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hemodynamic.lab

hemodynamic

Question	Answer
hemodynamic monitoring definition	direct pressure monitoring systems that invasively measure pressure, flow, and oxygenation in the cardiovascular system
hemodynamic monitoring is done	any critical care unit, surgery, and possibly the emergency room
invasive lines are placed by a	physician, PA, or and NP
consent must be obtained	from the patient or family prior to insertion
clinical indications for hemodynamic monitoring	frequent blood sampling, titration of vasoactive drugs, diagnosis of heart failure cardiogenic shock, or assessment of ventricular function
clinical indication for hemodynamic monitoring	frequent blood sampling
frequent blood sampling for ABG analysis or severe fluid and electrolyte imbalance
hemodynamic monitoring catheters provide a way of obtaining blood samples	without having to stick the patient as in the traditional way of lab draws the critical care patient may require frequent blood sampling for ABGs if on a ventilator or for the patient who may have severe fluid and electrolyte imbalance
clinical indication for hemodynamic monitoring	titration of vasoactive drugs
titration of vasoactive drugs	these patients may require the use of critical admixture drugs such as dopamine, levophed, or nipride
hemodynamic monitoring provides nurses with the data	to evaluate the effectiveness of vasoactive drugs and their titration
clinical indication for hemodynamic monitoring diagnosed	diagnosis of heart failure, cardiogenic shock, cardiac tapenade, and sepsis
hemodynamic monitoring helps in differentiating the diagnosis of heart problems by	measuring pressures in the heart or determine another cause of the patient's clinical status
clinical indication for hemodynamic monitoring	assessment of ventricular function in chronic heart failure
clinical indication for hemodynamic monitoring	management of high risk patients undergoing surgical procedures
hemodynamic monitoring may be indicated for surgical patients	that are high risk management of patients undergoing high risk procedures
patient with fluid instability the clinician can determine	if the patient needs more fluid or is fluid overloaded by analyzing per pressures obtained having the capability to gather and analyze this continuous data allows for prompt treatment
monitoring conditions with complex fluid instability	trauma, burns, sepsis, a RDS, G.I. bleeding that required fluid management and infusion of vasoactive drugs
fundamental components of cardiac performance	preload, after load, cardiac output see oh
data obtained from he hemodynamic monitoring can tell the caregiver	about preload after load and cardiac output in other words cardiac performance and fluid balance
preload	pressure stretching the ventricles right before systole
preload equals the amount of blood in the ventricles before contraction
preload	another term for preload is
after load	any resistance against which the ventricles must pump in order to eject its value
after load	how hard either side of the heart has to push to get the blood out
after load	resistance to flow or how clamped the blood vessels are
after load is what the heart has to push against	in order to get the blood ejected from the ventricles
on the right side of the heart, the ventral pushes against	the pulmonary system
on the left side of the heart, the ventricle pushes against	the aortic valve and peripheral vascular system
what can cause increased after load	pulmonary hypertension, elevated blood pressure, and aortic stenosis
cardiac output CO is	the amount of blood ejected from the ventricle in 1 min.
how is cardiac output measured	is measured in liters per minute
what is a normal cardiac output	normal cardiac output is 4 to 8 L per minute
there are two components that make up cardiac output	heart rate and asked the the amount of blood ejected with each contraction
what are two things that will change the cardiac output	altering either the heart rate or the stroke volume
what is stroke volume SVE stroke volume is on need to fill this in
what are three things that influence the stroke volume	the preload the after load and contractility
types of invasive catheters for hemodynamic monitoring	there are three types of catheters used
what are the three types of catheters	the arterial line, central venous pressure or CBP, or pulmonary artery catheter
the arterial line, also called art line, also called a line measures	continuous blood pressure
the central venous pressure or CVP	measures pressure on the right side of the heart a CVP reading can be done using a 3 lm catheter
pulmonary artery catheter, also called AP a catheter, or a Swan-Ganz catheter	this catheter measures pressures on both the left and right side of the heart CVP as well as the cardiac output and provides a port for fluid drug administration and blood draws
learning objectives for using a transducer system	state the purpose of using a transducer, demonstrate leveling and zeroing a transducer using level static access, and identify the level static access
pressure transducer system	this system converts mechanical energy into electrical energy
in order to perform invasive hemodynamic monitoring	a pressure transducer is required
the pressure transducer system converts mechanical energy into	electrical energy that displays as a waveform and digital readings on a monitor
transducers can be connected to three things	and arterial line, a central venous pressure or CVP line or a pulmonary artery catheter
example of a transducer system	picture shows a system attached to a normal saline bags around by a pressure bag and connected to a monitor and it maintains pressure to get digital readings
what pressure is needed to get adequate digital readings and waveforms for the pressure bag	pressure needs to meet maintain at 300 mmHg
for trans to inducer system, how does the to being flushed	3 mL per hour to ensure patency of the tubing and hemodynamic catheter
leveling a transducer, in order to ensure accurate readings the transducer must be level	to the first level static access
the level static access is	approximately the level of the right atrium
to determine the level static axis	locate the fourth intercostal space at the sternum and draw out to the side of the body beneath axilla halfway between the anterior and posterior surface of the chest
level static axis once connected you must level with the level static axis	and then zero calibrate the transducer
arterial line learning objectives	state indications for using an arterial line,
arterial line, identify the die chronic notch	on an arterial waveform and described how correlates with valve closure
arterial line discuss the rationale for doing and Allen's test	explain and perform a classmate
arterial line demonstrate withdrawing arterial blood samples	how to do it from an arterial line
arterial line	describe the procedure for discontinuing an arterial line
arterial line state nursing measures to maintain an arterial line
identify complications and trouble soothing Dobsons	for unexpected outcomes when maintaining an arterial line
define an arterial line also called an a line	a continuous invasive form of monitoring a patient's blood pressure
indications for for using an a line	hemodynamic instability, use of vasoactive medications, regular blood sampling, certain surgical procedures
use and a line for hemodynamic instability	where strict monitoring is required
indications are to use and a line when vasoactive medications are needed	and the response to such medications requires monitoring
indications for use in a line with regular blood sampling	and certain surgical procedures
the die chronic notch on an arterial line waveform represents	the closure of the aortic valve
nursing measures for a lines	level and zero the transducer every shift and with patient position changes
nursing measures for a lines ensure pressure bag is that	300 mmHg
nursing measure for a line	assessment assess circulation, neurovascular status of cannulated site every 1 to 2 hours
leave can nursing measures for a line we've cannulated extremity uncovered for easy observation
nursing measure for a line	change flush solution every 96 hours or according to hospital policy
nursing measure for a line	change dressing per hospital policy
a line possible complications for	hemorrhage, infection, thrombus, and neurovascular impairment
learning objectives for using a central venous catheter	state indications for monitoring central venous pressure, state normal range for a central venous catheter
central venous catheter	state the purpose of each lumen of a central venous catheter
discussed nursing measures to maintain a central venous catheter	identify complications that can occur with the central venous catheter
discuss critical thinking and troubleshooting options	for maintaining a central venous catheter
central venous pressure, central catheters are placed by	a physician
where are central venous catheters placed	into the jugular or subclavian vein
where does the tip of the catheter set	in the superior vena cava or the right atrium
what must be done before a central venous catheter can be placed	they must obtain consent
central venous pressure measurement reflects	be right atrial pressure or RAP
central venous pressure is a measurement of the	preload or filling pressures on the right side of the heart
central venous pressure guides	fluid administration helps assessed fluid volume status
central venous pressure can be measured using a	transducer which is most common or a magnetometer
measuring central venous pressure	also called right atrial pressure RAP
when obtaining a central venous pressure with a transducer it is measured in	millimeters of mercury attached to one port
normal central venous pressure or right Ajo pressure person with the dual is	today 8 mmHg
when measuring central venous pressure with a magnetometer	it is measured in centimeters of H2O rarely used
central venous pressure other ports can be used for	TPN meds IV fluids
Possible complications of central venous pressure	infection, dysrhythmias, air embolism
central venous pressure possible complication nursing measures include	pressure bag at 300 mmHg, assess site change dressing per hospital policy
learning objectives for using a pulmonary artery catheter	state indications for using a pulmonary artery catheter PAC
identify waveforms observed while using a PAC	identified the die chronic notch on the pulmonary artery waveform and how it correlates to valve closure
state the normal wedge pressure	discuss how a pulmonary artery catheter is inserted
state the per further purpose of each lumen for a pulmonary artery catheter	and where each exits in the heart
state nursing measures to maintain a pulmonary artery catheter	identify complications that can occur with the pulmonary artery catheter
discuss critical thinking options for unexpected outcomes	when using a pulmonary artery catheter
pulmonary artery catheter definition	multi-lumen catheter inserted in the jugular or subclavian vein that is floated through the heart and rest in the pulmonary artery
pulmonary artery catheter, purpose	monitor right-sided heart pressure is the CVP, indirectly monitor left-sided heart pressures the wedge pressure and cardiac output
using patient score who are	hemodynamically unstable or can be
pulmonary artery catheter insertion steps	once inserted in the subclavian vein or juggler vain the empty inflate the balloon at the tip in order for the catheter to float through the heart into the pulmonary artery
pulmonary artery catheter wave forms	reflect the location of the catheter within the heart
pulmonary artery catheter waveforms show	which part of the heart the catheter is in or waveforms reflect the location of the catheter within the heart
the pulmonary artery catheter has 4 to 5 lm	each lumen exits in a different location
pulmonary artery catheter proximal port	exits in the right atrium, used to obtain CVP readings and connect cardiac output CO inject a
thermistor port exits	in pulmonary artery, used to assist in cardiac output, measures core body temperature
pulmonary artery catheter has 4 to 5 lm	each lumen exits in a different location continued
pulmonary artery catheter the balloon port	sits in the pulmonary artery inflated to obtain a wedge pressure
pulmonary artery catheter distal port exits	in pulmonary artery to obtain pulmonary artery readings
pulmonary artery catheter VIP port	extra port on some models use for IV fluid exits in superior vena cava
pulmonary artery readings	pulmonary artery catheter can obtain pressure readings for the right atrium and ventricle, pulmonary artery pressure, and pulmonary capillary wedge pressure P CWP or wedge
pulmonary artery readings, a wedge pressure indirectly measures	left-sided preload
pulmonary artery readings, a normal range for wedge pressure is	5 to 12 mmHg
the die chronic notch in the pulmonary artery pressure waveform is	whole Monica valve closure
of teeny a pulmonary capillary wedge pressure or P CWP or wedge	beware never leave the balloon inflated in wedge position one's wedge pressure is obtain let's or a syringe balloon deflate
pulmonary artery pressure wedge pressure warnings repeats from other 1	never leave balloon inflated in wedge position because it can cause balloon rupture or a pulmonary infarct
pulmonary artery wedge pressure, one's wedge pressure is obtain the	left syringe and balloon passively deflate and watch waveform returned to the normal pulmonary artery waveform
nursing measures for pulmonary artery catheter and there are several	obtain consent, level of zero transducers, pressure bag a trigger millimeters Mercury, hemodynamic parameters, and monitoring
nursing measures for pulmonary artery catheter detail	obtain the consent, level of
for pulmonary artery catheters level and zero transducers transducers	every shift and with the patient's position change
pressure bag a trigger millimeters of mercury	and obtain hemodynamic parameters per empty order
potential complications for pulmonary artery catheter	rupture balloon, pulmonary infarct, infection, dysrhythmias, air embolism
troubleshooting a pulmonary artery catheter	is no waveforms on the monitor make sure monitor is turned.
troubleshooting for pulmonary artery catheter if you are unable to draw blood from the a line stop	possible spasm in the artery weight and try again to gently aspirate
troubleshooting pulmonary artery line if there is hemorrhage	apply pressure
troubleshooting if there is diminished or absent peripheral perfusion within a line	notify MD and prepare to discontinue
troubleshooting pulmonary artery catheter if arterial blood pressure is unusually low, check your patient and reposition the extremity	check your patient and reposition the extremity
pulmonary artery catheter if you have a significant change in hemodynamic reading	confirmed the digital readout with a waveform analysis
and then lab demonstrations	perform balanced has identify equipment for transducer set up demonstrate leveling answering transducer blood draw from an arterial line discussed discontinuation of arterial line, observe various waveforms on monitor and identify ports a pulmonary artery

Created by: walterina4327

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