N240 Olol - Test 1 - Hemodynamics - Test 1

Front 1

Hemodynamics

Back 1

The study of the forces involved in blood circulation.
Used to assess cardiovascular functioning when standard assessment techniques are not enough.
Arterial blood pressure, central venous pressure (CVP), Pulmonary artery pressure (PAP), Pulmonary capillary wedge pressure (PCWP), Cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), and intraaortic balloon pump.

Front 2

Arterial Blood Pressure

Back 2

Measured with an arterial line.
Inserted in the radial or femoral artery.
Measures arterial blood pressure continuously.
Used to draw arterial blood gases
Use of pressure line – harder, stiffer line than IV line

Front 3

Arterial line

Back 3

Allows for continuous monitoring of blood pressure when treatments are changing often.
Ex: vasoactive medications like dopamine, dobutamine, levophed, tridil, nipride will be titrated slightly through the day depending on cardiovascular response.
Caution: always given in an infusion carefully, on a pump, into a central line if possible, avoid sudden changes in flow rates, never flush the line.(can cause problems when flush, so with Dopamine, do not flush, aspirate fluid out, or put in D5 line)
must be on a pump

Front 4

Arterial line setup

Back 4

Arterial catheter is very similar to an IV catheter. Jelco with a larger gauge.
Inserted by anesthesiology and respiratory therapy.
Catheter is attached to a transducer to interpret pressure readings from the patient’s pulse.
Pressure tubing is needed with IV flush fluids under pressure. bag under pressure to fight blood pressure
Arterial blood pressure is measured in systolic, diastolic, and mean arterial pressure

Front 5

Arterial LineNursing Considerations

Back 5

Tighten all connections.- do not come packed w/tight connections
Monitor the site for bleeding (will be sutured in place).- look distal to pt of insertion for circulation, cap refill, color (pallor), pulse?
Monitor hand distal to the site for perfusion (color, temperature, absence of pulse).

Front 6

Central Venous Pressure (CVP

Back 6

A measure of fluid volume.
CVP is equal to right ventricular filling pressure.
Normal range 3-8mmHg but look at pt to judge
Low values are seen in hypovolemia
High values are seen in fluid overload.
Trends are more significant than single readings.
Supine with HOB flat preferred
Checked in the same position.

Front 7

Central Venous Pressure

Back 7

Measured with subclavian venous catheter. Can be single, double, or triple lumen.
Distal port attached to the transducer. Or hook to pressure tubing & get reading from cardiac monitor
Pressure tubing is needed with IV Flush bag under pressure.
CVP-measurement of right side of heart so
Goes in Vena cava or right atrium
Distal port is messed up-port in
Pt is considered distal port
In CHF- left vent fails, so CVP- needs to read LL
Lv, so Swan cath developed to go throughout
The heart

Front 8

CVP

Back 8

CVP is not very useful in CHF.
CVP measures right sided heart volumes.
Patients in CHF begin to have problems in the left ventricle long before they are reflected in the right ventricle.
So the information from a CVP is usually too late.

Front 9

Swan Ganz Catheter

Back 9

Measured with a Swan Ganz catheter.
Catheter is inserted through the subclavian or internal jugular vein.
It is attached to a transducer with a pressure tubing connected to a bag of IV fluids as a flush solution.

Front 10

Swan Ganz Catheter

Back 10

The catheter is 60cm long so it can pass all the way from the subclavian through the right side of the heart and into the pulmonary artery.

Front 11

Direct measurement of left ventricular filling pressure

Back 11

PAP diastolic is only a correlation.
A direct measurement is needed.

Front 12

Pulmonary CapillaryWedge Pressure

Back 12

Direct measurement of function of left ventricle.
Measured by wedging the swan ganz catheter in a pulmonary capillary.
By inflating the balloon on the tip of the catheter the balloon will float forward until it wedges itself in a pulmonary capillary

Front 13

Pulmonary Artery Pressure (PAP

Back 13

PAP diastolic closely correlates with left ventricular end diastolic pressure (LVEDP).
This is also called preload.
Expressed in systolic and diastolic.
Normal values PAP
Systolic 15-25
Diastolic 8-10 pulm. Artery pressure - <8 hypovolemia
>10 vol. overload
How can we measure PAP?

Front 14

PCWP

Back 14

The tip of the catheter will be taking readings from the left side of the heart.
Normal PCWP is 6-12 mmHg.
Low readings indicate hypovolemia.
High readings indicate fluid overload.
Direct measurement

Front 15

Complications of Swan Ganz Catheters

Back 15

Arrhythmias – The catheter can slip out of the pulmonary artery back into the right ventricle and cause arrhythmias.
Pulmonary infarction – the swan ganz catheter can stick in the wedged position causing an infarction of pulmonary tissue.
Sepsis – a potential problem with all central catheters.
Balloon rupture – Inflate the balloon carefully and only when necessary. Never aspirate the air out of the balloon. If the catheter does not wedge do not continue to inflate the balloon

Front 16

Cardiac Output

Back 16

A measure of amount of blood pumped out of the heart every minute.
Measured with the swan ganz catheter and a computerized cardiac output monitor.
Normal value 4-8 l/min.

Front 17

Cardiac index

Back 17

More precise than cardiac output because it takes into consideration body size.
Normal 2.5-3.5 l/min/m2
Range different btw index and output

Front 18

A patient is getting dopamine through an Arterial Line. The nurse reads orders to flush the line. She knows?

Back 18

never, ever, flush an Arterial line. If getting ex. Dopamine in the AL, she is to aspirate the rest of the Med. out or switch to a D5 line

Front 19

The nurse knows that she cannot use a regular IV bag when infusing through an Arterial Line because?

Back 19

the fluid would be pushed up with the Blood Pressure. Pressure tubing is needed with a bag under pressure to fight back against the Blood Pressure

Front 20

When ordered to get an Arterial BP on a pt, the nurse knows she must get readings on?

Back 20

Systolic, Diastolic and mean arterial pressure MAP -
MAP is equal/approximate to:
MAP = DP + 1/3(SP-DP)

Front 21

The priorty nursing interventions when caring for an Arterial Line are?

Back 21

1 Tighten all connections!!!
2 Monitor site for bleeding
3 Look for problems in circulation (cap refill, pulse, color)
4. Monitor hand distil for perfusion (color, temp, absence of pulse)

Front 22

A nurse told to get the CVP of a pt knows that CVP means?
She knows that normal values are?

Back 22

A measure of fluid volume

It is equal to right ventricular filling pressure

3-8mm - but assess pt

<3mm= hypovolemia
>8mm = fluid overload

Front 23

The nurses understand that when asked for the CVP she is to?

Back 23

get the info off of more than one reading, it is a trend

Front 24

Some nursing interventions when taking a CVP are?

Back 24

HOB flat
always get the readings with the pt in the same position

Front 25

The nurse reviews the procedures of measuring a CVP. She knows?

Back 25

1. measure w/ a subclavian venous catheter whether single, double or triple
2. attach the distal port to the transducer (pt is distal)
3. or she can hook up pressure tubing and get the reading from the cardiac monitor
4.

Front 26

The nurse knows that CVP reads? so it goes into?

Back 26

pressure of right side of heart, so it goes into the Vena Cava or right atrium

Front 27

The nurse is told to get a CVP reading on a CHF pt. She knows that the Left Ventricle fails in a CHF pt so she needs to get the reading from the left ventricle. What type of CVP does she use?

Back 27

Swan Ganz Catheter

Front 28

The nurse understands that the reasons the left ventricle is being read in a CHF pt is?

Back 28

CHF pts have problems in the left ventricle long before problems in right so to get info from the right may be too late for these pts.

Front 29

Since the Swan Ganz catheter is to measure the left CVP in a CHF pt, where is the cath. threaded through to start?
Where does it wind up?

Back 29

subclavian or internal jugular vein or femoral vein

Through the right side of the heart to the pulmonary artery

Front 30

The nurse runs through the procedure of hooking up a S.G Catheter. What are the steps?

Back 30

1. attach to the transducer with pressure tubing connected to a bag of IV fluids as a flush solution

Front 31

A Pulmonary Capillary Wedge pressure is ordered for a pt. The nurse knows that this will?

Back 31

take a direct measure of the function of the left ventricle by wedging a balloon in a pulmonary capillary

Front 32

PAP is the same thing as?
normal values are?

Back 32

preload
Systolic=15-25
Diastolic = 8-10
<8 hypovolmia > 10 overload

Front 33

The nurse knows that to measure PAP (pulmonary artery pressure) what is used?

Back 33

PCWP - Pulmonary Artery Wedge pressure catheter
normal PCWP is 6-12 mmHg
this is a direct measurment unlike PAP

Front 34

The nurse knows that there are problems with the Swan Gantz catheter. These are?

Back 34

Arrhythmias
Pulmonary infarctions
Sepsis
Balloon rupture

Front 35

The nurse knows that Cardiac Output (amt of bl pumped out of the heart q min) is measured with?

Back 35

A swan Ganz catheter and a computerized cardiac output monitor and normal is
4-8 l/min

Front 36

Which is more precise Cardiac Output or Cardiac Index?

Back 36

Cardiac Index, it takes into account body size