The nurse has noted increasing afterload in a patient in the ICU. How would the nurse expect this increase to affect the patient's cardiac output?
1. If afterload is high, cardiac output will be increased because the heart rate increases during afterload.
2. If afterload is high, cardiac output will be increased due to the increased volume in the heart.
3. If afterload is high, cardiac output will be decreased due to high systemic vascular resistance.
4. If afterload is high, cardiac output will be decreased due to decreased contractility.
3
Rationale 1: Afterload is a measure of pressure, not a cardiac event, so to say that heart rate increases during afterload is incorrect.
Rationale 2: If the increased volume in the heart has to overcome additional systemic vascular resistance (afterload), the cardiac output will not increase.
Rationale 3: Afterload measures the pressure that is needed to eject blood out of the heart. Systemic vascular resistance is the main factor that affects afterload. High resistance impedes flow and decreases cardiac output.
Rationale 4: Contractility may increase with high afterload to compensate for low stroke volume, or it may decrease if the patient decompensates. Either way, decreased contractility does not cause high afterload.
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