NURS 479 - MedSurg Hemodynamics VOPPT
NURS 479 - MedSurg Hemodynamics VOPPT NURS 479
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This 8 page Class Notes was uploaded by Lexi P on Thursday September 29, 2016. The Class Notes belongs to NURS 479 at Catholic University of America taught by Connor-Ballard, P. in Fall 2016. Since its upload, it has received 32 views. For similar materials see Adults in Health and Illness in NURSING at Catholic University of America.
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Date Created: 09/29/16
NURS 479 – Adults in Health and Illness – Hemodynamics Slide 1 – title Slide 2 Preload and afterload Heart rate Stroke volume Cardiac output and index Systole, diastole, and mean arterial pressure Slide 3 Preload Total amount of blood presenting to the RA/LA from the vena cava and pulmonic vein Afterload Resistance to CO from LV what LV faces when trying to produce cardiac output Increases with hypertension Heart rate (HR) # LV contractions per minute Stroke volume Amount of blood pumped out of LV per (SV) contraction Ejection % blood pumped out of LV fraction (EF) Cardiac output Amount of blood pumped out of LV per minute (CO) (SV X HR) Cardiac index CO per body size (CO divided by body surface (CI) area) Diastole Relaxation and filling of the atria and ventricles Systole Contraction and emptying of the atria and ventricles Primarily ventricles Mean arterial Minimal BP to ensure perfusion to coronary pressure arteries and major organs Slide 4 Diastole – filling – blood enters heart and goes to ventricles Systole – pumping o RV pulmonary system o LV arterial system with O2 blood to organs/tissues Slide 5 Preload o Volume entering ventricles o RA from SVC and IVC o LA through pulmonary/vascular system post oxygenation o Ideally the preload in the right = the preload in the left There are times where there are structural deficits in the pulm/vasc system where it is not equal Afterload o Resistance left ventricle must overcome to circulate blood Pump blood into the arterial system via the aorta Slide 6 Stroke volume o A. right sided preload from vena cava, left side heard from pulmonary vein o B. left ventricle per minute, hopefully equal between right and left o In reference to hemodynamics, usually talk about output as coming out of LV Blood is dispersed through the body to major organs Slide 7 Ejection fraction o When LV pumps, it does not completely empty The majority of the blood is pushed out, but not 100% of it Slide 8 Cardiac output o Increased HR – drugs, exercise, positive chronotropic drugs To decrease use a negative chronotropic agent o Increased SV – positive inotrobic agents Pumps stronger, contracts longer stronger CO o Increased CO by increased preload IV fluids increased preload increased blood in heart increased cardiac output Slide 9 Example values in a healthy 70 kg man (average adult) o SV – blood out of left ventricle with each contraction o Ef – % of blood that the left ventricle is ejecting ~35% of blood left in the LV which is pumped out in the next contraction End stage HF, EF less than or equal to 20% o CO – L/min – 75% to vital organs (heart, liver, kidney, brain, lungs) Slide 10 CardiacIndex=CardiacOutput÷BodySurface Area Individualized to each particular patient Slide 11 Mean Arterial Pressure (MAP) o Range = 70-110 mmHg o The average pressure of the arteries 2×diastolic+Systolic o MAP= 3 o MAP is multiplied by 2 because diastolic phase last longer than the systolic phase o Minimal BP that’s necessary to keep vital organs perfused Slide 12 CVP monitoring – monitor that goes into the heart to monitor the pressure the chambers are experiencing Central venous pressure = when the monitory is in right atrium ~5-7 Right ventricular pressure waveform – not a lot of emphasis on it because it is assumed that if the CVP/right atrium pressure is normal, the RV is too Slide 13 Swan Ganz Pulmonary Artery Catheter o Yellow catheter with multiple lumens at the end o Usually in the neck/jugular or subclavian vein heart o Cortis introducer – large diameter IV catheter It adds an additional 2 ports Yellow catheter is pushed through this Slide 14 Swan Ganz Line o 4 specific values Reflecting pressure in the different parts of the heart 1. RA pressure – CVP Average 5-7, hydration will increase or decrease it 2. RV pressure Changes based on systole/diastole Systolic 20-30 mmHg; Diastolic 0-8 mmHg 3. Pulmonary artery pressure Systole # divided by diastole number Systolic 20-30 mmHG; Diastolic 8-15 mmHg 4. Pulmonary artery wedge pressure 8-12 mmHg Closest indicator we have of preload coming into the Left side of the heart Once you get this number, immediately deflate the balloon Cant put a catheter into the left side of the heart because it is too dangerous, so put it as close to the left side as you can by using “wedge pressure” o Balloon at the tip – inflate for a very short amount of time, the pulmonary artery will pull the balloon as far as possible and it will get lodged in a branch of the pulmonary artery o Reading provided is pulmonary artery wedge press When deflated, it will float back to just the pulmonary artery itself 1 2 3 4 Slide 15 Pulmonary Artery wedge (PAOP) o Only get it when you inflate the balloon briefly Pulmonary artery waveform slowly inflate pulmonary artery wedge deflate pulmonary artery waveform Slide 16 Afterload and MAP – Direct monitoring via A-line o Catheter positioned in artery o Radial artery – direct BP reading Connected to hemodynamic line, connected to continuous flushing with heparinized saline under pressure, connected to transducer Cuff bag to provide pressure Transducer quantifies pressure reading o Appears on wave screen as waveform and number Slide 17 Dicrotic notch – opening/closing of aortic valve and LV