T1: Hemodynamic Monitoring

Question 1

what is end organ perfusion

Answer 1

the needed amount of blood and BP to perfuse a specific organ

Question 2

what is the mean arterial pressure for the kidney

Answer 2

60 or above

Question 3

what is the mean arterial pressure for the braain

Answer 3

80-100

Question 4

what area of the hearts tells us about JVD

Answer 4

atrium

Question 5

what does right arterial pressure tell us about a patient

Answer 5

the fluid status

Question 6

the pulmonary artery will tell us

Answer 6

the pressure in the lungs

Question 7

Central venous pressure (CVP)

Answer 7

pressure in the superior vena cava

Question 8

Cardiac Output (CO)

Answer 8

volume of blood pumped by heart in 1 minute

Question 9

Systemic and pulmonary arterial pressures

Question 10

Pulmonary artery wedge pressure (PAWP/PAOP)

Answer 10

6-12mmHg

Question 11

preload

Answer 11

Volume of blood within ventricle at end of diastole

Question 12

afterload

Answer 12

Forces opposing ventricular ejection

Question 13

Cardiac Index (CI)

Answer 13

CO adjusted for body surface area (BSA)

Question 14

contractility

Answer 14

◦Strength of ventricular contraction
No direct clinical measures (can’t really measure until we get an echocardiogram

Question 15

Stroke volume (SV)/stroke volume index (SVI)

Answer 15

The amount of blood pumped out of the heart with each contraction (heart beat)

Question 16

Stroke volume variation (SVV)

Answer 16

measuring the percent increase in SV after a fluid bolus

Question 17

O2 saturation of arterial blood (SaO2)

Answer 17

percentage of oxygen-saturated hemoglobin relative to total hemoglobin in the arterial blood
95-100%

Question 18

Mixed venous O2 saturation (SvO2)

Answer 18

Determines adequacy of tissue oxygenation, status, response to treatment/activity
60-80%

Question 19

where can Pulse oximetry (SpO2) be found

Answer 19

finger tip, toes, forehead, earlobe

Question 20

Where should the transducer be placed for accurate measure of pressure?

Answer 20

plebostatic axis (basically armpit)

Question 21

after the transducer is placed at the plebostatic axis what should be done

Answer 21

zero and calibrate it

Question 22

Referencing

Answer 22

placing transducer so zero-reference point is at level of atria of heart or phlebostatic axis

Question 23

what does the square wave test tell you

Answer 23

tells you if the equipment is working

Question 24

how can we create waves with the square wave test

Answer 24

◦Flushing system creates wave

Question 25

Too many spikes or whipping on square wave test

Answer 25

◦False HIGH reading

Question 26

No spikes or whipping with gradual return to normal on square wave test

Answer 26

◦BLOCKAGE

Question 27

when using invasive pressure monitoring, what should you never do

Answer 27

NEVER TURN A LINE OR VENTILATOR ALARMS OFF OR SILENCE IT

Question 28

dicrotic notch

Answer 28

brief rise in aortic pressure as blood rebounds off closed valve

Question 29

Central Venous Pressure (CVP) Monitoring measures

Answer 29

right ventricular preload that reflects fluid volume

Question 30

Central Venous Pressure (CVP) Monitoring is obtained from

Answer 30

◦Central venous catheter ◦PICC line-open ended ◦PA (pulmonary artery) catheter

Question 31

where must the tip of the catheter lie for CVP to be accurate

Answer 31

SVC (superior vena cava)

Question 32

SvO2 and ScvO2 reflect..

Answer 32

balance among oxygenation of arterial blood, tissue perfusion, and tissue oxygen consumption

Question 33

CVP measures

Answer 33

central venous oxygen saturation (ScvO2)

Question 34

PA measures

Answer 34

mixed venous oxygen saturation (SvO2)

Question 35

normal Systemic Venous Oxygen Saturation (SvO2)

Answer 35

60% to 80% at rest

Question 36

Decreased in SvO2 or ScvO2 may indicate:

Answer 36

◦Decreased arterial oxygenation ◦Low CO ◦Low hemoglobin level ◦Increased oxygen consumption or extraction

Question 37

PA Catheter Complications

Answer 37

-Infection and sepsis -Air embolus (e.g., disconnection) -Pulmonary infarction or PA rupture -Ventricular dysrhythmias

Question 38

PA Catheter Complications: Infection and sepsis intervention

Answer 38

◦Asepsis for insertion and maintenance ◦Change flush bag, pressure tubing, transducer, and stopcock every 96 hours

Question 39

PA Catheter Complications: Air embolus intervention

Answer 39

◦Monitor for balloon integrity ◦Luer-Lok connections; alarms on

Question 40

PA Catheter Complications: Pulmonary infarction or PA rupture intervention

Answer 40

◦Do not inflate balloon with more than 1.5 mL ◦Monitor waveforms continuously ◦Maintain continuous flush system

Question 41

PA Catheter Complications: Ventricular dysrhythmias intervention

Answer 41

◦Monitor during insertion and removal ◦Also for migration of PA catheter

Question 42

Nursing Management for Hemodynamics

Answer 42

◦General appearance ◦Level of consciousness ◦Skin color/temperature ◦Vital signs ◦Peripheral pulses ◦Capillary refill ◦Urine output

Question 43

what is the purpose of Circulatory Assist Devices (CADs)

Answer 43

Decrease cardiac work and improve organ perfusion

Question 44

Intraaortic Balloon Pump (IABP)

Answer 44

Provides temporary circulatory assistance by reducing afterload inserted in femoral artery

Question 45

IABP Complications

Answer 45

1)Thrombus and embolus formation 2)Thrombocytopenia 3)Ischemia to periphery, kidneys, bowel 4)Infection 5)Mechanical malfunction

Question 46

Ventricular Assist Devices (VADs) is for

Answer 46

Short- and long-term support for failing heart Bridge while awaiting transplant

Question 47

Ventricular Assist Devices (VADs) Shunts blood from

Answer 47

left atrium or ventricle to device, then to the aorta

Question 48

Implantable Artificial Heart

Answer 48

Fully implantable device Can sustain the body's circulatory system