HESI Critical Care Cardiac Hemodynamics.pdf

3 hob less than 30 degrees hob should be flat

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3. HOB less than 30 degrees : HOB should be flat . Catheter is going through groin so don’t want pt sitting up. Pts will be bedrest . Nothing is really holding catheter in place. 4. Turn pt with logrolling technique. Just can’t sit them up. 5. Monitor organ function : want it below aortic arch but above renal arteries. Renal arteries feed kidneys. If catheter migrates, you’ll see decreased urine output. Monitor urine output . 6. Assess for bleeding : a little oozing at femoral site is normal. However, blood in Balloon pump tubing means aorta ruptured !!
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Critical Care Test 2 (9) Obstructive shock (presents just like cardiogenic) Physical impairment to adequate circulating blood flow Causes : cardiac tamponade. PE. Tension pneumothorax. (Affects heart’s ability to contract) Decreases contractility. Increase preload (blood is just sitting there bc heart is not pumping well) (CVP, PAWP) Decrease cardiac output, decrease BP Decrease tissue perfusion Catecholamines stimulates SNS Increased HR, vasoconstriction Increase afterload (SVR, PVR) CM: more specific to cause. Tension pneumo = deviated trachea. Cardiac tamponade = Beck’s Triad is JVD (heart is being squished), Hypotension (heart is not contracting), Muffled heart sounds (fluid around heart). PE = dyspnea. Chest pain. Treatments : Treat underlying cause Tension pneumothorax: chest tube Cardiac tamponade: pericardial centesis PE: thrombolytics Distributive shock Widespread vasodilation and decreased vascular tone (resistance) resulting in a relative hypovolemia. With relevant hypovolemia, you have not loss any volume. It is because your blood vessels are so dilated, it looks like you are hypovolemic. 1. Neurogenic : temporary shock. Seen in spinal cord injury at or above T6. Sympathetic nervous system (SNS) takes a vacation/it is not working. Parasympathetic nervous system (PNS) takes over. Everything is low. PNS : decreases HR, vasodilation, decrease afterload (resistance), decrease preload (volume). CM : changes in mobility, pain, changes in sensation, changes in reflexes. Breathing issues depending on how high the injury is. Treatment : - Stabilize spine !! -Make sure pt is breathing. -Decreased HR treated with atropine or epinephrine. -Vasodilation treated with vasoconstrictors/vasopressors (dopamine or levophed. Levophed is preferred drug bedside because it does not affect HR. Dopamine is HESI/NCLEX preferred. In real world, not used a lot because side effect of dopamine is it increases HR) -To increase BP: Give fluid to treat decreased afterload because vessels are so dilated. 2. Anaphylactic : caused by allergic reaction. When you have allergic reaction, body releases histamine. Histamine vasodilates which decreases afterload (resistance/SVR) & increases capillary permeability (porous. Holes in walls of blood vessels get bigger) Fluid goes from blood vessels to tissue which decreases preload (volume/CVP/PAWP). Histamine causes bronchial constriction hypoxia pulmonary vessels constrict (increase PVR).
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