hemodynamic
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
walterina4327