HESI Critical Care Cardiac Hemodynamics.pdf

Inflation to float catheter into pa 3 waveform

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inflation to “float” catheter into PA 3. Waveform changes as catheter progresses: as a nurse you look for waveform changes 4. Check for proper “wedging” for PAOP 5. Chest x-ray Nursing Implications 1. Routinely measure pulmonary artery pressures In many patients the PADP can be substituted for PAOP measurements if values are similar Record amount of air to inflate balloon no more than 1.5 mL Never a continuous measurement 2. Assess for signs of infection 3. Assess placement of catheters: chest x-ray 4. Monitor for Complications: pts can develop dysrhythmias if catheter moves. Most are r/t insertion of line (pneumothorax, other dysrhythmias, heart perforation) How can these complications be prevented To get left sided preload, you need that balloon in place. There’s a sensor a t the tip of the cath so when you inflate the balloon you only read measure forward of the cath. PAWP & PAOP is never a continuous measurement ; you never keep the balloon inflated because it stops the blood flow into the lungs. You inflate it, get the reading & then deflate it. With the kit, you get 3 mm syringe. It only lets you go down to 1.5 mm of air . Because if you put too much, the balloon will pop & you have catheter pieces floating around. Nurses usually do not inflate the balloon.
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Critical Care Test 2 (6) Cardiac Output Monitoring: Thermodilution Method 10 mm syringe, room temperature saline, monitor, pulmonary artery catheter 10 mm of saline inserted into RA port Computer measures how long room temperature saline goes from point A (RA port) to point B (Thermistor port) & gives you cardiac output (number) New ways have continuous cardiac output monitoring where you don’t need to do all these things Monitoring O2 Delivery and Consumption SVO2: mixed venous oxygen saturation Obtained via monitoring catheters SvO 2 : mixed venous oxygen saturation via PAC Normal value: 60% to 75% meaning 60-75% of oxygen is still bound to hemoglobin in the venous system Amt of oxygen bound to hemoglobin in venous system. High values = tissues not able to use oxygen Ex. 80% (high) means oxygen is still bound to hemoglobin and tissues are unable to use it. Seen in trauma (injured tissues can’t take in oxygen), shocked states Harder to treat: why is tissue not taking it? Due to trauma? ARDS? Shock? Low values = oxygen demand exceeds delivery Ex. 40% (low) means that cells are taking more; tissues has higher demand for oxygen. Hypoxia, pain, fever, higher metabolic demand states, shivering, low hemoglobin (don’t have enough trucks to carry oxygen, you’re going to have less oxygen) Easier to treat than higher values: if your pt needs more, you either give them blood or more oxygen
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Critical Care Test 2 (7) What is Shock?
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