NUR 241 - Critical Care I Study Questions and Correct Answers
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Course
NUR 241
Institution
NUR 241
What is hemodynamic monitoring measure of pressure, flow, and oxygenation within the cardiovascular system - assess heart function, fluid balance and effects of drugs on CO
What is systemic vascular resistance (SVR) or pulmonary vascular resistance (PVR) opposition to blood flow by systemic and pu...
NUR 241 - Critical Care I Study
Questions and Correct Answers
What is hemodynamic monitoring ✅measure of pressure, flow, and oxygenation within
the cardiovascular system - assess heart function, fluid balance and effects of drugs on
CO
What is systemic vascular resistance (SVR) or pulmonary vascular resistance (PVR)
✅opposition to blood flow by systemic and pulmonary vasculature (high = tight, low =
loose)
What determines stroke volume (SV) ✅preload, after load and contractility
What needs to be done when using equipment of invasive pressure monitoring ✅it
needs to be referenced and zeroed out and the dynamic response characteristics need
to be optimized
How is the invasive pressure monitoring system referenced/zeroed out ✅place the
transducer so the zero-reference point is at the level of the atria of the heart
(phlebostatic axis) - open the stopcock to room air then close
Where is the phlebostatic axis ✅4th intercostal space at midline - at level of the atria
What does zeroing confirm ✅confirms that when pressure in system is zero, the
monitor will read zero. Allows us to be sure readings are most accurate
When does the equipment need to be zeroed out ✅whenever the patient is moved,
when something changes, or when we think the reading is not accurate
How is arterial blood pressure monitored ✅non tapere teflon catheter is used to
cannulate the peripheral artery - the HCP sutures it in place and then site is immobilized
What does arterial blood pressure monitoring tell us ✅MAP / how well organs are
being perfused
What are risks/complications of arterial pressure monitoring ✅hemorrhage, infection,
thrombus formation, neurovascular impairment, loss of limb
Describe the continuous flush irrigation system with an arterial line ✅delivers 1-3 ml of
saline per hour. This maintains line patency and limits thrombus formation
,How often do we need to assess neurovascular status when a patient has an arterial
line ✅every hour need to assess the site distal to the arterial line
What is arterial pressure based CO monitoring (APCO) ✅calculates continuous CO
and CCI - used to assess pt ability to respond to fluids
Describe pulmonary artery pressure monitoring ✅guides management of patients with
complicated cardiopulmonary problems - allows for precise manipulation of preload
What do pulmonary artery diastolic (PAD) and pulmonary artery wedge pressures
(PAWP) tell us ✅they are sensitive indicators of heart function and fluid volume status
Describe a pulmonary artery flow-directed catheter ✅has a balloon inflated tip to
measure PAWP, 2 proximal lumens to measure CPV, CO, draw blood and give
fluids/drugs, also has a temperature sensor at the tip
What does the pulmonary artery wedge pressure (PAWP) tell us ✅reflects the left
ventricular end diastolic pressure
What does the central venous pressure (CVP) tell us ✅reflects the right ventricular end
diastolic pressure
What do we do with the catheter to determine the pulmonary artery wedge pressure
✅inject up to 1.5 cc of air and then retract it to get the PAWP
What is used to determine the central venous pressure ✅a central venous catheter or
a pulmonary flow directed catheter
What is the normal CVP ✅2-8
Increased - RV failure, volume overload
Decreased - hypovolemia, vasodilation
What is the normal pulmonary artery wedge pressure ✅6-12
Increased: LV failure, hypervolemia, mitral regurgiation
Decreased: hypovolemia
What does systemic vascular resistance and arterial pressure indicate ✅left ventricular
after load
What does pulmonary vascular resistance and pulmonary arterial pressure tell us
✅right ventricular after load
What does a high or low SVR tell us ✅high - vasoconstriction
, Low - vasodilation
What is normal SVR (systemic vascular pressure) ✅800-1200
What can overinflation of the balloon cause in PA pressure monitoring ✅rupture of
pulmonary artery
What is venous oxygen saturation and what is the normal value (scvo2) ✅reflects
balance among oxygenation of arterial blood, tissue perfusion and tissue oxygen
consumption - normal is 60-80%
What might a decrease in scvo2 indicate ✅decreased arterial oxygenation, low CO,
low hemoglobin levels, increased oxygen consumption or extraction
What are some complications of pulmonary artery catheters ✅infection, sepsis, air
embolus, PA rupture, ventricular dysrhythmias
How often do the flush bag, pressure tubing, transducer, and stopcock need to be
changed ✅every 96 hours
What is normap mean arterial pressure (MAP) ✅70-105
Overall what does hemodynamic monitoring tell us ✅fluid status, pressures and
oxygenation of within the CV system
What do circulatory assist devices do ✅decrease cardiac workload and improve organ
perfusion when drug therapy is no longer working or provide interim support
Describe an intra aortic balloon pump ✅provides temporary circulatory assistance by
reducing afterload - pump inflates and deflates
What are the benefits of an intra aortic balloon pump ✅decreases ventricular workload,
increases myocardial perfusion, and augments circulation - used temporarily
What are some complications of intra aortic balloon pumps ✅thrombus/embolus,
thrombocytopenia, ichemia to periphery kidneys or bowels, and infection , improper
timing of balloons
As a nurse what do we need to do to decrease risk of the intra aortic balloon pump
✅frequent assessments, keep pt immobile, limit to side lying or supine positions with
HOB raised less than 45 degrees
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