Hemodynamic Monitoring Exam Rated A+ Verified

Hemodynamic Monitoring Exam Rated A+ Verified Crystalloid fluids - Answer- NS, LR Isotonic crystalloid solutions replace ___________ volume losses. - Answer- Intravascular Which isotonic crystalloid solution should be used cautiously in patients with liver dysfunction, and why? - Answer- LR- may contribute to lactate accumulation. What type of solution expands intravascular volume and INCREASE preload? - Answer- Colloids ex: albumin What precaution should you bear in mind when using NS? - Answer- May cause hyperchloremic acidosis What precautions should you bear in mind when using Dextran & Hetastarch? - Answer- Coagulopathy & altered capillary permeability as in septic shock Starlings law of the heart - Answer- The greater the volume, the greater the stretch, and the greater the force of the next contraction, until the heart reaches the point of overstretching and cardiac output falls. SVV is an an arterial pressure-based parameter now used to predict whether a patient will be __________ _____________. - Answer- Fluid responsive S/s of a volume depleted patient (5) - Answer- - tachycardic - hypotensive - low UO - cool skin d/t peripheral vasoconstriction - ALC What non-invasive method could you use to determine if a patient will be fluid responsive? - Answer- Passive leg raise Elevate legs 45deg for 1-2 min. This auto-transfuses 300-500mL blood. Should see SPV, PPV, or SVV decrease when the pt is fluid responsive. Medications that DECREASE preload - Answer- - diuretics - vasodilators (nitro, morphine sulfate, ACE inhib, ARBs) This medication produces a vasodilation that leads to the peripheral pooling of blood, which reduces blood return to the heart and relieves pulmonary congestion. - Answer- Morphine sulfate Pt is admitted for pulmonary edema with new onset HF. Pt has crackles throughout both lung fields and is coughing up frothy, white sputum. Which 2 PRELOAD reducers would you anticipate? - Answer- Loop diuretic & morphine sulfate The resistance that a ventricle must overcome to eject blood forward. - Answer- Afterload Afterload is the resistance that the ventricle must overcome to eject blood forward. What 2 factors determine afterload? - Answer- Volume and concentration of blood and the compliance of the blood vessels. Right ventricular afterload = ? - Answer- PVR normal range 100-250 Left ventricular afterload = ? - Answer- SVR normal range 800-1,200 An elevated PVR indicates an increase in ____________. - Answer- Pulmonary vascular pressure The simplest way to lower PVR is to ensure adequate ___________. - Answer- Oxygenation What medication will produce pulmonary vasodilation? - Answer- Nitroglycerin A high SVR (>1,200) may reflect what? (3) - Answer- Vasoconstriction due to physiologic stress OR left ventricular failure, OR excessive administration of vasopressors A low SVR (<800) may reflect what? - Answer- Vasodilation due to SIRS or sepsis, OR excessive administration of afterload reduction medications. Medications that decrease the SVR (5/8) - Answer- - Nitroprusside - Nicardipine - Hydralazine - ACE inhib - ARBs To a lesser: - Dobutamine - PDE inhibitors (milrinone) - Nitroglycerin Why would a vasodilator, normally used for bringing down BP, be used for a pt with hypotension? - Answer- Reducing SVR (LV afterload) allows the heart to eject more CO, which increases the BP Reducing a high SVR (LV afterload) increase _________ which then increases _________. - Answer- Cardiac output BP These 3 medications all provide a positive inotropic action to increase contractility and increase CO. - Answer- Dopamine Dobutamine Milrinone 5 medications commonly used to increase SVR (LV afterload) - Answer- Norepinephrine (Levophed) Epinephrine Vasopressin (Pitressin) Dopamine (Intropin) Phebylephrine (Neo-Synephrine) This medication is a potent alpha-adrenergic agonist with minimal beta-adrenergic agonist effects. At low dose, its primary effect is vasoconstriction resulting in increase in afterload (SVR). It has a positive inotropic effect and minimal effect on HR. First line drug for management of sepsis not responding to fluid resuscitation. Increases myocardial oxygen demand- use cautiously in pts with ischemic heart disease. - Answer- Norepinephrine (Levophed) This medication is a potent alpha and beta-adrenergic receptor agonist. At low dose, it stimulates beta receptors causing increase HR and contractility, resulting in increased cardiac index. At high doses, can increase preload (PAOP & CVP) due to vasoconstriction in the periphery; increased cardiac index; increased afterload (SVR). - Answer- Epinephrine Side effects of epinephrine - Answer- tachydysrhythmias myocardial, mesenteric, and renal ischemia hyperglycemia This medication is an antidiuretic hormone (ADH) that is synthesized in the hypothalamus and is released from the posterior pituitary in response to hyperosmolality, hypotension, or hypovolemia. Results in vasoconstriction and fluid retention. Often used in conjunction with levophed to increase MAP and SVR. - Answer- Vasopressin