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65 Cards in this Set
- Front
- Back
direct invasive monitoring of blood flow & pressures in the cv system
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hemodynamic monitoring
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what information is provided by hemodynamic monitoring
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blood volume, fluid balance, pumping effectiveness of heart & oxygenation
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6 types of hemodynamic monitoring
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pulse oximeter
blood pressure cuff cardiac monitor intra arterial line central venous pressure monitoring pulmonary artery wedge pressure |
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2 risks of hemodynamic monitoring
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infection
clotting |
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CO stands for
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cardiac output
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volume of blood pumped by heart in 1 minute
SV x HR |
cardiac output (CO)
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how is cardiac output determined (formula)
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CO=SV X HR
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cardiac output adjusted for body size
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cardiac index (CI)
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volume ejected with each heartbeat
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stroke volume (SV)
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stroke volume adjusted for body size
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stroke volume index (SVI)
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opposition to blood flow exerted by the blood vessels.
this is what you get when you take a blood pressure |
systemic vascular resistance (SVR)
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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)
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volume of blood in ventricles at end of diastole (money in pocket on payday)
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Preload
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3 causes of increased preload:
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hypervolemia
regurgitation of cardiac valves heart failure |
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resistance, not volume, left ventricles must overcome to circulate blood
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afterload
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2 causes of increased afterload:
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hypertension
vasoconstriction |
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increased afterload =
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increased cardiac workload
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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
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way to tell how well blood is perfused through organs
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mean arterial pressure (MAP)
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normal value MAP
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70-105 mm Hg
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MAP pressure needed to perfuse vital organs
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>60 mm Hg
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formula for determining MAP
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MAP = (SBP + 2 DBP) / 3
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other names for intra-arterial lines
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ART lines
A lines |
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information about ART lines
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are not used to admin fluids
inserted by MD Allen's test performed prior to insertion |
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4 things to assess for an ART line
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infection
circulation sensation movement |
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how do you assess circulation in an ART line
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pulse, capillary refill, color, temp
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how do you assess sensation in an ART line
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can they feel touching, no numbness or pin-prick feelings
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how do you assess movement in an ART line
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can they move fingers
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measures filling pressures on the right side of the heart as tip lies in superior vena cava or right atrium
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central venous pressure (CVP)
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normal CVP value
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2-6 mm Hg but trends are more important that normal values
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how is placement of a CVP confirmed
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chest x-ray
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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
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increased Pulmonary artery catheter readings caused by
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heart failure
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decreased Pulmonary artery catheter readings caused by
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hypovolemia
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when is the balloon on the pulmonary artery catheter inflated
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only when readings are taken
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way to measure venous O2 - amount of O2 in blood returning to heart
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pulmonary artery catheter
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normal SVO2 (blood returning to heart)
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60-80%
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6 EBP for preventing catheter related bloodstream infection
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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 |
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how can a physician know where a PA cath is located in the heart?
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by continuous EKG waveform
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3 essential pieces of hemodynamic monitoring system
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catheter
flush system (heparin) transducer |
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what measurement is used for the monitoring systems to be "zeroed"
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locating phlebostatic axis
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where is the phlebostatic axis
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right side 4th intercostal space midchest of side of chest (pt is lying supine w/arm above head)
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confirms that when pressure within system is zero, monitor reads zero
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zeroing
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when is zeroing performed
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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) |
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way to test pressure monitoring system. usually done Q shift, or when system is opened to air or if accuracy is questioned
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dynamic response test (square wave test)
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how is a dynamic response test (square wave test) performed
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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
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normal cardiac output
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4-8 L/min
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Normal cardiac index
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2.2-4 L/min
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normal CVP
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2-8 mm Hg
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normal PAWP
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6-12 mm Hg
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normal MAP
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70-105 mm Hg; must be >60 mm Hg for effective organ & tissue perfusion
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normal HR
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60-100 bpm
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normal SaO2 (arterial Hgb ox sat)
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95-99%
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normal SvO2 (mixed venous Hgb ox sat)
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60-80%
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5 nsg mgmt issues r/t hemodynamic monitoring
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inaccurate calibration/readings
bleeding thrombus formation air emboli infection |
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intervention for inaccurate calibration/readings
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square wave test done on end of expiration, not on inhalation
also check connections |
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bleeding w/hemodynamic monitoring
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it does occur
pt may be moving too much or stop cock may be open |
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intervention for thrombus formation
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may occur
aspirate through stop cock (pull out) may have orders for clot busters |
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how to prevent air emboli
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pt should hold breath while lines are being removed
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intervention for infection
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remove line
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what position should the pt be placed in to level the transducer at the phlebostatic axis
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supine position
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what does a blunted pulmonary artery catheter mean during a square wave test?
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catheter may be occluded by thrombus
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Patients CO is 3L/min. what correlating hemodynamic signs does the nurse expect to assess?
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hypotension
diminished peripheral pulses |
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for which device does the nurse monitor patient circulation, sensation & movement
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arterial line
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EBP PA/CVP measurement
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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 |