WVU NSG 460 Combined Cardiac (I&II) Content Questions And Answers With Verified Study Solutions Updated Solutions

Cardiovascular Problems CV Problems Are Related to... -the pump (contractility) -the pipes (afterload) -the fluid (preload) Hemodynamics Stroke Volume (SV) the volume that goes into the ventricles that will be ejected out How do we calculate cardiac output (CO)? CO = HR x SV What is the fundamental issue with any cardiovascular dysfuntion? -end organ perfusion ^are we sending out enough oxygenated blood in order for our other organs to be perfused?Cardiac Dysfunction Neuro -altered mental status Respiratory -SOB, CHF, pulmonary edema Cardiac -hypotension (poor CO), chest pain (hypoxia), EKG changes Renal -decreased urine output (kidneys are not being perfused) Skin -cool, pale, diaphoretic Basic/Advanced Hemodynamic Monitoring Basic -HR and BP Advanced -CVP (central venous pressure) ^direct measurement of R. sided cardiac function ^normal CVP: 0 to 8 -PCWP (pulmonary catheter wedge pressure) ^reflects L. heart function -- preload ^if PCWP is high, the patient has increased preload ^if PCWP is low, the patient has decreased preload ^normal PCWP: 6 to 12 -SVR (systemic vascular resistance) ^afterload -CO (cardiac output) Other Hemodynamics that Monitor L. Side -PAP -LVEDPPulmonary Artery Catheter -direct measurement of R. sided cardiac function -reflects the L. sided function through the use of PCWP measurement Swanz-Ganz Catheter -a catheter that is inserted into the R. atrium, then the R. ventricle, and is placed into a pulmonary capillary Cardiac Output -volume of blood ejected from the LV per min ^4 to 8 L/min -CO = HR x SV -cardiac index = CO / BSA (kg x cm/ 3600) Pre-Load -volume of blood in the ventricle at the end of diastole -sometimes called "filling pressures" -R. side of the heart: CVP -L. side of the heart: PCWP -PCWP is more important than CVP ^deals with the L. side which pumps to the rest of the body Decreased Pre-Load Causes -hypovolemia ^possible GI bleed, trauma, or dehydration -vasodilation: decreases venous return (gets stuck in the periphery) -anything which inhibits venous return -pregnant woman laying on her back ^this compresses the vena cava decreasing venous return; we want to have her lay on her left side -positive pressure ventilation-tumor pressing on the vena cava Treatment -fluids/volume(PRBCs) Increased Pre-Load Causes -fluid volume overload -heart failure: bad pump causes back up Treatment -diuretics -vasodilators (primarily venous) ^we can give morphine or nitroglycerin ^displaces the fluid out centrally