Hemodynamics Flashcards

1
Q

2 things Validity must have

A

Consistency
Integrity (accurate data) - nurse’s responsibility

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2
Q

*Equation for pressure

A

Pressure = flow X resistance
*(Increased flow &/or resistance = increased pressure)
*(increased volume = increased pressure)

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3
Q

Common types of hemodynamic monitoring

A
  • Arterial pressure monitoring (Art line)
  • Pulmonary artery pressure monitoring (PA catheter; Swan Ganz)
  • Right atrial pressure monitoring (RAP or CVP: central venous pressure)
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4
Q

What does the transducer do?

A

Converts physiological events into electrical signals

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5
Q

What does the amplifier do?

A

Picks up electrical signal and transmits to display through cable

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6
Q

What should the bag be pressurized at for hemodynamic monitoring?

A

300 mm Hg to keep line open

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7
Q

*What is the nurse responsible for when taking care of a hemodynamic monitoring device?

A

Level
Balance
Calibration

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8
Q

What is the level called? where is it?

A

Phlebostatic axis (4th ICS MAL) - where the transducer is leveled (transducer should be on IV pole, kept at this level)

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9
Q

What is the balance?

A

Zero reference (negates atmosphere pressure) - button on machine to take away atmosphere pressure

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10
Q

Why is calibration done?
How is it done?
When is it done?

A

For numerical accuracy

done with a *square wave test:
- 1x per shift
- during position changes
- after blood draw

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11
Q

Indications for intraarterial monitoring (minute to minute BP monitoring)

A
  • Continuous BP monitoring (severe hyper/hypotension)
  • Blood drawing
  • Vasopressor infusions
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12
Q

Sites for intraarterial monitoring:

A

Radial = preferred
Brachial
Femoral (no longer recommended)

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13
Q

Nursing consideration for radial intraarterial monitoring

A

Perform Allen test for circulation: to make sure ulnar artery is open & functional incase radial is damaged from this

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14
Q

**Nursing responsibilities for Intraarterial Monitoring

A
  • Monitor waveform
  • Compare values with BP cuff (A-line should be more accurate)
  • Check connections in system
  • Check site and circulation to extremities (q2hr)
  • Set alarms
  • Hold pressure for at least 5 min when dc’d (femoral at least 20 min)
  • Infection control
  • Maintain patency of system
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15
Q

Infection control nursing considerations for intraarterial monitoring

A
  • change dressing/bag/tubing per protocol
  • document dates for insertion/dsg changes
  • assess for s/s of infection q4hr
  • limit disconnecting system/sterile caps (keep system closed as much as possible)
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16
Q

Nursing considerations to maintain patency of system for intraarterial monitoring

A
  • flush after each use
  • maintain pressure of 300 mm Hg
  • ensure adequate amount of flush solution
17
Q

How much blood should be drawn from A-line and discarded?

A

3-10 mL, depends on hospital policy

18
Q

Possible complications for intraarterial monitoring

A

Air Embolus = major complication (keep connections tight to avoid)
Hemorrhage (keep connections tight to avoid)
Thrombosis
Infection

19
Q

Another name for Right Atrial Pressure

20
Q

What does right atrial pressure measure?

A

RV preload / RVEDP

21
Q

What is preload?

A

Volume of blood in right ventricle just prior to systole

22
Q

*What does preload affect?

A

*Stroke volume and cardiac output

23
Q

Normal CVP

24
Q

*Interpretation for if CVP is low:

A

1st think: *Hypovolemia
Tx: give fluids (prob IV, like saliene bolus)
If no improvement in output/CVP: *Vasodilation
Tx: vasopressor like: norepi (Levafed)

25
*Interpretation for if CVP is high
1st think: *hypervolemia Tx: diuretics (furosemide) If doesnt work think: *vasoconstriction (pt in shock) Tx: vasodilator like nitroglycerin or nitropresside OR *right CHF OR *pulmonary hypertension
26
Function of pulmonary artery catheter (swan ganz)
*Reflects left heart pressures Can also measure cardiac output *Wedge pressure aka *PA pressure aka *PCWP
27
Nurse’s job during insertion of PA catheter
Monitor pressures in each chamber Record values Assess for complications (dysrhythmias/pneumo/hemothorax)
28
*Interpretation of increased PA pressures
1st think: *volume overload (CHF) Tx: diuretics 2nd think: vasoconstriction Tx: vasodilators
29
*Interpretation of decreased PA pressures
1st think: *volume depletion Tx: correct IV fluids 2nd think: vasodilation Tx: correct with vasoconstrictor
30
What does TEE stand for?
Transesophageal echo
31
What is an esophageal Doppler? What does it do?
Thin silicone probe placed in distal esophagus to evaluate descending aortic blood flow (LV function)