FCCN 1 - Questions With Verified Solutions

FCCN 1 - Questions With Verified Solutions
Assessment of Perfusion (6) Correct Ans - - Oxygenation /
Ventilation
- Pulses
- Blood Pressure
- Skin
- Kidneys
- Sensorium

Oxygenation vs Ventilation (1) Correct Ans - - Patient can have
good oxygenation but not be ventilation adequately

Oxygenation (2) Correct Ans - - SPO2 assesses oxygenation
- Nasal cannula and oxygen masks help oxygenate

Ventilation (3) Correct Ans - - Need to look at pCO2 on ABG to
assess ventilation
- Ventilation is about how fast and/or deep a patient breaths
- BiPAP masks, Ambu bags, ventilators help ventilate

Blood Pressure: Systolic (2) Correct Ans - - Pressure on
arterial wall during ventricular contraction
- Increase in CO/force of contraction with exercise will increase SBP,
not necessarily DBP

Blood Pressure: Diastolic (5) Correct Ans - - Pressure during
ventricular relaxation

- Vasomotor tone of arterioles & venules
-- Basically how "clamped down" a patient is
--- Dilated arteries decrease DBP
--- Constricted arteries increase DBP

,Blood Pressure: Mean (3) Correct Ans - - Average pressure for
circulation
- Normal: 70-105 mm/Hg
- MAP <60 inadequate

Blood Pressure: Pitfalls (8) Correct Ans - - Insensitive sign of
early shock
-- If SBP is truly <80, current technology is INACCURATE

- Must compare to patient baseline
-- No absolute "NORMAL"

- Measurements
-- Not frequent enough
-- Poor technique

- First B/P should always be done manually!!!

Why is Physical Assessment so Important? (2) Correct Ans - -
Quality assessment is IMPERATIVE b/c all hemodynamic numbers
must be correlated with pt condition!
- Treat your patient, NOT the numbers!

Preload = What? (2) Correct Ans - - Volume
- How "wet" or "dry" a patient is

Afterload = What? (2) Correct Ans - - Resistance
- How "clamped down" or "dilated" a patient is

Contractility = What? (2) Correct Ans - - Squeeze
- How much "squeeze" the heart has

Preload (9) Correct Ans - - Amount of fluid returning to the
heart

,- Edema?
-- NOT part of intravascular volume
- Can have a lot of edema & be dehydrated at same time

- Physical assessment:
-- Thirsty, Dry mucous membranes, Concentrated urine, cool &
clamped down

- Since veins hold blood returning to heart, dilating or constricting
veins affects preload
-- Vein constriction increases preload (CVP)
-- Vein dilation decreases preload (CVP)

Optimize Perfusion: Preload - If Low (3) Correct Ans -
Optimize fluid volume inside vasculature
-- Crystalloids (IV fluids)
-- Colloids (albumin, hespan)
-- Blood (PRBCs, plasma)

Optimize Perfusion: Preload - If High (3) Correct Ans - If
preload is high (wet) give:
- Diuretics (lasix)
- Vasodilators (Nitroglycerine, Imdur (Isosorbide mononitrate))
- Dialysis (hemodialysis, CRRT)

Your patient is experiencing angina. The provider requests
nitroglycerin SL by given. What do you anticipate will happen?

A. Blood pressure will decrease
B. Preload will increase
C. Preload will decrease
D. A & C
E. A & B Correct Ans - D

, Optimize Perfusion: Afterload (5) Correct Ans - - Afterload is
the resistance to the heart ejecting blood
- Since heart ejects into arteries, arteries affect afterload

- Ex: large versus small hole in tip of a cake decorator or ketchup
bottle
-- Small: more resistance
-- Large: less resistance

Optimize Perfusion: Afterload - If High (2) Correct Ans - - High
= constricted arteries or "clamped down"
- Decreases forward flow, cardiac output

High Afterload: Causes (3) Correct Ans - - Hypothermia
- Hypovolemia (reduced CVP & increased peripheral vascular
resistance)
- Cardiogenic shock (increased pressure in aorta)
*ALL TREATED DIFFERENTLY*

High Afterload: Physical Assessment (3) Correct Ans - - Cool
extremities
- Pale
- Mottled

High Afterload: Treatment (4) Correct Ans - Dilate Arteries:
- Ace inhibitors
- ARBs
- Morphine
- Re-warm if patient cold

Optimize Perfusion: Afterload - If Low (1) Correct Ans - -
Dilated arteries