Preload
Preload is amount of ________ Returning to heart
Volume
Afterload is ?
The amount of resistance the heart pushes against
Can you infuse med or blood into art line?
Negative ghost rider
What’s normal urine output
30 ml/hr
What is the range for cvp
2-6
too high? Diuretics
too low? Fluids
What symptoms are indicative of new fluid volume changes you would be concerned about your pt presented with them. One comes before the other.
Crackles and edema
Name two factors affecting contractility
Electrolyte imbalance and myocardial oxygenation
Name the normal variables for
cardiac output, cardiac index, stroke volume, ejection fraction, and svr
Co - 4-8 L/min
ci - 2.5 - 4
sv - 60-130
ef - 50-75%
svr - 900 and 1440 dyn/s/cm− 5.
The nurse is educating a patient's family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC?
a. "The catheter will provide multiple sites to give intravenous fluid."
b. "The catheter will allow the physician to better manage fluid therapy."
c. "The catheter tip comes to rest inside my brother's pulmonary artery."
d. "The catheter will be in position until the heart has a chance to heal."
b. "The catheter will allow the physician to better manage fluid therapy."
A pulmonary artery catheter provides hemodynamic measurements that guide interventions that include appropriate fluid therapy. Even though a pulmonary catheter provides multiple intravenous access sites, this is not the primary purpose of the catheter. Although the catheter is positioned in the pulmonary artery, positioning is not the purpose of the catheter. The primary purpose of the catheter is not to aid in the healing of the heart but to guide therapy.
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter- related bloodstream infection (CRBSI)?
a. Review daily the necessity of the central venous catheter.
b. Cleanse the insertion site daily with isopropyl alcohol.
c. Change the pressurized tubing system and flush bag daily.
d. Maintain a pressure of 300 mm Hg on the flush bag.
Review daily the necessity of the central venous catheter.*****
Duration of the catheter is an independent risk factor for CRBSI, and removal of the catheter when not needed to guide treatment is associated with a reduction in mortality. Maintaining of the insertion site should be guided by institutional guidelines and is best accomplished with chlorhexidine skin antisepsis. Minimizing the number of times the flush system is opened by changing tubing no more frequently than every 72 to 96 hours reduces the risk of CRBSI. Maintaining a pressure of 300 mm Hg on the flush solution bag helps maintain the integrity of the invasive line and does not reduce the risk of infection.
List 3 causes of “little stretch” of the heart
hemorrhage, shock, dehydration
Name two meds that effect contractility and how they do so
Magnesium and calcium
mag - relaxes muscle (mag iv can be used in resp distress to dilate airway)
calcium channel blocker - acts on excitability of heart and smooth muscles
A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm-5, and a hematocrit of 20%. The nurse anticipates administration of which the following therapies or medications?
a. Blood transfusion
Both hemodynamic parameters and the reported hematocrit value indicate hypovolemia and blood loss requiring volume resuscitation with blood products. Furosemide administration will worsen fluid volume status. Inotropic agents will not correct the underlying fluid volume deficit and anemia. Vasoconstrictors are contraindicated in a volume-depleted state.
The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues?
a. Arterial lactate level of 1.0 mEq/L
b. Cardiac output of 2.5 L/min
c. Mixed venous (SvO2 ) of 40%
d. Cardiac index of 1.5 L/min/m2
Arterial lactate level of 1.0 mEq/L
An arterial lactate level of 1.0 mEq/L is within normal limits and is indicative of normal oxygen delivery to the tissues. The cardiac output, mixed venous saturation, and cardiac index values are all below normal limits indicating inadequate cardiac output sufficient to provide oxygen delivery to the organs and tissues.
The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action?
a. A dampened arterial line waveform
b. Numbness and tingling in the left hand
c. Slight bloody drainage at subclavian insertion site
d. Slight redness at subclavian insertion site
b. Numbness and tingling in the left hand
Numbness and tingling in the left hand, which is the location of an arterial catheter, indicates possible neurovascular compromise and requires immediate action. A dampened waveform can indicate problems with arterial line patency but is not an emergent situation. Slight bloody drainage at the subclavian insertion site is not an unusual finding. Slight redness at the insertion site, while of concern, does not require immediate action.
What causes overstretch of the heart? What happens to the heart?
Heart Failure ; hypertrophic cardiomegaly
Name interventions with potassium electrolyte imbalances. Bones if you can Name the ecg of high/low K level.
Too little - give K meds, PIV, elixir, food ( t wave inversion, st depression, prominent u wave)
Too much - Insulin/ dextrose , calcium gluconate, k-xalate, dialysis ( peaked t, flattened p, pr prolongation, wide qrs)
The nursing is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention?
A. Apply a pressure dressing to the insertion site.
b.Ensure all tubing connections are tightened.
c.Obtain a portable x-ray to confirm placement.
d.Restrain the affected extremity for 24 hours.
b. Ensure all tubing connections are tightened.
Loose connections in hemodynamic monitoring tubing can lead to hemorrhage, a major complication of arterial pressure monitoring. Application of a pressure dressing is required only upon arterial line removal. Blood return is adequate confirmation of arterial line placement; x-ray studies are not performed to confirm arterial line placement. Neutral positioning of the extremity and use of an arm board, without limb restraint, is the standard of care.
The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a blood pressure of 85/40 mm Hg, heart rate of 125 beats/min, respiratory rate 35 breaths/min, and arterial oxygen saturation (SpO2) of 90% on a 50% venturi mask. Hemodynamic values include a cardiac output (CO) of 1.0 L/min, central venous pressure (CVP) of 1 mm Hg, and a pulmonary artery occlusion pressure (PAOP) of 3 mm Hg. The nurse questions which of the following physician's order?
a. Titrate supplemental oxygen to achieve a SpO2 > 94%.
b. Infuse 500 mL 0.9% normal saline over 1 hour.
c. Obtain arterial blood gas and serum electrolytes.
d. Administer furosemide (Lasix) 20 mg intravenously.
d. Administer furosemide (Lasix) 20 mg intravenously.
A central venous pressure of 1 mm Hg, pulmonary artery occlusion pressure of 1 mm Hg along with a blood pressure of 85/40 mm Hg and heart rate of 125 are indicative of a low volume state. Infusion of 500 mL of 0.9% normal saline will increase circulating fluid volume. Administration of furosemide (Lasix) is contraindicated and could further reduce circulating fluid volume. Titrating supplemental oxygen, obtaining serum blood gas and electrolyte samples, although not a priority, are appropriate interventions.
Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: "The tip of the catheter is located in the superior vena cava." What is the best interpretation of these results by the nurse?
a. The catheter is not positioned correctly and should be removed.
b. The catheter position increases the risk of ventricular dysrhythmias.
c. The distal tip of the catheter is in the appropriate position.
d. The physician should be called to advance the catheter into the pulmonary artery.
c. The distal tip of the catheter is in the appropriate position.
X-ray results indicate proper position of the catheter. The tip of the central venous catheter should rest just above the right atrium in the superior vena cava. The central venous catheter is positioned correctly in the superior vena cava. Dysrhythmias occur if the catheter migrates to the right ventricle. Central venous catheters are placed into great vessels of the venous system and not advanced into the pulmonary artery.
Preload is dependent on what two factors?
Diastolic venous return and systolic ejection
15. The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first?
a. A patient with a central venous pressure (RAP/CVP) of 6 mm Hg and 40 mL of urine output in the past hour
b. A patient with a left radial arterial line with a BP of 110/60 mm Hg and slightly dampened arterial waveform
c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
d. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula
c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
A high pulmonary artery occlusion pressure of 25 mm Hg combined with low oxygen saturation is indicative of fluid volume overload and warrants priority action because the patient is at risk for hypoxemia. A CVP of 6 mm Hg with 40 mL of hourly urine output are acceptable assessment findings. A patient with a normal blood pressure and with a slightly dampened waveform does not require immediate action.
11. The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action?
a. Diminished breath sounds over left lung field
b. Localized pain at catheter insertion site
c. Measured central venous pressure of 5 mm Hg
d. Slight bloody drainage around insertion site
a. Diminished breath sounds over left lung field
Diminished breaths sounds over the lung field on the same side of the line insertion site may be indicative of a pneumothorax. A pneumothorax, which can develop slowly, is a major complication following insertion of central lines when the subclavian route is used. Localized pain at catheter insertion site is not the immediate priority in this scenario. A measured central venous pressure of 5 mm Hg is normal. Slight bloody drainage at the insertion site soon after the procedure does not require immediate action.
The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first?
a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min
b. A patient with a pulmonary artery systolic pressure (PAP) of 20 mm Hg
c. A hypovolemic patient with a central venous pressure (CVP) of 6 mm Hg
d. A patient with a pulmonary artery occlusion pressure (PAOP) of 10 mm Hg
A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min
A cardiac output of 2.0 L/min in a patient with cardiogenic shock warrants immediate assessment. A PAP of 20 mm Hg, CVP of 6 mm Hg, and a PAOP of 10 mm Hg are all within normal limi
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action?
a. Diminished breath sounds over left lung field
b. Localized pain at catheter insertion site
c. Measured central venous pressure of 5 mm Hg
d. Slight bloody drainage around insertion site
a. Diminished breath sounds over left lung field
Diminished breaths sounds over the lung field on the same side of the line insertion site may be indicative of a pneumothorax. A pneumothorax, which can develop slowly, is a major complication following insertion of central lines when the subclavian route is used. Localized pain at catheter insertion site is not the immediate priority in this scenario. A measured central venous pressure of 5 mm Hg is normal. Slight bloody drainage at the insertion site soon after the procedure does not require immediate action.