Nursing
Help!
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| Hemodynamic monitoring is | the measurement of pressure, flow and O2 of the blood within the cardiovascular system
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| Hemodynamic Monitoring is a diagnositc tool used for | continuous monitoring of force and flow of blood
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| hemodynamic monitoring is allows for | monitoring response o therapies in terms of pressure, flow and O2 within the blood
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| Nurse's role within hemodynamic monitoring | you must know the current treatments and how they work, focus on patient safety outcomes and be prepared to take action based on data
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| What are the hemodynmic monitoring system five basic components | bedside manner, flush system, transducer, high pressure tubing, and catheter
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| The hemodynmic monitoring system's catheter measures from | pulmonary artery, central venous, and arterial
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| Procedure for setting up the hemodynmic monitoring system | Place 500cc bag of NS spiked c pressure tubing under the pressure bag & inflate to 300mmhg, prime tubing, level the lines with the patient, zero the lines, test the system and set alarms.
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| To ensure accuracy, why do you level hemodynmic monitoring system | eliminate effects of hydrostatic pressure on transducer
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| where do you level hemodynmic monitoring system | with phlebostatic axis (4th intercostal space, midaxillary line
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| How to you zero? | turn stopcock and open to air
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| how do you caliberate | using the biomed function of bedside monitors
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| Dynamic response /square T wave is tested tosee if | the system is accurately transmitting the pressure detected in the vessel.
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| How to you do the dynamic response/square t wave test? | pull the pig tail and release for a fast flush, should produce a square wave. Normal is 1-2 oscillations below the baseline
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| when is the dynamic response... done? | after blood draws, or is accuracy is questioned, Q8-12 hrs
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| What is necessary to maintain patency and avoid clots? | constant flow of sterile solution
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| why must connections be secured | to withstand pressure
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| transducer position directly affects | accuracy
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| When do you repeat leveling? | every position, pole or bed change
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| When is zeroing done? | every shift
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| Stroke volume is | the amount of blood leaving the LEFT VENTRICLE with each CONTRACTION
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| What is a normal stroke volume? | 60-100ml /beat
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| stroke volume is sensitive to | changes in preload, afterload and contractility
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| Cardiac Output is | the amount of blood leaving the LEFT VENTRICLE per MINUTE
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| CO= | HR x SV
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| Normal CO is | 4-8 L/minute
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| Where is the CO obtained? | pulmonary artery catheter
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| Cardiac Index | CO per square meter of the body; more accurate than CO
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| CI | =CO/BSA
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| BSA is determined by | (weight in Kg x .425)(height in cm(.725) x .007184
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| Normal CI is | 2.2-4.0L / min
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| if CI is low | it is not enough to perfuse to all organs = cellular death
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| Contractility are made of | positive inotropes and negative inotropes
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| Positive inotropes | catecholamines, sympathetic stimulation, drugs (digoxin, dopamine, dobutamine, epinephrine and norepinephrine)
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| negative inotropes | acidosis, barbituates, alcohol, hypoxemia, drugs (progainamide, calcium channel blockers, and beta blockers)
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| Ejection fraction is | the percentage of blood that is efected with each heart beat
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| normal ejection fraction is | 65% (thus 35% is a reserve)
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| less than 35% ejection fraction is | serious ventricular failure
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| Contractility is | the force generated by the myocardium, related to the ability of the ventricle muscle fibers to lengthen/stretch
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| Frank-sterling law: | cardiac muscle fibers will strtch to accommodate the venous return of diastole
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| what is the optimal filling pressure in contractility | 10-12 mmhg
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| if greater than 12 than | cardiac muscle fibers are overstretched and the force produced decreased leading to HF
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| Preload- R Atrial (CVP) reflects the | pressure of the vena cava and RA, volume as well, but it is actually EDP
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| RV preload is dependent on | RA blood colume, CO and venous vascular resistance
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| CVP/RAP | 2-8 mmHg
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| Low CVP is | hypovolemia
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| CVP is determined by | CVP line of pulmonary artery catheter
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| Preload LVEDP (left Ventricular end diastolic pressure) | is the volume of blood in a chamber at the end of diastole, and how we measure L V preload
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| Pulmonary Artery occlsive pressure is | an indirect measure of the pulmonary capillary pressure and reflects the LVEDP under normal conditions
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| Normal PAOP = | 6-12 mmHG
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| Pulmonary Artery can be used as an estimate if | balloon is not working
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| you must have what to obtain LVEDP measurement? | PAC
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| Reasons for High PAOP | LV failure, myocardial failure, constrictive pericarditis, cardiac temponade, MV disease, fluid volume overload
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| Reasons for Low PAOP | fluid volume deficit, shock states, vasodilating medications
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| Afterload | the pressure the ventricles must overcome to eject blood
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| vascular resistance is | the major determinant but also affected by resistance offered by aortic valave, mass and density of blood
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| SVR= | (MAP-CVP) x 80/ CO
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| Pulmonary system afterload = | PVR systemic ciculation = SVR
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| Normal PVR | < 250 dynes/s/cm-5
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| SVR | =800-1200 dynes s/cm-5
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| elevated SVR maybe due to | hyperthermia, vasodilation, or drug therapy
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| invasive Pressure monitoring | intra-arterial catheters, central venous catheters, pulmonary artery catheters
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| intra arterial catheters | never for infusions, must fo an Allen's test first or a stick, radial artery is most common site, monitor continuous BP, used for those with unstable BP; those needing frequent blood draws/gasses; vasoactive meds requiring titration; careful monitoring
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| Arterial Waveforms | sys/and dystolic pressure by the heart' mechanical activity, dicrotic notch is aortic valve cloorue end of systole and begining of dystole
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| factors influencing ABP waveforms | cardiac arrhythmias , distance between heart and catheter site
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| MAP | ((2*DBP)+SBP)/3
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