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NUR325 FINAL EXAM QUESTIONS AND CORRECT ANSWERS
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NUR325 FINAL EXAM QUESTIONS AND CORRECT ANSWERScardiac output
-volume of blood pumped out by both ventricles per minute
- HR x stroke volume
-about 4-8 L/min
-take ejection fraction into account: should be btwn 60-70%
-HR is the major determinant of CO
contractility
-pt at risk for changes
-cannot directly monitor
-improve: catecholamines, meds - adrenaline, dig, dopamine, dobutamine
-decreased: hypoxemia, acidosis, meds - beta blockers
-increased contractility: increased SV and vice versa
-strength of contraction that pushes blood forward
-pt at risk for changes
-determines how much blood in ventricles
-increased blood return to heart, increased SV
-increased preload, creates increased oxygen demand (LOTS of work on heart): edema
and hypovolemia, HF, mitral stenosis and regurgitation
-decreased preload: hypovolemic shock, impaired atrial contraction
,afterload
-pt at risk for changes
-pressure or resistance against flow, r/t lumen size and viscosity
-systemic is force overcome by left ventricle
-pulm is force overcome by right ventricle
-increase: aortic stenosis, systemic HTN > eventually ventricular hypertrophy occurs,
can reduce ejection fraction
-decrease: any process that lowers BP, mitral regurgitation > causes left ventricle
hypertrophy
A line
-for pt requiring freq lab work, managed w vasoactive agents, hemodynamically
unstable
-need to do allen's test prior to inserting, assess the perfusion bc don't want to cut off
blood flow
-complications: thrombosis, embolism, hemorrhage, infection
A line nursing care
-neurovascular assessment
-assess every hour
pulse, pallor, cap refill <3s, no bleeding or hematoma, testing of sensation and mvmnt
-documentation- the neuro assessment and line assessment
-maintain and change occlusive dressing
-maintain patency of system
-tubing is free of kinks, tight and secure connections, limit use
-alarms turned on
-NO MEDS through A line
nursing care of invasive lines
-ensure transducer is ALWAYS at the phlebostatic axis!! freq reassess the level
-compare NIBP w the IBP, should be about the same
-make sure all the connectors are secure
,-nothing is pushed from this line but blood can be pulled from these
RAP/CVP
-only difference is type of catheter used and location but same readings
-direct measurement of pressure in right atrium
-assesses preload of the heart to determine fluids to give the pt
-normal should be 2-6mmHg
-comps: infection, pneumothorax or hemothorax, carotid puncture, heart perforation,
dysrhythmias
RAP/CVP nursing mgmnt
-zero/balance device and flush
-waveform analysis
- resp ventilation and PEEP
-pt position : HOB btwn 0 and 60 degrees to ensure transducers is at phlebostatic axis
-correlate values w assessment, number may not be right and smthn could be incorrect
w line
-monitor complications
-monitor how the pt is responding to this intervention
PAC
-reflects left ventricular function and direct monitoring of CO
-position pt correctly for insertion: trendelenburg w a towel roll btwn shoulder blades (pt
w likely be on their side)
-check proper wedging for PAOP: seen by looking at waveform
-prior insertion: take vitals, pt education and informed consent, set up equip and
position the pt
-during insertion: ensure sterility and assist MD, monitor and record chamber
pressures, monitor for complications, vitals, record the number length (think NG tube)
Normal Sinus
-60-100bpm
-regular rhythm
, PR interval .12-.20
QRS below .12
P and QRS are consistent shape, P wave before every QRS, QRS always followed by T
wave
brady
cause and trmnt
<60 bpm
causes: vagal, drugs, ischemia, nodal disease, increased ICP, hypoxemia, athletes
can have decrease in CO > could cause decreased organ perfusion
stop offending drugs, take VS first i.e. (beta blockers, etc.)
adm atropine, if atropine doesn't work then use TCP (transcutaneous pacing)
epi infusion, dopamine
-pacemaker: only if pt is symptomatic and determine cause
symptomatic brady process
-only treat symptomatic pts!! example, don't treat if athlete
-ABCD w CPR
-airway, O2, IV access
-atropine: last a in brady stands for atropine!
-consider cause
-transcutaneous pacing
-dopamine or epi
-no lidocaine
sinus brady s/s
-hypotension
-pale, cool skin
-weakness
-angina
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