CC Exam 2 Hemodynamic Monitoring Flashcards

pulmonary artery
Terms Definitions
direct invasive monitoring of blood flow & pressures in the cv system
hemodynamic monitoring
what information is provided by hemodynamic monitoring
blood volume, fluid balance, pumping effectiveness of heart & oxygenation
6 types of hemodynamic monitoring
pulse oximeter
blood pressure cuff
cardiac monitor
intra arterial line
central venous pressure monitoring
pulmonary artery wedge pressure
2 risks of hemodynamic monitoring
infection
clotting
CO stands for
cardiac output
volume of blood pumped by heart in 1 minute
SV x HR
cardiac output (CO)
how is cardiac output determined (formula)
CO=SV X HR
cardiac output adjusted for body size
cardiac index (CI)
volume ejected with each heartbeat
stroke volume (SV)
stroke volume adjusted for body size
stroke volume index (SVI)
opposition to blood flow exerted by the blood vessels.
this is what you get when you take a blood pressure
systemic vascular resistance (SVR)
measures left ventricular function and volume status at end of diastole (Preload)
-measures resistance in lung as blood is trying to get back into left side of heart
Pulmonary Artery Wedge Pressure/Pulmonary Artery Pressure (PAWP/PAP)
volume of blood in ventricles at end of diastole (money in pocket on payday)
Preload
3 causes of increased preload:
hypervolemia
regurgitation of cardiac valves
heart failure
resistance, not volume, left ventricles must overcome to circulate blood
afterload
2 causes of increased afterload:
hypertension
vasoconstriction
increased afterload =
increased cardiac workload
used in any condition that compromises CO, tissue perfusion and/or fluid volume status
provides direct continuous measurement of systolic, diastolic, MAP and ABGs
arterial lines
way to tell how well blood is perfused through organs
mean arterial pressure (MAP)
normal value MAP
70-105 mm Hg
MAP pressure needed to perfuse vital organs
>60 mm Hg
formula for determining MAP
MAP = (SBP + 2 DBP) / 3
other names for intra-arterial lines
ART lines
A lines
information about ART lines
are not used to admin fluids
inserted by MD
Allen's test performed prior to insertion
4 things to assess for an ART line
infection
circulation
sensation
movement
how do you assess circulation in an ART line
pulse, capillary refill, color, temp
how do you assess sensation in an ART line
can they feel touching, no numbness or pin-prick feelings
how do you assess movement in an ART line
can they move fingers
measures filling pressures on the right side of the heart as tip lies in superior vena cava or right atrium
central venous pressure (CVP)
normal CVP value
2-6 mm Hg but trends are more important that normal values
how is placement of a CVP confirmed
chest x-ray
assesses several parameters at the same time including cardiac output
used for diagnosis & eval of conditions affecting CO and fluid volume
used to evaluate pt response to tx
pulmonary artery catheters
increased Pulmonary artery catheter readings caused by
heart failure
decreased Pulmonary artery catheter readings caused by
hypovolemia
when is the balloon on the pulmonary artery catheter inflated
only when readings are taken
way to measure venous O2 - amount of O2 in blood returning to heart
pulmonary artery catheter
normal SVO2 (blood returning to heart)
60-80%
6 EBP for preventing catheter related bloodstream infection
1.clean hands before & after pt contact
2.disinfect clean skin utilizing friction & chlorhexadine before insertion & site care
3.full barrier precautions when inserting
4.replace peripheral sites in adults at least Q96 hrs but no more than 72 hrs (leave in children until tx completed)
5.replace IV tubing Q96 hrs but no more than 72 hrs
6.for prehospital inserted or unknown insertion dates, replace ASAP but w/in 48 hrs
how can a physician know where a PA cath is located in the heart?
by continuous EKG waveform
3 essential pieces of hemodynamic monitoring system
catheter
flush system (heparin)
transducer
what measurement is used for the monitoring systems to be "zeroed"
locating phlebostatic axis
where is the phlebostatic axis
right side 4th intercostal space midchest of side of chest (pt is lying supine w/arm above head)
confirms that when pressure within system is zero, monitor reads zero
zeroing
when is zeroing performed
during initial setup of arterial line
immediately after insertion of arterial line
when transducer has been disconnected from pressure cable
when pressure cable has been disconnected from monitor
when accuracy of values is questioned
per institutions protocol/policy (Qshift)
way to test pressure monitoring system. usually done Q shift, or when system is opened to air or if accuracy is questioned
dynamic response test (square wave test)
how is a dynamic response test (square wave test) performed
activating the fast flush valve and watching monitor/strip for a square wave. If it's blunted or oval instead, MD must be notified immediately -- may have clot on end of line
normal cardiac output
4-8 L/min
Normal cardiac index
2.2-4 L/min
normal CVP
2-8 mm Hg
normal PAWP
6-12 mm Hg
normal MAP
70-105 mm Hg; must be >60 mm Hg for effective organ & tissue perfusion
normal HR
60-100 bpm
normal SaO2 (arterial Hgb ox sat)
95-99%
normal SvO2 (mixed venous Hgb ox sat)
60-80%
5 nsg mgmt issues r/t hemodynamic monitoring
inaccurate calibration/readings
bleeding
thrombus formation
air emboli
infection
intervention for inaccurate calibration/readings
square wave test done on end of expiration, not on inhalation
also check connections
bleeding w/hemodynamic monitoring
it does occur
pt may be moving too much or stop cock may be open
intervention for thrombus formation
may occur
aspirate through stop cock (pull out)
may have orders for clot busters
how to prevent air emboli
pt should hold breath while lines are being removed
intervention for infection
remove line
what position should the pt be placed in to level the transducer at the phlebostatic axis
supine position
what does a blunted pulmonary artery catheter mean during a square wave test?
catheter may be occluded by thrombus
Patients CO is 3L/min. what correlating hemodynamic signs does the nurse expect to assess?
hypotension
diminished peripheral pulses
for which device does the nurse monitor patient circulation, sensation & movement
arterial line
EBP PA/CVP measurement
verify accuracy of system by performing square wave test beginning of each shift & anytime system is disturbed
position pt supine
level transducer to phlebostatic axis
obtain measurements at end of expiration
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