A&P Unit 5

Conditions that affect central venous pressure Decrease in CVP- 1)__ and 2)___ Increase in CVP- 1)__, 2)__, 3)__, 4)__, and 5)__

1) absolute hypovolemia (blood loss, dehydration) 2) shock, vasodilation 1) PPV 2) Increased PVR 3) Hypervolemia 4) right ventricular failure 5) left ventricular failure (late change in CVP)

This catheter is typically ___ with multiple lumens. the exterior is marked off in __ segments by thin and thick black lines to estimate the __ location upon insertion. At the tip the __ is connected with __ lumen; about __ back from the tip is another opening (___) which is in the right atrium ad connected to another __; near the tip is a small __ connected to a lumen which allows for __ with a syringe.

110 cm long, 10 cm, tip, PA distal port, one, 30 cm, proximal injectate port, lumen, balloon, inflation

Chemical composition of plasma Na+ ___ K+ ___ Cl- ____ HCO3- ____ Glucose ___ Creatinine ___ Bilirubin ___

143 mEq/L 4 mEq/L 103 mEq/L 27 mEq/L 100 mg/100 mL 1 mg/100 mL 0.2-1.2 mg/100 mL

The wall of the heart is composed of __ layers ___- composed of a single sheet of squamous epithelial cells overlying delicate connective tissue. ___- a thick contractile middle layer of uniquely constructed and arranged ___ cells. It forms the ___ of the heart and is the layer that actually ___. ___- a glistening white sheet of squamous epithelium that rests on a thin connective tissue layer. Located in the inner myocardial surface, it lines the hearts ___. It is continuous with the ____ of the great blood ___.

3, Epicardium, myocardium, muscle, bulk, contracts, endocardium, chambers, endothelium, vessels

Normal Vital signs ranges for the newborn Respiratory rate- Heart rate- Blood pressure-

35-50/min 130-150/min 60/40-70/45 mm Hg

Normals: PvO2 PCO2

40 46

The infants PO2 must increase to more than _____ in order for the ____ to close. If this level is not reached, the ___ will remain open and ___ will remain elevated producing a syndrome known as ____ or previously known as ____. Also if the ____closes due to an initial rise in PO2, but the PO2 falls within the first ___ hours after birth, the ______ will reopen.

45 to 50 mmHg, ductus, ductus, PVR, Persistent Pulmonary Hypertension of the Neonate, Persistent fetal circulation, ductus, 24 to 48, ductus

At rest, the heart receives about ___ of the total cardiac output and the venous blood returns to the __ via the ____ (the great and middle cardiac veins empty into the ___) ___ veins- empty into both right and left ____.

5%, right atrium, coronary sinus, sinus, Thesbian, atrium

___ of CO is in the systemic circulation ___ in the heart ___ in pulmonary circulation Overall, 60% of the blood is in the ___; 10% in the __. Normally the P-C bed holds ___ of blood, but can hold ___ if needed.

75%, 15%, 10%, veins, arteries, 75mL, 200mL

____- (non granulated) cells (developed from ___ and __ tissue (like marrow). A) ____- are the second most numerous leukocytes in the blood. Larger numbers exist in the ___ but only a small amount in the ____. Most are found in ___ tissues (___) where they play an important role in ____. ___ (__) function in the immune response by acting directly against virus-infected ___ and ___. ____ (___) give rise to plasma cells, which produce ___ aka ___ that work to inactivate invading ___.

Agranulocytes, lymphoid, myeloid, lymphocytes, body, bloodstream, lymphoid, lymph nodes, immunity, T-lymphocytes, T cells, cells, tumors, B-lymphocytes, B cells, antibodies, immunoglobulins, antigens

____- pressure receptors located throughout the body that send signal to the ____ and ___ centers in the ___, thus regulating blood ___ as needed.

Arterial baroreceptors, vasomotor, cardiac, medulla oblongata, pressure

____ aka ____ are specialized stretch receptors located in the walls of the ___ arteries and the arch of the ___. When stimulated or stretched, the carotid receptors send ___ to the ___ center through the __ or ___ nerve. The aortic receptors send impulses to the ___ center through the __ or __ nerve. The ___ center regulates blood pressure by initiating ___ adjustments to deviations in ___ received from the ____.

Barorecptors, pressoreceptors, carotid, aorta, impulses, vasomotor, 9th cranial, glossopharyngeal, vasomotor, 10th cranial, vagus, vasomotor, reflex, impulses, baroreceptors

The three components that make up the circulatory system.

Blood, Heart (pump), Vascular System

___- calculated by dividing the CO by BSA. CO varies with body ___. By indexing it with BSA normal are standard and ___ can be made among pts of different __ and __. Normal ____.

Cardiac index, size, comparisons, height, weight, 2.5-4.0 Lmin/m2

CVP= ____ normal ___ RAP= ____ normal___ MPAP= ___ normal___ PAP=____ normal ___ PCWP=___ normal ___ pt. assess ___ CO=___ normal ____ aka PAWP, PAOP, LVEDP

Central venous pressure, 0-8 mm Hg right atrial pressure, 0-8 mm Hg mean pulmonary artery pressure, 9-18 (15) mm Hg PAP (systolic/diastolic), 25/8 mm Hg Pulmonary capillary wedge pressure, 4-12 mm Hg, 5-12 mm Hg Cardiac Output, 4-8 Lpm Pulmonary artery wedge pressure, pulmonary artery occlusion pressure, left ventricular end diastolic pressure

B) ____ are approx. the same size as neutrophils. They lessen the severity of __ by ____ immune (antigen/antibody) complexes involved in allergic attacks. This action in turn inactivates certain ___ chemicals that are typically released during an ___ reaction. An increase in their number indicates an ___ reaction. (___ episode) C) ____- are the least numerous of WBC accounting for __ or less of the leukocyte population. These are also combat ___ reactions. These cytoplasmic granules contain ___ and __. remember, ___ is a inflammatory substance that causes ___ that attracts other WBC to the inflamed site. ___ inhibits blood clotting (it is an ____)

Eosinophils, allergies, phagocytizing, inflammartory, allergic, allergic, asthmatic, Basophils, <1%, allergic, histamine, heparin, Histamine, vasodilation, heparin, anticoagulant

_____ (RBC)- constitute the ___ portion of the blood cells. Normal count: male- ____ female-___. The body produces RBC in the red ____ in response to the release of _______ which is released by the _____. _____ the percentage of RBC in relation to total blood volume. Normal values; male- ___ female-___ newborn-_____.

Erythrocytes, major, 5 million/mm3 blood, 4 million/mm3 blood, bone marrow, erythropoietin, kidneys, Hematocrit, 45%, 42%, 45-60%

Blood flows into the right atrium via the __________

Forman Ovale

____- within limits, an increase in VEDP(___) results in increased SV, but beyond a given point, there is no longer ___ in volume with further ___ in VEDP. The left ____ end-diastolic pressure is measured using a ___ (___); the pressure monitored is called the ____ aka ___, ___, ___. This pressure clinically assesses the left ventricular ___. In patients with left heart ___, the limit is reached much earlier than __ and the heart does not pump as ___. If the left heart ___ pump the blood out, it backs up into the pulmonary ___, ____ the lungs-- _____.

Frank-Starling Relationship, preload, improvement, increase, ventricular, pulmonary artery catheter, swan-ganz, pulmonary capillary wedge pressure, LVEDP, PAOP, PWP, preload, failure, normal, efficient, cannot, vasculature, congesting, congestive heart failure

The distribution of pulmonary blood flow is determined by: 1)_____ 2)____ 3.)____

Gravity, cardiac output, pulmonary vascular resistance

Blood enters the left ventricle and is pumped primarily to the _________ and the ________.

Heart and brain

___- a hollow, four chambered muscular organ that consist of the upper right and left ___ and the lower right and left ____. _____- thin, muscular wall separating the ___. ____- thick, muscular wall separating the ___.

Heart, atria, ventricles, Interatrial septum, atria, interventricular septum, ventricles

B) ___ PO2 (__) causes pulmonary vascular resistance to ___ most likely due to the increased ___ ion concentrations resulting from respiratory ___.This vasoconstriction does not occur with a normal __ and increased ___ (compensated ___) C) ___ pH (__)- metabolic or respiratory.

Increased, hypercapnia, increase, H+, acidosis, pH, CO2, respiratory acidosis, Decreased, acidemia

___- the actual blood pressure in the lumen of any vessel at any point relative to the barometric pressure. This is also called the ____. ___- the difference between intravascular pressure and the pressure surrounding the vessel. ___- the difference between the pressure at one point in a vessel and the pressure at any other point downstream in vessels.

Intravascular pressure, intraluminal pressure, transmural pressure, driving pressure

____ (WBC)- their primary function is to ___ the body against invasion of ___ and other harmful ___ agents. Normal count- ___. Unlike RBC the WBC can leave the capillary blood vessels when needed for an ____ or ____ response through a process called ____. It is activated by chemical signals released by damaged cells -______. These move outside the bloodstream using an ____ motion. Since these combat ___ and ___ it is clinically helpful to diagnose infection by getting a ___ and ____ count, which is a component of one of the most useful diagnostic test-- the ___. WBC > ____

Leukocytes, protect, bacteria, foreign, 4000- 11,000/mm3 blood, inflammatory, immune, diapedesis, positive chemotaxis, amoeboid, inflammation, infection, WBC, differential WBC, Complete blood count (CBC), 11,000/mm3

About half of the blood enters the ______ and the rest flows through the ______ _______ and enters the ______.

Liver, Ductus Venosus, Inferior Vena Cava

Formula for MAP-___ An MAP of ___ is considered the minimum pressure needed to maintain adequate tissue ___. Arterial pressure is the product of ___ (blood volume pumped by the ventricles in one contraction) and __ resistance. Changes in either of these parameters can affect the ___ pressure.

MAP=(Psystolic + 2 x Pdiastolic)/3, 60 torr, perfusion, stroke volume, vascular, arterial

Normal differential Counts Neutrophils- ____ or ____ Lymphocytes- ____ or ___ Monocytes- ___ or ___ Eosinophils- ___ or __- Basophils- ____ or ___ total _____

Normal range or typical value 65-75 or 65 20-25 or 25 3-8 or 6 2-5 or 3 0.5-1 or 1 total for both 100

The __ catheter is usually inserted into either the __ or __, an advanced to the __ and the __. The balloon is then inflated and the blood flow moves the catheter with its inflated balloon just as the wind moves a __. The catheter proceeds into the __ ventricle and into the pulmonary __ where it will eventually ___ in a smaller branch of the __ artery. The balloon is the deflated and the catheter __. The balloon is inflated only when the pulmonary ___ pressure is being taken!

PA, subclavian, jugular vein, superior vena cava, right atrium, sail, right, artery, wedge, pulmonary, stabilized, wedge pressure

____- affecting pulmonary vascular resistance (___): ___ in this context refers to a ___ change that occurs in the pulmonary vascular resistance in response to another mechanical change. A) ___- under normal conditions, as pulmonary arterial pressure increases, the PVR ____. This happens because of the increase in ___ distending pressure which opens up the __ of the pulmonary vascular system through mechanisms of ___ and ___.

Passive mechanisms, PVR, Passive, secondary, Pulmonary artery pressure changes, decreases, intraluminal, vessels, recruitment, distention

D) ____: drugs which cause pulmonary ___ and increase vascular ____: ___ (__), ___ (__,__), ___ (__), __ (__), ____ (__)

Pharmacologic stimulation, vasoconstriction, resistance, epinephrine (adrenalin), norepinephrine (levophed, levarternol), dobutamine (dobutrex), dopamine (intropin), Phenylephrine (neo-synephrine)

___- a pale yellow liquid which makes up __ of the total blood volume. It is __ water and the other __ is composed of __, ___, ___, ___, ___, ___, and waste.

Plasma, 55%, 90%, 10%, proteins, electrolytes, food substances, respiratory gases, hormones, vitamins, waste products

As the infant inhales for the first time, the ______ falls dramatically and blood flow to the lungs ____ dramatically. The major mechanism which account for the decreased ____: The sudden increase in the _____, which offsets hypoxic _______. The removal of fluid from the lungs, reducing the _____ pressure on the pulmonary vessels. The mechanical increase in lung volumes, which widens the ____ of the _____vessels.

Pulmonary Vascular Resistance (PVR), increases, PVR, alveolar PO2, vasoconstriction, external, caliber, extra-alveolar

___- (__) is a flow-directed, balloon-tipped catheter. It also has a __ (for cardiac output measurement), and a light reflective __ element (for mixed venous __ saturation measurement). The __ is placed within the pulmonary __ and can measure __, __ as well as __ and __ (normal CO in adults is __) Since it is inserted at the same site as the __ catheter, it has similar complications as well as additional ones related to __ inflation such as pulmonary artery __ and pulmonary __.

Pulmonary artery catheter, swans-ganz, fiberoptic, O2, catheter, artery, PAP, PCWP, CVP, CO, 4-8 Lpm, CVP, balloon, hemorrhage, infarction

The blood travels up the inferior vena cava and enters the __________.

Right atrium

___ - aka ____ is computed by dividing the SV by the BSA. If the heart rate remains the same, an increase or decrease in stroke volume results in __ or ___ in stroke volume ___, which results in __ or ___ ____. The stroke volumes index reflects: ___, ___ ____.

Stroke volume index, stroke index, increase, decrease, index, increase, decrease, cardiac index, contractility of the heart, overall blood volume status, amount of venous return

___- the volume of blood ejected by the ventricles with each contraction. (formula_____) The major determinants of stroke volume are: ____, ____ , _____

Stroke volume, SV= CO/HR, ventricular preload, ventricular afterload, myocardial contractility

___- contract- ___BP; ___ pressure- the maximum pressure generated during ventricular contraction (normal- ___ systemic and ___ pulmonary) ___- relax- ___ BP; the lowest pressure that remains in the arteries prior to the next ventricular contraction. (normal- __ systemic and ___ pulmonary)

Systole, Increase, Systolic, 120 mm Hg, 25 mm Hg, Diastole, decrease, diastolic, 80 mm Hg, 8 mm Hg

The _________ blank carries oxygenated blood and nutrients from the placenta to the fetus.

Umbilical vein

Formula for Vascular Resistance=

Vascular resistance = BP (Mean)/ CO

____- the force against which the ventricles must work to pump blood. It is determined by: A) __ & __ of blood ejected from the ventricle B) ___ in the left heart, ___ in the right heart C) Total cross-sectional area of ___ space into which the blood is ___.

Ventricular afterload, volume, viscosity, peripheral vascular resistance, pulmonary vascular resistance, vascular, ejected

Stroke volume is determined by: ____ - occurs during the diastole when the ventricle is ___ with blood to eject during systole); refers to the degree the ___ fiber is stretched (how much __ is being ___ from the atria to the ___) prior to contraction (measured at end-___ when the end-___ volume is reflected by the end ____) Under normal conditions, as VEDP ____ the SV and CO will increase. But the heart is like ___, in that there is a ___ to how much the ___ fibers will stretch.

Ventricular preload, loaded, myocardial, blood, loaded, ventricles, diastole, diastolic, diastolic pressure, increases, lungs, limit, myocardial

____- the top of the lungs- the ___ gravity dependent; sometimes the ___ pressure is greater than ___ and ___ blood pressures, resulting in compressed ___ - so there is no blood flow to these inflated ____. Normally, the ___ pressure is sufficient to overcome the increased ___ pressure in the ____, but in conditions such as severe ___, ___ and ___, the ___ can be compressed. There is a ____ where there is ___ but NO ____--- which is the definition of ____.

Zone I, least, alveolar, arterial, venous, capillaries, alveoli, arterial, alveolar, apices, hemorrhage, dehydration, PPV, capillaries, ventilation to perfusion (V/Q) mismatch, ventilation, perfusion, alveolar deadspace

___- arterial pressure is greater than alveolar pressure, thus the pulmonary ___ are perfused with ___. The flow of blood ___ from the upper part of the lower part.

Zone II, capillaries, blood, increases,

___- gravity- dependent areas of the ____. Blood flow through this region is ____.

Zone III, lungs, constant

Two major groups of leukocytes- ___ and ___. _______(produced in red bone marrow) A) ____ (polymorphonuclear) the most numerous of the WBC (____ of total) and are active in response to ____ destruction. They are __ the size of RBC. These are very mobile active ___ cells. Their cytoplasmic granules contain powerful ____, which are ____ enzymes that aid in the ____ and destruction of ____. An increased ___ count indicates __ infection (__ phase)

agranular, granular, granulocytes, Neutrophils, 40-70%, tissue, twice, phagocytic, lysosomes. digestive-like, ingestion, bacteria, neutrophil, bacterial, acute

Two major subdivisions of the vascular network of the circulatory system (both systems have ___, ___, ___, __, and ___) 1,) ____- begins with aorta, ends with right atrium 2.) ____- begins with pulmonary trunk (which branch into 2 arteries), ends with left atrium

arteries, arterioles, capillaries, venules, veins, systemic system, pulmonary system

___- vessels that carry blood away from the heart; strong, elastic, well-suited for ___ pressures; subdivide into smaller vessels (___). ____- play a major role in distribution and regulation of blood ___ and are referred to as ____. ____- where gas exchange occurs: ___ respiration- gas exchanges between blood and air (__) ___ respiration- gas exchange between blood and tissues. ___- tiny veins continuous with capillaries ___- carry blood back to the heart. These are capable of holding ___ amounts of blood (unlike arteries) with very little ___ change. - ___ (approx. __ of body's total blood volume is contained in the ___ system)

arteries, high, arterioles, Arterioles, pressure, resistance vessels, capillaries, external, lungs, internal, venules, veins, large, pressure, capacitance vessels, 60%, venous

Other baroreceptors are found in the large ___, large __, and ___ vessels and the ___ walls themselves. They function in the way as those in the ___ sinuses, in that ___ impulses from them results in ___ sympathetic activity from the medulla. The extra receptors enable the medulla to be more ___ to ___ changes.

arteries, veins, pulmonary, cardiac, carotid, decreased, increased, sensitive, pressure

The ___ of the heart is broad and flat and points toward the right ___. The __ points inferiorly toward the left __. When fingers are pressed b/w the 5th and 6th rib just below the left ___, the heart beat can be felt where the ___ is in contact with the ___ chest wall. This site is the ___ (___).

base, shoulder, apex, hip, nipple, apex, internal, point of maximal, PMI

RBC microscopically are ___ discs, produced in the ____ in the spongy bone of the cranium, bodies of the vertebrae, ribs, sternum, humerus and femur. RBC are produced at a rate of ___, but an equal number of worn out RBC are ____ each second by the ___ and ____. The life span s about ____. _____ is the major constituent of the RBC, it is responsible for the transport of ___ and ____.

biconcave, red bone marrow, 2 million/sec, destroyed, spleen, liver, 120 days, Hemoglobin, O2, CO2

C.) ___- as blood volume increases, ___ and ___ occur, which results in ___ of the pulmonary vessels and PVR will ____. D.) ___- (derived from hematocrit) as viscosity ___, the pulmonary vascular resistance increases (__)

blood volume changes, recruitment, distention, widening, decrease, blood viscosity, increases, polycethemia

Other substances that are released at birth which contribute to the closure of the ductus:

bradykinin, serotonin, prostaglandin inhibitors

The PCWP measurement may be used to distinguish __ and __ pulmonary edema. In pulmonary edema caused by __ heart failure, the PCWP is usually ___. When pulmonary edema occurs with a normal PCWP, it is probably due to an increase of ___ as seen in ARDS.

cardiogenic, noncardiogenic, left, elevated, capillary permeability

Externally the heart appears as a ___ structure, it is enclosed in the ____ and extends obliquely b/w the __ and __ space. The heart rest on the ___ surface of the ___, anterior to the __ column and posterior to the ___. Approx. __ of the heart lies to the left of the ___ line; the balance extends to the ___.

cone-shaped, mediastinum, 2nd rib, 5th intercostal, superior, diaphragm, vertebral, sternum, 2/3's, midsternal, right

decreased blood pressure ____ stretch the receptors so they send ___ signals to the vasomotor center; the center in turn sends out ___ numbers of ___ impulses which result in; increased __, ___, ___, ___. These result in; increased ___, ___ and return the blood pressure towards the ____.

doesn't, decreased, increased, sympathetic, heart rate, myocardial force of contraction, arterial constriction, venous constriction, cardiac output (due to increase heart rate and stroke volume), in total peripheral resistance, normal

In hemodynamically unstable patients who are receiving fluid infusion or drugs to improve circulation, heart function and blood vessel caliber, continuous and accurate BP readings are ___. With an ___ catheter, most bedside monitors will display a ___, as well as a ___ of systolic pressure, ___ pressure, and ___ pressure (the average BP in the ___ circulation) Normal is ___

essential, arterial, graphic waveform, digital readout, diastolic, mean arterial, arterial, >80 mm Hg

Whole blood consist of a variety of specialized cells called ______, which are suspended in a ______ matrix called _______. The functions of the blood are to: 1.) transport O2 to the ____ and CO2 to the _____. 2.) transport ____ and ____ products. 3.) transport processed ____ from one part of the body to another-- for ex, _____ is carried by the blood to the liver, where it is converted into ______.

formed elements, matrix, plasma, tissue cells, lungs, nutrients, waste, molecules, lactic acid, glucose

Venous return is determined by the pressure __ b/w the __ and ___, so if the CVP increases, there will be a lower blood return to the ___. This is seen during ___ pressure ventilation or as a result of ___ ventricular failure.

gradient, MAP, CVP, heart, positive, right

Blood is relatively ___ so it naturally moves due to gravity, to the portion of the lung ___ to the ground. The lower part of the ____ gets the most blood. it is ___.

heavy, closest, lungs, gravity dependent

___- the study of the forces that influence the circulation of blood. Pulmonary hemodynamic measurements are ___ obtained by means of the ___ pulmonary artery (__) catheter. The catheter can measure several hemodynamic parameter ___ (other measurement can be computed or ___ from these measurements)

hemodynamics, directly, swans-ganz, PA, directly, derived,

Function of blood cont.- 4) transport regulatory __ and __ 5) regulate the __ and ___ 6) Maintain body ___ 7) protect against ____ substances 8) form ___

hormones, enzymes, pH, osmosis, temperature, foreign, clots

___- with chronically high BP, the baroreceptors function as ___ regulators. If the situation that alter BP continues, they will __ or ___ to the situation. (the new pressure will be ____ as ____)

hypertension, short term, accept, adapt, accepted, normal

From the aorta, branch the common ________ which in turn branch into the ______ and _____ ____. The blood in the _______ _____ branch into the _______ and again flows back to the _____ to start the process again.

iliac arteries, external, internal iliacs (2x), umbilical arteries, placenta

Increased blood pressure stretches the receptors and then send ___ signals to the ___ center; the center in turn sends out ___ numbers of ___ impulses which result in ____ and a ___ in blood pressure toward normal.

increased, vasomotor, decreased, sympathetic, vasodilation, decrease

Measurement of ventricular preloads and afterloads Arterial Catheter- ___ Central Venous Catheter-____ Pulmonary Artery Catheter (balloon deflated)- ____ Pulmonary Artery Catheter (balloon inflated)- ____

left ventricular afterload right ventricular preload right ventricular afterload left ventricular preload

The pulmonary system is a ___ pressure system while the systemic system is a ___ pressure system. (With pressures ___ greater than those in the ___ system)

low, high, 10x, pulmonary

B) ___- (depends on the location of blood vessels) _____- surround the alveoli (pulmonary __)- during inspiration, the vessels are stretched and ___; during expiration the shorten and __. As lungs inflate, the resistance in the alveolar vessels __ (this should be considered during __) ____- larger arteries and veins- different from the alveolar vessels- as lung volumes ___ in response to more ___ intrapleural pressure during ___, the transmural pressure (within the ___) ___ and the extra-alveolar vessels distend. Another factor is radial ___ generated by connective __ and the alveolar __ that holds the larger ___ in place act to pull the ___ open. At low lung volumes (with low ___) the extra alveolar vessels ___ and vascular resistance ___.

lung volume changes, Alveolar vessels, capillaries, flattened, widen, increases, PPV, Extra-alveolar vessels, increase, negative, inspiration, vessels, increases, traction, tissue, septa, vessels, vessels, distending pressure, narrow, increases

Once in the pulmonary artery most of the blood bypasses the ______ and flows directly into the ______ through the __________.

lungs, aorta, ductus arteriosus

As the PVR decreases, a greater amount of blood flows through the _______, and therefore, more blood returns to the ______. This causes the pressure in the ____ to increase and the flap of the _____ to close functionally. The closure of the ____ is further aided by the fall in pressure that occurs in the right atrium as the ____ flow ceases. A few minutes later, the smooth muscle of the _____ constrict in response to _____ PO2.

lungs, left atrium (2X), foramen ovale (2x), umbilical, ductus arteriosus, increased

CVP is reported as a ___ pressure and its normal range (affected by placement of the ___): in the vena cava is ___; in the right atrium, it is ___.

mean, catheter, 0-6 torr, 2-8 torr

B) ___- an increased in their number indicates a ___ infection. (___) In tissue, these differentiate into highly mobile ____ with large appetites. These take longer to reach the site of ___ than neutrophils, but they destroy more ___. They are also ___. They are also effective against ___ and certain ___ bacterial parasites.

monocytes, chronic, tuberculosis, macrophages, infection, bacteria, phagocytes, viruses, intracellular

After birth the following changes occur, the placenta is passed by the ______. The umbilical arteries ______ and become the lateral _______. The umbilical vein becomes the round ______ (_____) of the _____. The ductus venosus becomes the __________ which is a fibrous cord in the liver. The flap on the foramen ovale usually closes and becomes a depression in the _____ called the _______. The ductus arteriosus _____ and becomes the _______.

mother, atrophy, umbilical ligaments, ligament (ligamentum teres), liver, ligamentum venosum, interatrial septum, fossa ovalis, atrophy, ligamentum arteriosum.

___- this may be viewed as the force generated by the myocardium when the ventricular muscle fibers ____ (snap ___ after being stretched) An increase in ___ results in and increase in Cardiac output

myocardial contractility, shorten, back, contractility

The blood supply that ___ the heart originates directly from the ___ by means of the left and right ____. Left coronary artery- divides into the ___ and ___. These supply the ___ wall of the __ ventricle and ___ surface of the ___ ventricle, ___ wall of the __ ventricle and portions of the ___ ventricle and ___septum. Right coronary artery- ____ branch. It supplies the __ ventricle and ___ portion of the ___ and portions of the ___ surface of the ___ ventricle.

nourishes, aorta, coronary arteries, circumflex, anterior descending branches, lateral, left, diaphragmatic, left, anterior, left, right, interventricular, posterior descending, right, posterior, septum, diaphragmatic, left

E) ___ (increases vascular resistance): the pulmonary vasculature constricts due to: ___ or ___ (___ or __) ___ (__,__,___) ___ (__,__,__) ___ (__,__,___) If the resistance originates in the ___ or ___ the ___ pressure increases and in severe cases, causes pulmonary ___ (this can be seen in left __) If the resistance arises in the ___ and ___, the ___ increases, but the PCWP will be normal or __. this will be followed by ___ right ventricular ___, right ventricular __, right ventricular ___ and a right heart failure- ___.

pathologic conditions, vessel blockage, obstruction, (thrombus or embolus), vessel wall disease, (sclerosis, scleroderma, polyarteritis), vessel destruction (emphysema, pulmonary embolus, interstitial fibrosis), vessel compression (pneumothorax, hemthorax, tumor mass), veins, venules, transmural, edema, heart failure, arteries, arterioles, PAP, low, increase, pressures, strain, hypertrophy, cor pulmonale

Blood pressure increases and decreases in a ___ corresponding to the phases of the ___ cycle. During ___ (___) the BP in the aorta and pulmonary artery ___.

pattern, cardiac, systole, contraction, increase

The heart is enclosed in a double-walled sac called the ___, the outer wall, the ____ functions to:1) ___ the heart 2) ___ the heart to surrounding structures, such as the ___ and the great ___. 3) prevent the heart from ___.

pericardium, fibrous pericardium, protect, anchor, diaphragm, vessels, overfilling

The increased blood flow increases the ___ in the ___, which causes them to ___ to accept the increased blood flow- a manipulation of ___ law. This increases the total ____ area through mechanisms of ___ and ___. The increased ____ surface area decreases the ____ .

pressure, vessels, widen, Poiseulle's, cross-sectional, recruitment, distention, cross-sectional, vascular resistance

____- reflects the afterload of the right ventricle. It is the resistance of the arterial system into which the ___ heart is pumping. Formula=__ Normal ___ ___- reflects the afterload of the left ventricle. It is the resistance of the arterial system into which the ___ heart is pumping. Formula=___ Normal-____

pulmonary vascular resistance, right, PVR=PA-PCWP/CO x 80, 110-250 dynes.sec.cm-5, systemic vascular resistance, left, SVR=MAP-CVP/CO x 80, 800-1500 dynes.sec.sm-5

A small amount of blood flows through the lungs and returns to the left atrium via the _______________. _____% of fetal circulation passes through the lungs.

pulmonary veins, 15%

In the ___ system, several known mechanisms change ___ resistance. They are classified as ___ or ___ mechanisms. ___ (have a direct or primary effect) resulting in increased vascular resistance: 1) abnormal blood gas volume A) ___ PO2 (___) , the pulmonary vasculature ___ in areas with decreased PAO2.This directs the blood away from the ___ lung regions to areas with ___ PAO2. If the number of ___ lung regions ___ significantly (Ex. __ or __), widespread ___ can develop, which __ pulmonary vascular __. This ___ the workload of the right __, which could lead to right ventricular ___ and ___ - cor pulmonale- ___ due to lung disease.

pulmonary, active, passive, Active mechanisms, Decreased, hypoxemia, constricts, hypoxic, increased, hypoxic, increases, advanced emphysema, chronic bronchitis, vasoconstriction, increases, resistance, increases, ventricle, hypertrophy, failure, right heart failure

Changes in contractility are detected by clinical assessment-- __, ___, ___, ___. ____- increased myocardial contractility ____- decreased myocardial contractility ____ - increase in heart rate ____- decrease in heart rate

pulse, blood pressure, skin, temperature, positive inotropism, negative inotropism, positive chronotropism, negative chronotropism

The arterial catheter may be placed in the __ artery (first choice, be sure to check for __ circulation through the __ artery, using the __ test) the ___, ___, and __ arteries, shows the normal arterial pressure __. The __ notch is caused by the closure of the ___ valves during ___. Normal systolic: ___ Normal diastolic:___ (adults)

radial, collateral, ulnar, Allen, brachial, femoral, dorsalis pedis, waveform, dicrotic, semilunar, diastole, 100-140 torr, 60-90 torr

Arterial catheter is inserted into these sites; ___ (__), __, ___, or ____. It is located within the ____ artery near insertion site. It is used for 1) ___ 2) ___. Central venous catheter is inserted into the ___ or ____. The location sites ___ or ____ . It is used to 1)___ 2)____. Pulmonary artery catheter is inserted into the ___ or ___. Located in the ____. Its common used for 1)__ 2)___ 3)____ 4)___ 5)____ The proximal opening in the pulmonary artery catheter can also measure the right ____ (___)

radial, first choice, brachial, femoral, dorsalis pedis artery, systemic, measure systemic artery pressure, collect arterial blood gas samples, Subclavian, internal jugular vein, superior vena cava near right atrium, within the right atrium, measure CVP/RAP, administer fluid or medication, subclavian, internal jugular vein, branch of pulmonary artery, measure CVP-PAP-and PCWP, collect mixed venous blood gas samples, monitor mixed venous O2 saturation, measure cardiac output, provide cardiac pacing, atrial pressure, CVP

____- entails the opening of vessels that were closed or not being used for blood flow before the pressure increases. ____- entails the stretching, or widening, of vessels that were open but not to their full capacity. Body position can significantly ___ the ___ portion of the lungs.

recruitment, distention, change, gravity-dependent

There is ___ to flow as blood moves through the pulmonary and systemic systems. Pulmonary - ___ Systemic- ___

resistance, low resistance systems, high resistance systems

The rest of the blood in the right atrium moves into the __________ and is pumped into the ____________.

right ventricles, pulmonary artery

The ___ side of the heart propels blood into the pulmonary system to the ____. The ___ side of the heart propels blood into the systemic circulation to the rest of the ___.

right, lungs, left, body

Since hemodynamic parameters vary with __ of an individual some values are ___ by the body surface area (___) obtained from a __-__ __, the ___ body surface chart. Normal adult BSA is ___.

size, indexed, BSA, height-weight nomogram, dubois, 1.5-2 m2

___- the volume of blood ejected from the ventricle during each contraction (normally ___) ___- the total volume of blood discharged from the ventricles per minute. Formula:_____ CO is measured in ___ normal is ___ range is ____ As CO ____ BP ___; CO ___ influences BP.

stroke volume, 40-80 mL, Cardiac output, CO= SV x HR, Lpm, 5.0Lpm, 4-8Lpm, increases, decreases, directly

Arteries and arterioles are controlled by ___ impulses. These are governed by the ___ located in the ___. ____- state of vascular contraction maintained by a continual stream of ____ impulses from the vasomotor center which controls both ___ & ___ by controlling the number of ____ impulses.

sympathetic, vasomotor center, medulla oblongata, Vasomotor tone, sympathetic, vasodilation, vasoconstriction, sympathetic

Clinically, arterial ___ blood pressure best reflects ventricular afterload. Increased ___ pressure increases the resistance against which the ___ must work. This could be serious in a failing heart with low ___. To correct this, ____ are given to decrease ____. The heart will not have to work as hard to __ blood and the SV will ___. The BP will remain stable even with the ___ resistance bc it is a function of CO & SVR (so while the VR ___; the ___ SV results in ___ CO-- these changes ___ each other out and ___ remain stable. Formula Systemic BP=

systolic, systolic, heart, stroke volume, parasympathomimetics, vascular resistance, eject, increase, decreased, increases, increased, increased, balance, BP, CO=SVR

___- blood platelets- smallest of the formed elements in the plasma. Normal count ___ Pt. assess values___. their function is to prevent blood loss from a ___ area by: A) forming platelet ___ that seal ___ in small blood vessels. B) forming blood ___, which work to seal off larger ___ in the blood vessels. Platelets also have ___, which causes smooth muscle ___ and decreased __ flow to ___ sites.

thrombocytes, 250,000-500,000/mm3 blood, 150,000-450,000/mm3 blood, traumatized, plugs, holes, plugs, tears, serotonin, constriction, blood, traumatized

Drugs which relax the pulmonary ___ and decrease vascular ___. ___, ___, ___, ___

vasculature, resistance, O2, isoproterenol, aminophylline, calcium-blocking agents

Increased sympathetic impulses- ____ decreased sympathetic impulses- ____ Exceptions- ___ of the heart, brain, an skeletal muscles. In these groups increased sympathetic impulses results in _____- this allows for increases blood flow to these areas in times of stress (___ or ___)

vasoconstriction, vasodilation, arterioles, vasodilation, fight or flight