- balloon is inflated with less than or equal to 1.5 mL. Important to note that a balloon that doesn't need 1.5 mL may have migrated further into pulmonary vasculature and never to force inflation of the balloon. D- the balloon can be inflated for no more than 8-10 seconds while noting the waveform change. The balloon is essentially cutting off blood flow to the lungs so we don't want to keep it inflated too long.) The rhythm strip is printed off along with the plethora and the PAOP waveform so that you can measure the PAOP at end expiration and end diastole. You are taking care of a patient in the Open Heart Unit and obtain the following measurements from their pulmonary artery catheter (Swan Ganz): RAP: 8 mm Hg, PAS: 28 mm Hg, PAD: 14 mm Hg, MPAP: 18 mm Hg, SvO2: 45%. The patient is on the vent w/ settings: SIMV, tidal volume 700 mL, RR 12, FiO2: 60%. Which of the following actions may be indicated in this situation? A. Nothing, the patient's PAC readings are WNL. B. Increase the FiO2 to 80% C. Decrease the FiO2 to 50% D. Decrease the rate of their IV fluids - Answer- B (A- The SvO2 is only 45%. This means that there is too little oxygen being delivered or that there is a state of increased oxygen consumption. C- Decreasing the FiO2 would cause the SvO2 to decrease further. The normal range for SvO2 is 60-80%. D- The pressures from the PAC all are WNL so there is no need to decrease or increase the fluid rates.) Which of the following can cause a decrease in SvO2? (select all) A. Late septic shock B. Shivering C. Hypovolemia D. Hypothermia - Answer- B, C (A- late septic shock decreases oxygen consumption secondary to inability of tissues to extract oxygen. B- shivering increases metabolic demand for oxygen C- hypovolemia causes less oxygen to reach tissues and so tissues become hypoxic and pull more oxygen from the hemoglobin. D- hypothermia decreases metabolic demand for oxygen) A way to remember this is that things that reduce oxygen delivery (DO2) to tissues are going to reduce the SvO2 but the relationship between oxygen consumption (VO2) and SvO2 is inverse (so things that reduce oxygen consumption increase SvO2 and vice versa). Which of the following can increase SvO2? (select all) A. Increase in FiO2 B. Anesthesia C. Congestive heart failure D. Hyperthyroidism - Answer- A, B (C- CHF would cause a decrease in SvO2 r/t less oxygen being delivered to tissues r/t poor CO. D- Hyperthyroidism would increase oxygen consumption. Hypothyroidism decreases oxygen consumption so it would increase the SvO2)