Clinical Application of Perfusion Exam -with 100% verified solutions 2024-2025, Exams of Nursing

Download Clinical Application of Perfusion Exam -with 100% verified solutions 2024-2025 and more Exams Nursing in PDF only on Docsity! Clinical Application of Perfusion Exam -with 100% verified solutions 2024-2025 What are cannulation sites for an LVAD? Pulmonary Vein and Aorta What is the minimum pressure for an LVAD inflow, before you are at risk for drawing air? 5 mmHg Correction for cannula entrapment in LVAD's can be accomplished by doing what? increasing the left atrial preload (decreasing flow) --> Cannula is sucking down in the LVAD inflow either in the pulm vein, lv apex, or just below crossing the aortic valve. What is the indication that indicates to add an RVAD? Right atrial pressure >20 mmHg with IABP and inotropic support Cannulation sites for RVAD support? Right atrium and pulmonary artery. Which would not be an important consideration in cannula selection? A. size B. Shape C. Cannula Circuit connector Size D. Flow requirements C. Cannula Circuit Connector Size Right Ventricular flow rates should be adjusted in relation to what? Left ventricular flow rate. In RVAD's, pump inflow cannula entrapment is indicated by? snapping or chattering of the line What action can correct RVAD cannula entrapment? Increasing the right atrial preload. (slow flow) When is heparin therapy to maintain coagulation in VAD's usually started? Within 24 hours after initial bleeding from surgery has been controlled. Sometimes patients will get protamine. ACT's should be between 150-200 seconds. When do patients diagnosed with atrial petal defects become diagnosed in relation to Qp/Qs ratio? 1:1.5 What would normal urine output for a child who weights 12 kg be? What is the standard for urine output in cardiac patients? ~20 ml/hour In cardiac patients it is suggest that urine output should be .5-1.0 ml/kg/hour What is the estimated blood volume of a child who weights 12 kg? 75 * 12= 900 ml clinical manual of perfusion states that blood volume for a 11-20 kg child should be 80 ml/kg A 2 year old child weighting 12 kg is going on bypass. Prebypas Hct is 40% and priming volume is 1200 ml what is the diluted hematocrit? ((1275)40)/((12*75)+1200)= 17.1% What of the following is a pre operative indication for IABP support? a) a fib b)transient ischemic attack c)Ao dissection d) post infraction angina d) post infarction angina Which is a contraindication of a balloon pump? a)RV dysfunction b) vent arryth. c)Ao regurg d)bivent. fail C--> Ao regard IABP would cause blood to be pushed back into the left ventricle. Where should the IABP balloon be position in aorta before pumping begins? In the descending aorta just distal to the left subclavian artery base. In a patient recommended for a CABG what type of venous cannulation should be used. Single two stage cannula. Cavoatrial cannula. (IVC/RA) In a patient with cold agglutinins what type of cardioplegia should be given? warm crystalloid cardioplegia. Effluent from integrate cardioplegia is typically collected from where? The right atrium. What is the max temperature gradient between the heat exchanged water bath and patient blood? 10 C? Practice test answer is 12 C. What temperature does destruction to formed elements and protein denaturation occur? 42 C. Osu Board review states that temps should not exceed 38 C. In which way would an increase in blood shift the oxyhemoglobin curve. Shifts to the right. Increase in O2 metabolism causes decreased O2 levels and shifts the curve to the right. SKIP SKIP Late IABP deflation results in what. a. Enhanced after load reduction b. sub optimal coronary perfusion c. decrease pulm wedge pressure d. increase in myocardial O2 demand. D. increase in myocardial O2 demand. Late deflation would cause the heart to have to pump harder against the balloon costing it more O2 and energy. What IABP trigger mode is appropriate for a patient in Ventricular Fibrillation? Internal triggering, which will cause the balloon to deflate anytime it detects an r wave. Management of a patient with clinically significant cold agglutinins would include all of the following EXCEPT ? a) bicaval venous cannulation b)hemodilution c)hypothermic CPB above critical temperature d) high systemic flows(2.6-2.8 L/min/M^2) A. bicaval venous cannulation. Hypothermic CPB would not be ideal but would be ok as long as it is not below the critical temperature. What is the predominant hemoglobin type in a patient with sickle cell? Hemoglobin S What is the definitive test for sickel cell disease? hemoglobin electrophoresis 6 hours What percentage of cardiac output is bronchial blood flow normally? 2% of cardiac output comes from bronchial blood flow What is an indicator of increased bronchial blood flow on CPB? Increased left ventricular vent return During CPB and after the Aortic Cross clamp is applied bronchial blood flow is removed from where? The left ventricle What should be done to compensate for bronchial blood flow and maintain adequate SVO2? increase the pump flow rate. If upon initiation of CPB fibrillation occur and the LV distends. What is the primary cause of the distention. Aortic insufficiency may be one cause. Another may be improper LV vent placement. What would be the appropriate action if at 5L/min of flow you have a patient pressure of 30 mmHg? a) increase pump flow b)administer neo bolus c) apply the cross clamp d)increase LV venting B.--> administer a neo bolus. LV venting has what major benefit for myocardial preservation? LV venting reduces the wall tension in the Left Ventricle. 4:1 crystalloid cardioplegia is being given. After 500 ml of blood cardioplegia is given what was the total amount of K administered? (50 mEq KCl in 500 mL .9% saline) 10 mEq A concentration of K+ in blood cardioplegia for a liter total? (4:1 blood cardioplegia, 50mEq KCl in 500 ml .9% saline) 20 mEq/l + patients serum K+ At a flow rate of 250 ml/min how long will it take to administer 1L of blood cardioplegia. 4 Minutes. Yes this is a real test question. What type of cardioplegia is 4+ aortic insufficiency a contraindication of? Antegrade/ Ao root cardioplegia The efficacy of coronary postal cardioplegia delivery has diminished because of what? There have been problems with excessive line pressures in their use. If you are giving cardio through a coronary ostia and you notice high line pressure at low flow and the myocardial temp not dropping, which is the most likely cause? a) sludging due to cold blood b)malfunctioning of roller pump c)increased non coronary collateral bf d) ostial stenosis D--> ostial stenosis May impede the passage of your cardio flow causing high pressure and low flows. May block all together preventing myocardial temp from dropping. What is one of the biggest known complications of coronary postal cardioplegia? a) Coronary Artery Dissection b)LV distention c) increased capillary permeability d) coronary sinus pressure Coronary Artery Dissection While giving retrograde cardio, what is the max sinus perfusion pressure? 50 mmHg Total clearance of creatinine and urea by an ultrafiltrator is? a) identical b)not affected by temperature c) increased with increasing hematocrit d) proportional to their sieving coefficients D) proportional to their sieving coefficients Example Patient: CI of 1.71, ABP of 80/45, PA 60/35, PCWP 30, CVP 15, HR 120. What is most likely wrong with this patient? Patient is in Left Heart failure A patient with renal failure and poor urine output on pump should receive what intervention first? a) dobutamine infusion b) nitroprusside infusion c) insert an IABP d) give a 500c.c bolus of clear A) dobutamine infusion Dobutamine although an inotrope is not necessarily a pressor. One characteristic is that infusion may cause increased renal blood flow due to its B2 stimulation characteristics. What is the direct physiological effect of using an IABP? (technical, not simply just increased coronary perfusion) IABP causes after load reduction. Coronary perfusion pressure is NOT affected by: a)diastolic mmHg b)pCO2 c)HR d)Hct B. pCO2 Question may be based on idea that Hct increases blood viscosity causing increased pressures and lower flow capabilities. Note: know equation for perfusion pressure Perf Pressure= (flow)/(vascular resistance *viscosity) What is the equation for Perfusion Pressure? Perf Pressure= Flow/(vascular resistance * viscosity) How does the IABP enhance coronary perfusion pressures besides the fact it decreases end-diastolic pressures? It increases the mean diastolic pressures Mean Diastolic pressures are increased end diastolic pressure is lowered. Allowing the Ao valve to snap shut and decrease the end diastolic pressure by increasing contractility and coronary blood flow. To approximate insertion length of IABP balloon catheter. The tip should be aligned with what anatomical marker seen ex vivo? The sternal notch. The head vessels of the Aortic Arch are just above the sternal notch. Meaning that the proper placement of the balloon should be right about at the sternal notch. Where is the proper place for a IABP balloon in vivo? Just distal, about a cm or two, to the left subclavian artery. Ex. Patient: CI 1.5, ABP 85/35, PA 65/35, PCWP 35, CVP 25, HR 120, IABP set at 1:1. What condition does this patient most likely have? Biventricular Failure Patient has little ejection with high CVP and PCWP. High CVP is an indication of RH failure while low CI means LH is not ejecting well. RH is likely secondary to LH and patient is in complete heart failure. What device should be used for a patient with RH failure secondary to LH failure if you are unable to come off pump? An LVAD. What is the most common complication with the use of VADs ? Hemorrhage. Answer may be infection. But practice exam states it is this answer. Thought that centrifugal pumps were to prevent. May be referring to bleeding at cannulation sites. What venous cannula size is appropriate for each weight? (0-20, 20-60, 60-80, >80) 0-20--> 12-20 dual, 18-24 single 20-60--> 20-32 dual,28-36 single 60-80--> 32-36 dual, 36-51 single >80--> 36-40 dual, 51 single. What annual size is appropriate for each weight for arterial cannula? 18 fr--> 4.75 L/min max drop=100mmhg 20 fr--> 6.25 L/min max drop=100 mmHg 22 fr--> 7.0 L/min max drop= 70 mmHg 24 fr--> 7.0 L/min max drop=50 mmHg What are the cannulation sites for left heart bypass both inflow and outflow? Inflow--> right superior pulm vein or left inferior pulmonary vein Outflow--> femoral artery or descending aorta past aneurysm What does an increased SVR/decreased CVP mean when on left heart bypass? Flows are to high. Pulling to much (decreased CVP) giving to much(high SVR) What would indicated you to increase flows when on left heart bypass? Increased CVP and decreased SVR. Or surgeon stating that the heart is to full. What is meconium aspiration? during infants first breath amniotic(fecal waste) is inhaled and enters the lungs. What are the cannulation sites for pediatric ECMO? V-A--> carotid artery and r internal jugular V-V--> typically dual lumen placed in R IJ What is the ACT range for a pediatric ECMO patient? 150-170 seconds and should not be cannulated before 70-90 seconds is reached. What are the levels of hypothermia ? mild-37-32, moderate 31-28, Deep 27-18, profound <18 At what temperature will brain function cease? <15 degrees as been seen to cease brain activity. What part of the brain regulates body temperature? Hypothalamus What is the max warming gradient for a patient who has hypothermia from falling in freezing water? 4 degrees an hour. MAP should be maintained around 60mmHg What hemodynamic change is usually seen in patients experiencing hypothermia? vasoconstriction. Mainly vasoconstriction of the limbs and peripheral vasculature. How does increasing the filling and wash speed of a hemoconcentrator effect product hematocrit? increased filling speeds will lead to potential washing away of red cells and looser packing of cells at the bottom of bowl. Wash speed may wash away some red cells. Can cell saver products from a patient with a GI bleed/trauma injury be returned to the patient? No The product from these patients is considered to be contaminated. Pros and cons of retransfusing should be discussed with surgeon. What is the most common complication in a VAD patient? Bleeding. 3/8" 40 ml/ft (408)-(208)=320-160=160 cc of volume What percent of blood flow is the heart, brain, kidney, and liver? heart--> 4-5% brain-15% kidneys--> 20 % liver 30% Blood volume in tubing sizes? 1/4=10 ml/ft 3/8=20 ml/ft 1/2=40 ml/ft 5/8=50 ml/ft What position should you place the bed in when air embolism occurs? steep trendlenberg Why is sodium pentathol used during air embolism events? Decreases brain metabolism. In cases of total anomalous pulmonary venous return, where does the blood return to? Returns to the right ventricle. Calcium when given with the cross clamp may lead to ? stone heart syndrome What is the only source of blood return to the right heart during total bypass? coronary sinus blood At what part of contraction is Aortic insufficiency worst? during the start of ventricular diastole When banked blood is given in large quantities what may also need to be given? Calcium citrate in banked blood kelates caclium What is the universal recipient of banked blood? AB positive What type of drug will increase myocardial contractility and increase O2 consumption? positive inotrope Besides keeping the PDA patent what else will prostaglandin E do to the patients vascular system? decrease the blood pressure and SVR What hormone is secreted by the anterior pituitary gland? ADH The sodium potassium pump pumps_____ in and _____ out of the cell. potassium in sodium out What % of blood is made up by red blood cells? 45% The AV node is located where in the heart? right atrium When giving retrograde cerebral perfusion how is blood returned to the heart? through the subclavian typically What is bubble point pressure? The pressure at which gas will start to come out of solution.