Hemodynamics

Mean Arterial Pressure (MAP) equation

(2 x Diastolic) + Systolic --------------------------- 3

Normal mean PAP is _________ mmHg

14

PVR normal and where measured

150-250 dynes lungs

Normal CVP is _________ mmHg

2-6

Cardiac index normal

2.5-4

Normal PAP is _________ mmHg

25/8

Normal PCWP is _________ mmHg

4-12

What is perfect pulse pressure

40

Normal cardiac output is

5-8 LPM

Normal mean arterial pressure is

70-105

SVR normal and where measured

900-1600 dynes whole body

A patient has a blood pressure of 136/72. What is this patient's MAP?

93 mmHg

What factor does cardiac index include to make it a more accurate reflection of the cardiac function than cardiac output?

Body surface area

calculate CO (both equations)

CO = HR x SV CO = VO2 ---------------- (CaO2- CvO2) x 10

Stroke volume equation

CO X 1000 ------------ HR

To assess a problem in the right heart, you would look at _____ and ______.

CVP and PAP

T/F Blood leaves the right ventricle through the aorta to circulate to the rest of the body.

False

CaO2 equation

Hb x 1.34 x SaO2

CvO2 equation

Hb x SvO2 x 1.34

A patient is being monitored with a pulmonary artery catheter. The readings are as follows: PAP 35/18, PCWP 23, CVP 17 CMH2O, CO 3.4 LPM. This patient would most benefit from which of the following measures? I. Inotropic agents II. Diuretic therapy III. Beta 2 sympathomimetic agents IV. Peripheral vasoconstrictors

I and II I. Inotropic agents II. Diuretic therapy

Which of the following are indications for systemic arterial line insertion? I. Frequent arterial blood gas sampling II. Accurate arterial blood pressure monitoring required III. Hypervolemia IV. Drop in SvO2 V. Intracranial bleed

I, II only

Which of the following conditions are associated with an elevated PAWP? I. Mitral valve prolapse II. left ventricular infarction III. Polycythemia IV. Tricuspid valve stenosis V. Systemic hypertension

I, II, III, and V I. Mitral valve prolapse II. left ventricular infarction III. Polycythemia V. Systemic hypertension

A 40 y.o. male is receiving mechanical ventilation and has a flow directed pulmonary catheter (swan ganz) in place. An increase is noted in his PCWP. What could be the cause? I. Increased Mean Airway Pressure II. Right Ventricular Failure III. Mitral Valve Stenosis IV. Left Ventricular Failure

I, III and IV I. Increased Mean Airway Pressure III. Mitral Valve Stenosis IV. Left Ventricular Failure

Which of the following are responsible for maintaining fluid within the intravascular space? I. Intravascular oncotic pressure II. Extravascular oncotic pressure III. Intravascular hydrostatic pressure IV. Diffusion V. Intravascular osmotic pressure

I, V only I. Intravascular oncotic pressure V. Intravascular osmotic pressure

Left ventricular failure would present as: I. decreased PAP II. increased PAP III. decreased cardiac output IV. increased PWP V. increased cardiac output

II, III and IV only II. increased PAP III. decreased cardiac output IV. increased PWP

What factor does cardiac index include to make it a more accurate reflection of cardiac function than Cardiac output?

Includes body surface area

A decrease in contractility is known as ________ __________, where an increase in contractility is known as ______ ________.

Negative inotropism Positive inotropism

To asses a problem in the lungs you would look at _______ and ______.

PAP and PCWP

What can the Swan-Ganz catheter measure?

PAP and PCWP

To assess a problem in the left heart, you would look at _______ and _______.

PCWP and CO

P/F ratio

PaO2/FiO2

Define afterload

Resistance to bloodflow from the ventricles

Pulse pressure equation

Systolic - Diastolic

What does the PCWP measure

The left heart

Define hemodynamics

The movement of blood

T/F Blood returns to the left atrium via four pulmonary veins

True

T/F Pressure Dampening is when the monitor does not show the normal dicrotic notch and the catheter is somehow obstructed

True

T/F The presence of a double spike (dicrotic notch) is normal for the pulmonary artery pressure (PAP) waveform and occurs when the pulmonic valve closes.

True

Normal central venous pressure is: a. 2 to 6 mmHg b. 0 to 3 mmHg c. Left end-diastolic pressure X2 d. 12 to 20 mmHg e. 120/80 mmHg

a. 2 to 6 mmHg

Normal capillary wedge pressure is: a. 4 to 12 mmHg b. 20 to 25 mmHg c. 15-30 mmHg d. 2.4-4.2 mmHg e. 1 to 7 mmHg

a. 4 to 12 mmHg

Which of the following parameters are most likely seen for right heart failure? a. CVP 14 mmHg b. PAP 22 mmHg c. CO 12 liters d. PWP 0 mmHg

a. CVP 14 mmHg

Identify the correct statement regarding the pulmonary artery catheter. a. Must have at least two lumens b. Carries very little risk for the patient during insertion c. Sometimes has an opening at the level of the left atrium d. Will have a port for injecting air to check for ventricular septal defects e. Can be used for monitoring systemic blood pressure

a. Must have at least two lumens

Identify from the following the complication that does not result from a central venous line. a. balloon rupture b. hemorrhage c. arrhythmias d. thromboembolism e. infection

a. balloon rupture

A 55 kg patient in bed 3 has a CVP catheter in place. Currently his CVP is 2 mmHg. His urine output over the past 3 hours is 80 ml. In addition, he has poor skin turgor and pale, cool skin. Which of the following statements is most true about this patient? a. this patient is showing signs of dehydration b. this patient has evidence of a pulmonary emboli c. this patient is showing signs of overhydration d. this patient is in renal failure

a. this patient is showing signs of dehydration

A patient is being monitored in bed 6 of CCU. The following data is collected: CVP 8 mmHg, PAP 33/15 mmHg, PWP 19 mmHg, CO 2.9 L, HR 122, BP 128/82, RR 32 The patient is demonstrating signs of pulmonary edema. Which of the following statements is true? a. this patient's pulmonary edema is cardiogenic b. this patient is in right heart failure c. this patient has a pulmonary emboli d. this patient is in renal failure

a. this patient's pulmonary edema is cardiogenic

From the following, which are appropriate for non invasively evaluating hemodynamic status? I. Blood pressure II. Capillary refill III. Mentation IV. Skin color V. Urinary output VI. Presence of petal edema

all of the above

Define stroke volume

amount of blood that comes out of the heart with every beat

What is the systemic arterial catheter

art line

Normal cardiac index is: a. 5-6 b. 2.5-4.0 c. 3.8 d. 48

b. 2.5-4.0

A patient in CCU has the following hemodynamic parameters: PAP 15/11 mmHg, PWP 5 mmHg, CVP 3 mmHg, HR 175 bpm, CI 2.1. The physician has asked the respiratory therapist to interpret this data. What interpretation is the most appropriate? a. pulmonary hypertension b. hypovolemia c. cor pulmonale d. hypervolemia

b. hypovolemia

Assuming the balloon of a balloon-tipped-flow-directed pulmonary artery catheter is inflated and the line in correct placement, the pressure measured at the distal tip of the catheter reflects: a. right atrial pressure b. left atrial pressure c. left ventricular systolic pressure d. systolic pulmonary artery pressure

b. left atrial pressure

A patient enters ER with hypotension. The patient shows decreased skin turgor, capillary refill greater than 3 seconds, pale, gray skin. For the past 3 days the patient has had diarrhea and vomiting. Which of the following is most correct? a. insert a PAP line stat b. this patient's hemodynamic status points to dehydration c. this patient is anemic d. this patient is hypoxemic

b. this patient's hemodynamic status points to dehydration

Systolic/Diastolic

blood pressure

blood pressure is determined by

blood volume heart rate vessel characteristics

Normal mean pulmonary artery pressure is: a. 0 to 8 mmHg b. 20 to 25 mmHg c. 10 to 20 mmHg d. 28 mmHg e. 1 to 7 mmHg

c. 10 to 20 mmHg

Normal mean pulmonary pressure is: a. 0-8 mmHg b. 20-25 mmHg c. 10-20 mmHg d. 28 mmHg e. 1-7 mmHg

c. 10-20 mmHg

A 56 year old man requires continuous mechanical ventilation following cardiac arrest. His heart rate is 110/min and BP is 96/50 mmHg. A pulmonary artery (Swan Ganz) catheter has been inserted. Pertinent data are below: Body surface area- 2m CO - 3.6 L/min Mean PAP - 30 mmHg PCWP - 8 mmHg Based on this information, which of the following is increased? a. Stroke volume b. Mixed venous O2 c. Pulmonary vascular resistance d. Venous return

c. Pulmonary vascular resistance

The tip of the central venous catheter lies in the: a. right ventricle b. pulmonary artery c. superior vena cava d. femoral vein e. left atrium

c. superior vena cava

A patient presents with a decreased CVP, decreased PAP, decreased systemic vascular resistance, and decreased CO. Which of the following is most correct? a. this patient is hypervolemic b. this patient is in left heart failure c. this patient is Hypovolemic d. this patient has cor pulmonale e. this patient has ARDS

c. this patient is Hypovolemic

A patient has a blood pressure of 120/62. What is this patient's MAP? a. not enough information b. 68 mmHg c. 58 mmHg d. 81 mmHg e. 90 mmHg

d. 81 mmHg

A postoperative patient has an arterial line placed in the radial artery. It is noticed that the previously normal looking waveform is now damped on the oscilloscope. What should be done first in this situation? a. Remove the catheter b. Flex the patient's elbow and wrist joints c. Pump up the pressure in the infusion bag d. Aspirate and then flush the catheter

d. Aspirate and then flush the catheter

A patient with right ventricular hypertrophy due to pulmonic valve disease is represented by which of the following hemodynamic values? a. CVP increased, PAP increased, PWP decreased, CO decreased b. CVP decreased, PAP decreased, PWP decreased, CO decreased c. CVP decreased, PAP increased, PWP increased, CO increased d. CVP increased, PAP decreased, PWP decreased, CO decreased e. hemodynamic parameters will look normal

d. CVP increased, PAP decreased, PWP decreased, CO decreased

A patient with a Swan-Ganz catheter in place has the following results: CVP 3 mmHg, PAP 13/5 mmHg, PWP 4 mmHg, CO 3.2 liters. Which is the most likely cause of these parameters? a. left ventricular failure b. aortic stenosis c. mitral valve stenosis d. hypovolemia e. systemic hypertensive crisis

d. hypovolemia

The distal tip of the pulmonary artery catheter lies: a. in the superior vena cava b. in the right atrium c. in the left atrium d. in one of the peripheral pulmonary arteries e. in the radial artery

d. in one of the peripheral pulmonary arteries

Left ventricular pressure could be decreased secondary to all except: a. massive systemic vascular vasodilation b. right ventricular failure c. hypovolemia d. increased systemic vascular resistance due to polycythemia

d. increased systemic vascular resistance due to polycythemia

How will hypovolemia affect preload?

decrease preload

The stage in which both the atria and ventricle is relaxed is called

diastole

In which of the following patients is monitoring of the pulmonary artery pressure indicated? a. Multiorgan failure b. Burn c. Cardiogenic shock d. Severe ARDS e. All of the above

e. All of the above

Where does the transducer of the art line need to lie

even with the heart

Define contractility

force with which the ventricles contract

What will the affect be for heart work if faced with increased afterload?

increase

What happens if the art line transducer is placed below the heart

it will read higher

What happens if the art line transducer is placed above the heart

it will read lower

Pressure within the pulmonary circulation is _____________ (higher/lower) than the systemic circulation.

lower

Name the pressure that is mainly responsible for maintaining fluid within the intravascular space.

oncotic pressure osmotic pressure

Define ejection fraction

percentage of blood ejected from the heart with every beat (60% is perfect)

The most common complication of CVP placement is

pneumothorax

You are taking care of a patient showing signs of hypovolemia. The physician decides to place a Swan-Ganz catheter. As the catheter is placed into the subclavian vein, the patient's compliance quickly drops. The high pressure alarm on the vent is activated. Breath sounds are absent over the left chest and the trachea is deviated to the right. What do you think has happened?

pneumothorax

The three factors that affect stroke volume are

preload contractility afterload

What does PAP reflect

pressure of blood moving into the lungs

Blood returns from the body through the superior and inferior vena cava to the _____________. This is known as venous return.

right atrium

What does the CVP measure

right heart

If venous return decreases, then cardiac output decreases. If venous return increases, then cardiac output increases. This is part of

starlings law

Define preload

the amount of blood filling the heart

The valve found between the right atrium and the left ventricle is called

theres no valve that does this

When do you see the dicrotic notch

with a swan ganz catheter when you have gone through the pulmonic valve (when you are in the pulmonary artery)