HEMØDYNAMIC MÖNITÕRING Flashcards
What is a CVAD?
A Catheter that is placed on large blood vessels of people who require frequent access to their vascular system
What is a PICC line?
A peripherally-placed non-tunneled catheter that sits in the superior vena-cava just above the Atria
What may be an indication for a PICC line?
- Compromised/inadequate peripheral access
- Infusion of hyperosmolar or highly acidic/alkalotic solutions
- Continual infusion of an irritating agent (Chemo, etc)
- Short/long acting IV antibiotics
What are some nursing assessments for a PICC line?
- Insertion is Verified via diagnostic imaging
- Insertion site is clean with tissue dressing
- Infusion tubing is secured, labelled with Ø leakage
When should a physician be notified in regards to a PICC line?
- Excessive bleeding
- New/change in cardiac rhythms
- Sudden onset of unexplained respiratory distress
- Chest pain
- Pain, Edema, Numbness, Tingling, Swelling or decreased circulation in cannulated arm
What does Cardiac Output mean?
Volume of blood pumped by heart in 1 minute
WHat is preload?
Volume of blood within chamber of the heart at the end of diastole (After contraction)
What does afterload mean?
Forces opposing ventricular ejection (What the heart has to pump against in order to empty)
What is the normal range of pH in the blood?
7.35-7.45 (7.40)
What is the normal range of PaCO2? A/ 35-45 B/ 40-50 C/ 32-45 D/ 28-38
A/ 35-45
What is the normal range of BiCarbonate (HCO3)? A/ 22-28 B/ 20-26 C/ 22-26 D/ 26-32
C/ 22-26
A decrease in cardiac contractions is a common side effect of a ___ imbalance
Acidic imbalance
The interference with muscular functioning is attributed to a ____ imbalance.
Alkalotic imbalance
A decrease in tissue oxygenation can be attributed to a ____ imbalance.
Alkalotic imbalance
This type of imbalance can decrease to response and actions of certain medications significantly.
Acidic imbalance
Explain what the respiratory buffer system in relation to CO2 and what it does.
When CO2 is in the blood, it binds to Water and forms Carbonic acid (H2CO3), triggering the lungs to increase or decrease rate and depth of respirations based upon the levels in the blood.
CO2 increases - Respirations increase
CO2 decreases - respirations decrease
Explain the Renal buffer system and how it works.
Kidneys excrete or retain Bicarbonate depending on the body’s needs.
If blood is alkalotic, Kidneys release HCO3 (alkalinic) through the urine to equalize pH
If Blood is acidic, HCO3 is release in urine to equalize the pH
What are common signs of Respiratory Acidosis on an Arterial Blood gas assessment?
Increased PaCO2 with a decreased pH
What are signs and symptoms of respiratory acidosis?
dyspnea, respiratory distress, shallow respirations.
Headache, restlessness confusion.
Tachycardia, dysrhythmias
What are signs and symptoms of respiratory alkalosis?
Lightheadedness, numbness and tingling, confusion, inability to concentrate
Dysrhythmias, palpitations
Mostly changes in awareness and cognitive functioning
What are common signs of Respiratory Alkalosis on an Arterial Blood gas assessment?
Decreased PaCO2 (Carbon dioxide), increased pH
What are common signs of Metabolic Acidosis on an Arterial Blood gas assessment? What are some signs and symptoms of Metabolic acidosis?
Decreased HCO3 (BiCarbonate); decreased pH
Headache, confusion and restlessness -> lethargy, stupor -> COMA
Kussmaul Respirations to release more CO2
Warm-flushed skin, nausea, emesis
What are common signs of Metabolic Alkalosis on an Arterial Blood gas assessment? What are some signs and symptoms of Metabolic alkalosis?
Increased HCO3 (Bicarbonate), Increased pH
Dizziness, Lethargy, disorientation, seizures, coma
Weakness, muscle twitching, muscle cramps, tetany
Nausea emesis
Respiratory depression - to decrease acid
What can happen to Potassium during Metabolic acidosis/alkalosis? Why?
Hyperkalemia or Hypokalemia (depending on levels of H+
Acidosis = increased H+ levels in ECF that moves into the cell pushing K+ out = Hyperkalemia
Alkalosis = H+ moves out the the cell and into the ECF, bringing more K+ into the cell = Hypokalemia
How do you know someone is Fully compensated during an imbalance?
If their pH is within normal values
How do you know if someone is partially compensated?
pH is abnormal, but evidence suggests that mechanisms are in place to bring about balance.
Interpret the Following….
pH: 7.28
PaCO2: 24mmHg
HCO3: 11 mEq/L
Metabolic Acidosis, with partial respiratory compensation.
HCO3 is lower than the PaCO2 value, suggesting it was the initial imbalance. PaCO2 is low too suggesting compensation, but the pH is still off…
Interpret the Following….
pH: 7.33
PaCO2: 47mmHg
HCO3: 24 mEq/L
Respiratory acidosis, with Ø compensation from the kidneys.
Interpret the Following….
pH: 7.36
PaCO2: 64mmHg
HCO3: 35 mEq/L
Respiratory Acidosis with Fully compensated Metabolic Alkalosis
pH = Normal
PaCO2: Very high
HCO3: Very high
Interpret the Following….
pH: 7.49
PaCO2: 58mmHg
HCO3: 43 mEq/L
Metabolic Alkalosis, Partially compensated by Respiratory Acidosis.
Why is this combined acidosis?
pH: 7.23
PaCO2: 47mmHg
HCO3: 19 mEq/L
Because….
pH is Low (Acidosis)
PaCO2 is high (TOO MUCH CO2 = Acidosis)
HCO3 is Low (No enough Bicarb = Acidosis)
Interpret the Following….
pH: 7.48
PaCO2: 32 mmHg
HCO3: 24 mEq/L
Respiratory Alkalosis uncompensated.
Because the Bicarb levels are normal. Could be early stages of imbalance…
Interpret the Following…. How might the patient be presenting?
pH: 7.51
PaCO2: 24 mmHg
HCO3: 19 mEq/L
Respiratory Alkalosis, with partially compensated metabolic acidosis.
Lightheadedness, numbness fatigue.
Interpret the Following….
pH: 7.27
PaCO2: 57 mmHg
HCO3: 25 mEq/L
Uncompensated Respiratory Acidosis.
Interpret the Following….
pH: 7.36
PaCO2: 35 mmHg
HCO3: 22 mEq/L
Ø imbalance present.
Interpret the Following….
pH: 7.29
PaCO2: 63 mmHg
HCO3: 30 mEq/L
Respiratory Acidosis, Partially compensated by Metabolic Alkalosis. Is considered partially compensated because the Increase of HCO3… even though the pH is still low
