EXAM 1 Flashcards
What are the roles of a critical care nurse?
- Has in-depth knowledge of anatomy, physiology, pathophysiology, pharmacology, and advanced assessment skills, and ability to use advanced technology
- Frequent physical assessment, monitor patterns with signs and symptoms, laboratory results, hemodynamic values
- coordinate with the healthcare team
Describe critical care patients
- One who is at risk for actual or potential life-threatening health problems
- Has Hemodynamic instability
- Serious complications if not closely guarded
- Complicated medical and surgical management
- Requires close monitoring and nursing care
- Drug titration
- Intricate, frequent assessment using advanced equipment
What are the common problems of a critical care patient
Anxiety Pain Impaired Communication Sleep Sensory-Perceptual Problems ICU Psychosis / Delirium Nutrition
What is hemodynamic monitoring?
the measurement ofpressure,flow,andoxygenation within the cardiovascular system
What is the purpose of hemodynamic monitoring?
assessheart function,fluid balance, and the effects of fluids and drugs on CO
What is cardiac output and its normal range
volume of blood in liters pumped by the heart in 1 minute
normal range= 4-8L/min
What is cardiac index and its normal range
measurement of the CO adjusted for body surface area (BSA)
more precise measurement of the efficiency of the heart’s pumping action
normal range= 2.5-4.2L/min
What is stroke volume and its normal range
volume ejected with each heartbeat
normal range= 60-130 ml/beat
What is stroke volume index and its normal range
measurement of SV adjusted for BSA
normal range= 30-65ml/min/m3
What is systemic vascular resistance (SVR) and its normal range
- opposition encountered by the left ventricle
- the resistance of the systemic vascular bed
normal range= 770-1500 dynes/sec/cm3
What is pulmonary vascular resistance (PVR)
- opposition encountered by the right ventricle
- theresistance of the pulmonary vascular bed
What is preload
volume within the ventricle at the end of diastole
What is afterload
forces opposing ventricular ejection
- Systemic arterial pressure
- Resistance offered by the aortic valve
- Mass and density of the blood to be moved
Define PAWP
ameasurement of pulmonary capillarypressure,reflects left ventricular end-diastolic pressure under normal conditions
Define CVP and its normal range value
a measurement right ventricular preloadorright ventricular end-diastolic pressure
normal range value= 2-6mmHg
What is zeroing
confirms that when pressure within the system is zero, the monitor reads zero.
(Referencing) means placing the transducer (stopcock) so that the zero reference point is at the level of the atria of the heart.
What is Invasive Pressure Monitoring Arterial Blood Pressure known as?
A-line
What are some complications of Invasive Pressure Monitoring Arterial Blood Pressure?
Hemorrhage,infection,thrombus formation,neurovascular impairment, andloss of limb.
How often should you change the pressure tubing, flush the bag and transducer for?
How often do you assess the flush system?
Change thepressure tubing, flush bag, andtransducer every96 hoursoraccording to agency policy.
Assess the flush system every 1-4 hours and use normal saline to flush. System is delivering a continuous slow (approximately 3 mL/hr) flush
How do you perform the Allen test?
Apply pressure to Ulnar and Radial Artery.
Release the pressure on the ulnar artery while maintaining pressure on the radial artery.
If pinkness fails to return within 6 seconds, the ulnar artery is inadequate and you should not use theradial artery for line insertion.
What does ↑ PAD pressure and PAWP indicate?
heart failure and fluid volume overload; ↓with volume depletion
Left ventricular afterload
SVR
Right ventricular afterload
PVR
↑ afterload =
↓ decreased CO , ↑ O2demand
↑ Preload =
↑ SV, ↑ CO, ↑ O2 requirement
What are some indications for Pulmonary Artery Catheterization
Assessment of response to therapy in patients with pulmonary hypertension and mixed types of shock
Cardiogenic shock
Differential diagnosis of pulmonary hypertension
Myocardial infarction with complications (e.g., heart failure, cardiogenic shock)
Potentially reversible systolic heart failure (e.g., fulminant myocarditis)
Severe chronic heart failure requiring inotropic, vasopressor, and vasodilator therapy
Transplantation work-up
What are some contraindications for Pulmonary Artery Catheterization
Coagulopathy (may be overlooked in emergency situations)
Endocardial pacemaker
Endocarditis
Right heart mass (e.g., thrombus, tumor)
Mechanical tricuspid or pulmonic valve
What are arterial lines used for
Hemodynamic instability
Assess efficacy of vasoactive medications
Frequent blood gas analysis
What are central venous catheters used for
Measure right heart lung pressures
Estimate fluid status
Guide volume resuscitation
Assess central venous O2 saturation (ScvO2)
Administer large-volume resuscitation or irritant medications
Access to place transvenous pacemaker
What PA catheter is used for
Hemodynamic instability
Assess pulmonary artery pressures
Assess mixed venous O2 saturation (SvO2)
Directly measures cardiac output
What is the significance of Central venous oxygen saturation (SCVO2)?
Provides as assessment of balance between O2 supply and demand. Measured in the pulmonary artery. Increased values indicate ↑ supply and ↓ demand, or ability to extract O2 from blood. Decreased values indicates low Hgb, low CO, low Sao2, ↑ consumption
Describe the journey of the PA catheter
PA Catheter -> central vein -> RA -> RV -> PA
What is thermodilution?
Used to calculate preload and afterload which signifies when to adjust hemodynamic drips
What is an ability that is a primary difference in the skills of a certified critical care nurse compared with nurses certified in medical-surgical nursing?
a. Diagnose and treat life-threatening diseases
b. Detect and manage early complications of health problems
c. Provide intensive psychological support to the patient and family
d. Use advanced technology to assess and maintain physiologic function
d
Identify the rationale for the following four patients’ admissions to the intensive care unit (ICU) based on the common three reasons for why patients are admitted to the ICU.
a. Patient with diabetic ketoacidosis
b. Patient with nondisplaced skull fracture who is alert and oriented
c. Postoperative patient with mitral valve replacement
d. Comatose patient who had an anaphylactic reaction with cardiopulmonary arrest at home yesterday
- Physiologically unstable
- Risk for serious complications
- Intensive nursing support required
a= 1 b= 2 c= 2 d= 3
What is a priority nursing intervention that is indicated for the patient in the ICU who has a nursing diagnosis of anxiety related to the ICU environment and sensory overload?
a. Provide flexible visiting schedules for caregivers.
b. Eliminate unnecessary alarms and overhead paging.
c. Administer sedatives or psychotropic drugs to promote rest.
d. Allow the patient to do as many self-care activities as possible
b
Why should the critical care nurse include caregivers of the patient in the ICU as part of the health care team?
a. The costs of critical care will affect the entire family.
b. Caregivers play a valuable role in the patient’s recovery.
c. Caregivers are responsible for making health care decisions for the patient.
d. Caregivers who are ignored are more likely to question the patient’s quality of care.
b
What factor will cause a decrease in cardiac output (CO)?
a. Decreased afterload
b. Decreased heart rate (HR)
c. Increased stroke volume (SV)
d. Decreased systemic vascular resistance (SVR)
b; all other factors increase cardiac output
The patient with shortness of breath is scheduled for an impedance cardiography to differentiate if the cause is cardiac or pulmonary. How should the nurse best explain this test to the patient?
a. It is an invasive method of measuring CO.
b. Electricity is transmitted through the bones in the chest.
c. It will be most effective when the patient has generalized edema.
d. Thoracic fluid status is determined by changes in impedance with each heartbeat.
d
The patient has experienced an increased preload, which supports an increase in CO. What nursing action contributes to an increased preload?
a. Diuretic administration
b. Dopamine administration
c. Increased fluid administration
d. Calcium channel blocker administration
c
During hemodynamic monitoring, the nurse finds that the patient has a decreased CO with unchanged pulmonary artery wedge pressure (PAWP), HR, and SVR. The nurse identifies that the patient has a decrease in what?
a. Preload
b. Afterload
c. Contractility
d. Stroke volume
c
Before taking hemodynamic measurements, how must the nurse reference the monitoring equipment?
a. Position the stopcock nearest the transducer level with the phlebostatic axis.
b. Place the transducer on the left side of the chest at the fourth intercostal space.
c. Confirm that when pressure in the system is zero, the equipment is functioning.
d. Place the patient in a left lateral position with the transducer level with the top surface of the mattress.
a or c?
Which statement is accurate in describing advanced technology in critical care?
a. A pulmonary artery flow–directed catheter has a balloon at the distal tip that floats into the left atrium.
b. In the absence of mitral valve impairment, the left ventricular end-diastolic pressure is reflected by the cardiac index.
c. The pressure obtained when the balloon of the pulmonary artery catheter is inflated reflects the preload of the left ventricle.
d. When a patient has an arterial catheter placed for arterial blood gas (ABG) sampling, the low- pressure alarm must be activated to detect functioning of the line.
c
In preparing the patient for insertion of a pulmonary artery catheter, what should the nurse do?
a. Place the patient in high Fowler’s position.
b. Obtain an informed consent from the patient.
c. Perform an Allen test to confirm adequate ulnar artery perfusion.
d. Ensure that the patient has continuous electrocardiographic (ECG) monitoring.
d
What is a rationale for the use of arterial pressure–based CO (APCO) monitoring instead of a pulmonary artery catheter?
a. Dysrhythmia
b. Atrial fibrillation
c. Less invasive technique
d. Mechanical atrial or mitral valve
c or d?
A patient has central venous oxygen saturation/mixed venous oxygen saturation (ScvO2/SvO2) of 52%, CO of 4.8 L/min, SpO2 of 95%, and an unchanged hemoglobin level. For what should the nurse assess the patient?
a. Dysrhythmias
b. Pain or movement
c. Pulmonary edema
d. Signs of septic shock
b?
The nurse observes a PAWP waveform on the monitor when the balloon of the patient’s pulmonary artery catheter is deflated. What should the nurse recognize about this situation?
a. The patient is at risk for embolism because of occlusion of the catheter with a thrombus.
b. The patient is developing pulmonary edema that has increased the pulmonary artery pressure.
c. The patient is at risk for an air embolism because the injected air cannot be withdrawn into the syringe.
d. The catheter must be immediately repositioned to prevent pulmonary infarction or pulmonary artery rupture.
b or d?
A patient with which disorder would benefit from the use of the intra aortic balloon pump (IABP)?
a. An insufficient aortic valve
b. A dissecting thoracic aortic aneurysm
c. Generalized peripheral vascular disease
d. Acute myocardial infarction (MI) with cardiogenic shock
d
Which statement about the function of the IABP is accurate?
a. Deflation of the balloon allows the HR to increase.
b. A primary effect of the IABP is increased systolic blood pressure.
c. The rapid deflation of the intra aortic balloon causes a decreased preload.
d. During intra aortic counterpulsation, the balloon is inflated during diastole.
d
