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Critical Care > Hemodynamics > Flashcards

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
Q

*Interpretation for if CVP is high

A

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
Q

Function of pulmonary artery catheter (swan ganz)

A

*Reflects left heart pressures
Can also measure cardiac output
*Wedge pressure aka *PA pressure aka *PCWP

27
Q

Nurse’s job during insertion of PA catheter

A

Monitor pressures in each chamber
Record values
Assess for complications (dysrhythmias/pneumo/hemothorax)

28
Q

*Interpretation of increased PA pressures

A

1st think: *volume overload (CHF)
Tx: diuretics
2nd think: vasoconstriction
Tx: vasodilators

29
Q

*Interpretation of decreased PA pressures

A

1st think: *volume depletion
Tx: correct IV fluids
2nd think: vasodilation
Tx: correct with vasoconstrictor

30
Q

What does TEE stand for?

A

Transesophageal echo

31
Q

What is an esophageal Doppler? What does it do?

A

Thin silicone probe placed in distal esophagus to evaluate descending aortic blood flow (LV function)

Critical Care (35 decks)

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