Cc Exam 2 Hemodynamic Monitoring

Front 1

direct invasive monitoring of blood flow & pressures in the cv system

Back 1

hemodynamic monitoring

Front 2

what information is provided by hemodynamic monitoring

Back 2

blood volume, fluid balance, pumping effectiveness of heart & oxygenation

Front 3

6 types of hemodynamic monitoring

Back 3

pulse oximeter
blood pressure cuff
cardiac monitor
intra arterial line
central venous pressure monitoring
pulmonary artery wedge pressure

Front 4

2 risks of hemodynamic monitoring

Back 4

infection
clotting

Front 5

CO stands for

Back 5

cardiac output

Front 6

volume of blood pumped by heart in 1 minute
SV x HR

Back 6

cardiac output (CO)

Front 7

how is cardiac output determined (formula)

Back 7

CO=SV X HR

Front 8

cardiac output adjusted for body size

Back 8

cardiac index (CI)

Front 9

volume ejected with each heartbeat

Back 9

stroke volume (SV)

Front 10

stroke volume adjusted for body size

Back 10

stroke volume index (SVI)

Front 11

opposition to blood flow exerted by the blood vessels.
this is what you get when you take a blood pressure

Back 11

systemic vascular resistance (SVR)

Front 12

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

Back 12

Pulmonary Artery Wedge Pressure/Pulmonary Artery Pressure (PAWP/PAP)

Front 13

volume of blood in ventricles at end of diastole (money in pocket on payday)

Back 13

Preload

Front 14

3 causes of increased preload:

Back 14

hypervolemia
regurgitation of cardiac valves
heart failure

Front 15

resistance, not volume, left ventricles must overcome to circulate blood

Back 15

afterload

Front 16

2 causes of increased afterload:

Back 16

hypertension
vasoconstriction

Front 17

increased afterload =

Back 17

increased cardiac workload

Front 18

used in any condition that compromises CO, tissue perfusion and/or fluid volume status
provides direct continuous measurement of systolic, diastolic, MAP and ABGs

Back 18

arterial lines

Front 19

way to tell how well blood is perfused through organs

Back 19

mean arterial pressure (MAP)

Front 20

normal value MAP

Back 20

70-105 mm Hg

Front 21

MAP pressure needed to perfuse vital organs

Back 21

>60 mm Hg

Front 22

formula for determining MAP

Back 22

MAP = (SBP + 2 DBP) / 3

Front 23

other names for intra-arterial lines

Back 23

ART lines
A lines

Front 24

information about ART lines

Back 24

are not used to admin fluids
inserted by MD
Allen's test performed prior to insertion

Front 25

4 things to assess for an ART line

Back 25

infection
circulation
sensation
movement

Front 26

how do you assess circulation in an ART line

Back 26

pulse, capillary refill, color, temp

Front 27

how do you assess sensation in an ART line

Back 27

can they feel touching, no numbness or pin-prick feelings

Front 28

how do you assess movement in an ART line

Back 28

can they move fingers

Front 29

measures filling pressures on the right side of the heart as tip lies in superior vena cava or right atrium

Back 29

central venous pressure (CVP)

Front 30

normal CVP value

Back 30

2-6 mm Hg but trends are more important that normal values

Front 31

how is placement of a CVP confirmed

Back 31

chest x-ray

Front 32

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

Back 32

pulmonary artery catheters

Front 33

increased Pulmonary artery catheter readings caused by

Back 33

heart failure

Front 34

decreased Pulmonary artery catheter readings caused by

Back 34

hypovolemia

Front 35

when is the balloon on the pulmonary artery catheter inflated

Back 35

only when readings are taken

Front 36

way to measure venous O2 - amount of O2 in blood returning to heart

Back 36

pulmonary artery catheter

Front 37

normal SVO2 (blood returning to heart)

Back 37

60-80%

Front 38

6 EBP for preventing catheter related bloodstream infection

Back 38

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

Front 39

how can a physician know where a PA cath is located in the heart?

Back 39

by continuous EKG waveform

Front 40

3 essential pieces of hemodynamic monitoring system

Back 40

catheter
flush system (heparin)
transducer

Front 41

what measurement is used for the monitoring systems to be "zeroed"

Back 41

locating phlebostatic axis

Front 42

where is the phlebostatic axis

Back 42

right side 4th intercostal space midchest of side of chest (pt is lying supine w/arm above head)

Front 43

confirms that when pressure within system is zero, monitor reads zero

Back 43

zeroing

Front 44

when is zeroing performed

Back 44

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)

Front 45

way to test pressure monitoring system. usually done Q shift, or when system is opened to air or if accuracy is questioned

Back 45

dynamic response test (square wave test)

Front 46

how is a dynamic response test (square wave test) performed

Back 46

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

Front 47

normal cardiac output

Back 47

4-8 L/min

Front 48

Normal cardiac index

Back 48

2.2-4 L/min

Front 49

normal CVP

Back 49

2-8 mm Hg

Front 50

normal PAWP

Back 50

6-12 mm Hg

Front 51

normal MAP

Back 51

70-105 mm Hg; must be >60 mm Hg for effective organ & tissue perfusion

Front 52

normal HR

Back 52

60-100 bpm

Front 53

normal SaO2 (arterial Hgb ox sat)

Back 53

95-99%

Front 54

normal SvO2 (mixed venous Hgb ox sat)

Back 54

60-80%

Front 55

5 nsg mgmt issues r/t hemodynamic monitoring

Back 55

inaccurate calibration/readings
bleeding
thrombus formation
air emboli
infection

Front 56

intervention for inaccurate calibration/readings

Back 56

square wave test done on end of expiration, not on inhalation
also check connections

Front 57

bleeding w/hemodynamic monitoring

Back 57

it does occur
pt may be moving too much or stop cock may be open

Front 58

intervention for thrombus formation

Back 58

may occur
aspirate through stop cock (pull out)
may have orders for clot busters

Front 59

how to prevent air emboli

Back 59

pt should hold breath while lines are being removed

Front 60

intervention for infection

Back 60

remove line

Front 61

what position should the pt be placed in to level the transducer at the phlebostatic axis

Back 61

supine position

Front 62

what does a blunted pulmonary artery catheter mean during a square wave test?

Back 62

catheter may be occluded by thrombus

Front 63

Patients CO is 3L/min. what correlating hemodynamic signs does the nurse expect to assess?

Back 63

hypotension
diminished peripheral pulses

Front 64

for which device does the nurse monitor patient circulation, sensation & movement

Back 64

arterial line

Front 65

EBP PA/CVP measurement

Back 65

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