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21 Cards in this Set
- Front
- Back
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Using hemodynamic monitoring, what are the pressures that indicate patient’s preload? Patient’s afterload?
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Preload is measured via CVP (normal 2-8 mm Hg) and PAWP (normal 6-12 mm Hg)
Afterload is measured via SVR (normal 800-1200) & PVR (normal <250). |
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2. Identify the steps the nurse will take to obtain accuracy when using hemodynamic monitoring systems?
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a. System must be referenced and zero balanced. Referencing means positioning the transducer at the level of the atria of the heart (phlebostatic axis – mid axillary line & 4th ICS). Zeroing is confirmed by opening the stop cock to room air, monitor should read zero. Zeroing should be done immediately after insertion of arterial line, when transducer has been disconnected from pressure cable or pressure cable disconnected from monitor, when accuracy of values is questioned, and per hospital protocol.
b. Square wave test – performed to ensure the equipment reproduces a signal. It is performed per protocol (Q shift) and whenever the system is opened to air or accuracy of measurement is questioned. It involves activating the fast flush device and checking that the equipment reproduces a distortion-free signal (a square wave). If wave is blunted, may have a clot on end of line. c. Positioning – patient should be lying supine initially but can be at up to 45 degrees if no orthostatic changes are noted. |
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3. When preload and afterload are improved, how is this indicated in hemodynamic monitoring systems?
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Cardiac output will be increased. Preload = CVP, Afterload = SVR
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4. What are complications that can occur with arterial lines?
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hemorrhage
infection thrombus formation neurovascular impairment |
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5. How are complications identified in arterial lines?
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may have a thrombus which will cause CSN changes
signs of infection |
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6. How are complications prevented in arterial lines?
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a. Hemorrhage – check connections, immobilize arm
b. Infection – redness, edema, pain, temp at insertion site; WBC count c. Thrombus formation – assess continuous flush irrigation system (bag inflated to 300 mm Hg, fluid in bag, rate of infusion), aspirate if thrombus found d. Neurovascular impairment – circulation, sensation & movement i. Circulation – pulse, capillary refill, color, temp ii. Sensation – feel touching, no numbness or pin-prick feeling iii. Movement – move fingers |
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7. How are problems of a pulmonary artery catheter identified?
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a. Infection – signs of infection as above, aseptic technique used
b. Air embolus – balloon may rupture c. Hemorrhage – check connections |
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8. What patients are at risk for hypovolemic shock?
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a. Trauma
b. Surgery c. GI bleed d. Excessive vomiting/diarrhea e. Diabetes Insipidus f. Burn patients g. Internal bleeding (long bone fractures, pancreatitis) |
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9. What patients are at risk for cardiogenic shock?
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a. Primary ventricular ischemia (MI)
b. Structural problems c. Dysrhythmias |
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10. What patients are at risk for anaphylactic shock?
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a. Contrast media
b. Blood/blood products c. Drugs/anesthetics d. Insect bites e. Foods f. latex |
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11. What patients are at risk for neurogenic shock?
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a. Spinal injury above T6
b. Spinal anesthesia c. Opioid/barbiturate OD |
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12. What are signs of hypovolemia in patients?
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a. Tachycardia
b. hypotension c. decreased output d. confusion |
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13. What are signs of hypervolemia in patients?
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a. Crackles
b. Dyspnea c. Peripheral edema d. Periorbital edema e. ascites |
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14. What are priorities of care for patients admitted to hospital in shock?
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a. ABC’s (patent airway, oxygen, fluid replacement)
b. Identify patients at risk for development of shock (see above) c. Except for cardiogenic & neurogenic shock, volume expansion with NS, LR, albumin, blood) – watch for hypothermia & Coagulopathy) d. Drug therapy – to increase tissue perfusion |
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15. What are clinical signs that a person in shock has progressed to MODS?
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a. Alveolar collapse leading to ARDS
b. ↑HR/CO/RR/temp/CVP, bleed times c. ↓SVR, BP, capillary refill, GI motility d. skin mottling,dysrhythmias, ARF mental status changes - early sign |
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16. How does the nurse manage the patient in shock who experiences fear?
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a. Explain to patient/family what you are doing before/as doing it
b. Encourage family to be at bedside to comfort, if applicable c. Show a calm, confident attitude |
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17. What are priorities of nursing care for anaphylactic shock?
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a. ABC’s – patent airway, O2, fluid resuscitation
b. Epinephrine – breathing – bronchodilation c. Antihistamines – Benadryl d. Identify cause |
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18. What are the priorities of nursing care for septic shock?
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a. ABC’s – patent airway, O2, fluid resuscitation
b. Antibiotics as ordered c. Dopamine as ordered d. Blood cultures, monitor VS, stress ulcer prophylaxis |
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19. Which labs indicate acute renal failure? Are those levels high or low?
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a. BUN >25 mg /dL – normal 8-12
b. Creatinine >1.5 mg/dL – normal 0.6-1.2 c. Urine osmolality <300 – normal 300 to 900 |
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20. What is the most common cause of death in patients w/acute renal failure? How is this prevented?
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a. Infection is the leading cause of death in ARF.
b. Prevented w/meticulous aseptic technique i. Protect from other individuals w/infectious diseases |
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21. For a patient with acute tubular necrosis, what treatments will be used to correct fluid overload and electrolyte imbalance?
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a. Diuretics
b. dialysis |
