PCCN Exam Questions and Correct Answers, With Complete Verified Solution.

PCCN Exam Questions and Correct Answers, With Complete Verified Solution. What is the function of the cardiovascular system to drive O2 to the cell so that the cell can make ATP for energy production What is the formula for CARDIAC OUTPUT Stroke volume x Heart Rate CO = HR X SV ( Preload + Afterload + Contractility) What is the term for the amount of blood that is pumped out of the ventricle each MINUTE? Cardiac Output ( approximately 4 - 8 LPM ) What is the term for the amount of blood that is pumped out of the ventricle each BEAT? Stroke Volume What is the term for the number of contractions / minute? Heart Rate IMPORTANT RELATIONSHIPS TO KNOW 1. CO DECREASED - HR INCREASES ( to maintain adequate stroke volume ) 2. CO INCREASED - HR DECREASES ( as stroke volume decreases ) 3. HR DECREASED - SV DECREASES and CO DECREASES 4. HR INCREASES ( 150 ) - SV DECREASES and CO DECREASES 5. SV DECREASES - CO DECREASES and HR INCREASES 6. SV INCREASES - CO INCREASES and HR DECREASES What is the term for the volume of blood ejected from the ventricle per minute adjusted for body size Cardiac Index What is a normal cardiac index? Normal = 2.5 to 4.4 L/min/m2 **Always utilize CI values on exam (especially for bigger patients) What is a normal amount (mL/beat) for stroke volume? 60 to 100 mL What is the term for the end-diastolic volume stretching the ventricle? Preload ( increased fluid = increased stroke volume ) What is the term for the pressure that the ventricle must OVERCOME in order to eject blood into the circulatory system? Afterload What is the term for the inotropic state the cardiac muscle Contractility (how well the heart is contracted) Preload is the function of which part of the circulatory system? VEINS FUNCTION OF VEINS = PRELOAD What is the RIGHT VENTRICLE PRELOAD assessed by? CVP (Central venous pressure) (Normal is approx. 2 - 8 mmhg) What is a normal central venous pressure ? Approximately 2 - 8 mmhg What is the LEFT VENTRICLE PRELOAD assessed by? PAOP (Pulmonary artery occlusion pressure) / PAW pulmonary artery wedge pressure -Swans ganns in placed wedge pressure (PA) What are the signs and symptoms of an altered preload? 1. Dehydration (decreased preload) 2. Fluid overload (increased preload) What are some causes of a low preload? 1. Hemorrhage 2. Dehydration 3. Burns 4. Over-diuresis 5. Third spacing (fluid moving into spaces they shouldn't be) What are some causes of high preload? 1. Hypervolemia 2. Heart failure 3. Renal failure 4. Pulmonary HTN 5. Tamponade 6. Tension pneumothorax (most likely seen in right ventricle preload) What are the venous dilating drugs? 1. NITRO (given to drop preload) 2. ACE I/ARB 3. Ca-Channel blocker Which venous dilating drug is given to drop the preload amount? Nitro What are some causes that can alter the vascular space? 1. Sepsis 2. Neurogenic shock 3. Anaphylaxis 4. Warming after cardiac surgery 5. Venous dilating drugs What part of the circulatory system determines the afterload? Arteries Afterload determines the functions of the __________ ARTERIES RIGHT VENTRICLE AFTERLOAD is assessed by PVR (pulmonary vascular resistance) Normal is 20 - 200 dynes /sec/cm2 What is a normal range for pulmonary vascular resistance Normal is 20 - 200 dynes / sec / cm2 What is the LEFT VENTRICLE AFTERLOAD assessed by? SVR (systemic vascular resistance) Normal is 800 - 1600 dynes / sec / cm2 What is a normal range for systemic vascular resistance Normal is 800 - 1600 dynes / sec / cm2 What are the S/S of increased afterload? 1. CVP 8 2. s/s of fluid overload ** 3. CO 4 LPM --- 4. signs of cardiogenic shock 5. PA wedge 12 mmhg 6. EF fraction 60 % 7. MAP 60 mmhg --- 8. SVR 1600 dynes / sec / cm5 9. Decreased urine output --- 10. LV hypertrophy **LEFT VENTRICLE HYPERTROPHY **SYSTEMIC HTN What are the main signs of increased afterload? Left ventricle hypertrophy Systemic HTN What are the s/s of decreased afterload? 1. CVP 4 2. s/s of fluid depletion ** 3. CO 4 LPM --- 4. PA wedge 8 mmhg 5. MAP 60 mmhg (b/c patient is vasodilated) --- 6. SVR 800 dynes / sec/ cm5 7. decreased urine output --- 8. HR 90 BPM **common with sepsis What can affect afterload? 1. Vasodilation 2. Vasoconstriction What are some causes of vasodilation that can affect the afterload? 1. Nipride ** 2. ACE I / ARB 3. Milirinone 4. Ca - Channel blocker 5. Antihypertensives All arterial dilating drugs What are some causes of vasoconstrictors that can affect the afterload? 1. Hypertension 2. SNS stimulation 3. Compensatory vasoconstriction (hypothermia, sepsis) 4. Arterial constricting drugs (phenylephrine , norepinephrine, high - dose dopamine, epinephrine, vasopressin) This type of heart failure has reduced LV ejection fraction systolic heart failure ( HFrEF) Heart failure with ejection fraction EF 40 % (leads to increasing end-diastolic volume and pressure) How does the hearts anatomy change when a pt has systolic heart failure Ventricle will dilate with the heart wall thinning large outward bulging of muscle of heart What causes systolic heart failure? ***USUALLY D/T VOLUME OVERLOAD 1. MI (decreased CO - fluid retention by kidney) 2. Aortic and mitral regurgitation 3. Congenital defects This type of heart failure presents with preserved LV ejection fraction Diastolic heart failure (HFpER) heart failure with ejection reserved EF 40% (increased filling pressures due to stiff, non compliant ventricle) How does the hearts anatomy change with diastolic HF? Ventricles become thickened without the dilation of the chamber What are some causes for diastolic HF? 1. Chronic HTN 2. Aortic Stenosis 3. Hypertrophic cardiomyopathy Explain the difference between systolic and diastolic's HF heart anatomy change 1. Systolic HF'S ventricle's dilate with wall thinning 2. Diastolic HF'S ventricle's DOES NOT dilate with wall thickening