HESI Critical Care Cardiac Hemodynamics.pdf

Pink skin warm skin strong bounding pulses decreased

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: pink skin, warm skin, strong & bounding pulses, decreased BP Treatment : vasoconstrictors, fluid Contractility : ability of our heart to contract Increased contractility Causes : stimulants (pain, anxiety, drugs) exercise Clinical Manifestations: HTN, bounding pulses Treatment: don’t treat because usually caused by something; treat cause. ONLY treat if pt is hypertensive; give meds to lower blood pres sure. Decreased contractility : tissue perfusion is bad Causes: potassium, MI Clinical Manifestations : pale skin, cool skin, weak pulses, decreased cap refill, decreased urine output, changes in LOC, CP Treatment : positive inotropic drugs (digoxin)
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Critical Care Test 2 (3) Blood Pressure : cardiac output x SVR (systemic vascular resistance) MAP: Mean Arterial Pressure MAP = (systolic + (diastolic (x2)) / 3) At least 70 mm Hg Hemodynamic Monitoring Preload: CVP (right sided preload), PAWP/PAOP (left sided preload) CVP: central venous pressure - Increased CVP: CM of right sided HF PAWP: pulmonary artery wedge pressure - Low PAWP: treat with fluids or PAOP: pulmonary artery occlusive pressure Afterload: PVR (right sided afterload) and SVR (left sided afterload) PVR: Pulmonary Vascular Resistance SVR: Systemic Vascular Resistance -Increased SVR: due to HTN or vasoconstriction Noninvasive modalities 1. Noninvasive blood pressure : when you are taking a BP, you are assessing pt hemodynamic status. Important to use right cuff size otherwise it won’t be accurate. 2. Assessment of jugular venous pressure : increased preload if jugular veins distended. 3. Assessment of serum lactate levels : hypoxia anaerobic metabolism buildup of lactate. o Increased lactate levels = decreased tissue perfusion Invasive modalities : 5 components are the same 1. Arterial pressure monitoring 2. Right atrial pressure/central venous pressure monitoring 3. Pulmonary artery pressure monitoring Indications: Ineffective Tissue Perfusion. Decreased Cardiac Output. Fluid Volume Deficit/Fluid Volume Excess Components: 5 components 1. Catheter : can go in vein or artery depending on what we are measuring 2. Noncompliant Pressure Tubing: helps reduce artifact & improves accuracy of data we are getting 3. Stopcock & Transducer: square piece is transducer with data chip inside; takes pressures from artery or vein & turns them into numbers you can see in monitor. 4. Pressurized Flush System: involves pressure gauge, bag of saline, & pressure bag 5. -When you inflate the bag, it will instill 3 mm of saline per hour through catheter and the pt. 6. -Purpose is to keep catheter patent. What happens is blood cells will stick to IV & clot it. 7. Monitor: see numbers
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Critical Care Test 2 (4) Nursing Implications: 1. Patient position : we like pt to be flat (but they don’t like this position so put them where they are comfortable) 2. Leveling the air fluid interface to the phlebostatic axis : 4 th intercostal space mid-axillary line (right were pulmonary artery is). Has to b at phlebostatic axis in order to get accurate numbers. Everytime you reposition pt, you position them & then level the transducer. If it is too high
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