AAH EXAM 1- CHAPTER 65 CRITICAL CARE
QUESTIONS AND ACTUAL ANSWERS.
What,is,hemodynamic,monitoring?,,ANS,-,,-
measurement,of,pressure,,flow,,and,oxygenation,within,the,cardiovascular,system
-assesses,heart,function,,fluid,balance,,and,effects,of,drugs,on,cardiac,output
What,are,we,monitoring,with,hemodynamic,monitoring?,,ANS,-
,,Invasive,and,noninvasive,measurements,such,as,systemic,and,pulmonary,arterial,pressures,,central,ven
ous,pressure,(CVP),,pulmonary,artery,wedge,pressure,(PAWP),,cardiac,output/cardiac,index,(CI),,stroke,v
olume,(SV)/stroke,volume,index,(SVI),,stroke,volume,variation,(SVV),,O2,sat,,mixed,venous,O2,sat,(SvO2)
what,is,cardiac,output,(CO)?,,ANS,-,,-
The,volume,of,blood,pumped,per,minute,by,each,ventricle,of,the,heart.
-
continuous,cardiac,output,(CCO):,measures,with,PA,catheter,w/thermal,filament,located,in,right,atrium,,
senses,change,in,temp,of,blood,as,it,passes,thru,right,ventricle,,measures,every,30-
60,secs,,reflects,average,CO,for,past,3-6,mins
what,is,cardiac,index,(CI)?,,ANS,-,,CO,adjusted,for,body,surface,area,(BSA)
what,is,stroke,volume,(SV)?,,ANS,-,,volume,ejected,with,each,heartbeat
what,is,stroke,volume,index?,,ANS,-,,measurement,of,SV,adjusted,for,BSA,(body,surface,area)
what,is,systemic,vascular,resistance,(SVR),or,pulmonary,vascular,resistance,(PVR)?,,ANS,-
,,opposition,to,blood,flow,by,systemic,and,pulmonary,vasculature.,(resistance,of,the,systemic,vascular,be
d,&,pulmonary,vascular,bed,,reflects,afterload),preload,,after,load,,and,contractility,determines,SV
what,is,preload?,,ANS,-,,volume,of,blood,in,ventricles,at,end,of,diastole
-PAWP,(pulmonary,artery,wedge,pressure),reflects,left,ventricular,end-diastolic,pressure
-CVP,(central,venous,pressure),reflects,right,ventricular,end-diastolic,pressure
,what,is,afterload?,,ANS,-,,forces,opposing,ventricular,ejection
-SVR,(systemic,vascular,resistance),and,arterial,pressure,indices,of,left,ventricular,afterload.,
-
PVR,(pulmonary,vascular,resistance),and,pulmonary,arterial,pressure,indices,of,right,ventricular,afterloa
d
What,are,the,components,of,a,pressure,monitoring,system?,,ANS,-
,,pressure,bag,,flush,solution,,monitor,,3,way,stopcock,,transducer,,continuous,flush,valve,,fast,flush,devi
ce,,pressure,cable,from,transducer,to,monitor,,connection,for,specimen,collection,,pressure,tubing
What,is,the,swan,gantz?,,ANS,-
,,a,pulmonary,arterial,catheter,that,is,balloon,tipped,and,used,for,measuring,pulmonary,capillary,wedge,
pressure,(PCWP)
Why,is,it,important,to,zero,reference,the,transducer,and,perform,a,dynamic,response,test,during,initial,s
etup,of,the,equipment?,,ANS,-
,,pressure,monitoring,equipment,is,referenced,and,zero,balanced,to,the,environment,and,dynamic,respo
nse,characteristics,optimized,for,accuracy.,Referencing,means,positioning,the,transducer,so,that,the,refe
rence,point,is,at,the,level,of,the,atria,of,the,heart.,The,stopcock,nearest,the,transducer,is,usually,the,zero
,reference,for,the,transducer.
Where,is,the,phlebostatic,axis,located?,,ANS,-
,,to,place,the,level,with,the,atria,,you,use,the,external,landmark,(phlebostatic,axis),which,is,located,midw
ay,between,the,anterior,and,posterior,chest,at,the,fourth,intercostal,space
How,is,level,and,zeroing,done,on,the,pressure,monitor?,,ANS,-
,,by,opening,reference,stopcock,to,room,air,(off,to,patient),with,initial,setup,and,periodically,thereafter
dynamic,response,test,(square,wave,test),,ANS,-
,,Verifies,the,transducer,system,accurately,reflects,displayed,pressures.,Optimally,damped,system.,using,
the,fast,flush,system:,normal,response.,No,adjustment,in,the,monitoring,system,is,needed.
What,are,types,of,invasive,monitoring?,,ANS,-,,Arterial,blood,pressure,monitoring-
,various,indications,when,continuous,BP,measurements,useful,,non-
, tapered,Teflon,catheter,used,to,cannulate,peripheral,artery,,HCP,sutures,in,place,,immobilize,insertion,si
te
arterial,pressure,monitoring,,ANS,-
,,A,,Simultaneously,recorded,electrocardiogram,(ECG),tracing.,B,,Systemic,arterial,pressure,tracing.,Systol
ic,pressure,is,the,peak,pressure.,The,dicrotic,notch,indicates,aortic,valve,closure.,Diastolic,pressure,is,the,
lowest,value,before,contraction.,Mean,pressure,is,the,average,pressure,over,time,calculated,by,the,moni
toring,equipment
Nursing,interventions,for,an,arterial,line,,ANS,-
,,high,and,low,pressure,alarms,(adjust,as,needed,,may,need,physician,order),,risks/complications,(hemor
rhage,,infection,,thrombus,formation,,neurovascular,impairment,,loss,of,limb),,continuous,flush,irrigatio
ns,system,(delivers,1-
3,mL,of,saline/hr,,maintains,line,patency,,limits,thrombus,formation),,assess,neurovascular,status,distal,t
o,arterial,insertion,site,hourly,,left,jugular,vein,should,never,be,used
Arterial,pressure,based,CO,,ANS,-,,-calculates,continuous,CO,and,CCI
-used,to,assess,patient's,ability,to,respond,to,fluids
-uses,arterial,waveform,characteristics,and,patient,demographic,data,to,calculate,SV,and,pulse,rate,to
-calculate,CCO/CCI,and,SV/SVI,every,20,seconds
Pulmonary,artery,(PA),pressure,,ANS,-,,-
guides,management,of,pts,w/complicated,cardiopulmonary,problems,
-PA,diastolic,(PAD),pressure,and,PAWP,are,sensitive,indicators,of,heart,function,and,fluid,volume,status
-allows,for,precise,manipulation,of,preload
PA,(Pulmonary,Artery),monitoring,,ANS,-,,PA,flow-directed,catheter,(e.g.,,Swan,Gantz):
-distal,lumen,port,in,PA
-balloon,inflated,to,measure,PAWP
-2,proximal,lumens,to,measure,CVP,,inject,fluid,for,CO,,draw,blood,,administer,fluids,or,drugs
-temp,sensor,near,distal,tip
Specialized,features:
-atrial,electrode