Download Med Surg III Quiz 2: Pressure Monitoring Systems, Heart Failure, and Pacemakers and more Exams Nursing in PDF only on Docsity!
N420 Med Surg III Quiz 2 Questions With Complete Solutions 4 components of a pressure monitoring system -invasive catheter -transducer -flush system -bedside monitor Invasive catheter attached to high pressure tubing which connects to the transducer Transducer
- converts the pressure coming from the artery or heart chamber into an electrical signal (waveform)
- needs to be zeroed at least once a shift and when it is set up
- must be at phlebostatic axis phlebostatic axis level of right atrium; 4th intercostal space at mid-axillary line flush system heparinized saline so line won't clot; maintained at 300 mmHg at 3-5 mL/hr Bedside monitor
displays the electrical signal into a waveform Arterial Line
- catheter inserted in radial or femoral artery
- used for monitoring and data collection only (ABG blood; BP reading)
- NEVER used for meds
- assess for distal or collateral circulation using Allen Test
- doctor must confirm before using the line Indications for an A-Line critically ill patient with hypertension/hypotension or on vasoactive meds such as nipride, dobutamine (dopamine), epi/norepi, phenylephrine MAP of ___ to ___ is desirable, but ___ is bare minimum to perfuse vital organs (heart and brain) 70 to 105, but 60 Arterial waveform
- should have dicrotic notch indicating the closure of the aortic valve
- if no notch -> may not be in artery or there is some issue with the pressure reading system dampened arterial waveform
- hematoma
- air embolism central venous pressure monitoring (CVP)
- direct measure of the pressure in the vena cava or right atrium (RAP)
- can be single, double or triple lumen
- measure preload (filling pressure) of right ventricle
- NORMAL: 2-
- looks at trends
- CAN administer fluid, blood, meds, etc.
- must have chest xray and verify by doc
- goes through subclavian or internal/external jugular causes of a LOW CVP
- hypovolemia
- vasodilation
- gas tank is EMPTY causes of high CVP
- hypervolemia
- vasoconstriction
- HF
- pulm HTN
- cardiac tamponade
- gas tank is FULL CVP complications
- infection
- pneumothorax
- air embolism CVP nursing interventions
- dry sterile occlusive dressing
- confirm placement with CXR
- monitor pressure trends
- change dressing
- frequency of measurements in accordance with pt's condition Pulmonary Artery Pressure Monitoring (PAP)
- aka Swan Ganz
- balloon tipped, flow directed cath with distal and proximal lumens (4-5 lumens) pulmonary artery pressure (PAP) measurements
- R atrial pressure or CVP
- pulmonary artery pressure
- pulmonary artery occlusion pressure (PAOP) aka wedge pressure
- CO & CI PAP indications
- hemodynamically unstable
- need fluid management
- continuous cardiopulmonary assessment
- increased: hypervolemia, mitral valve stenosis or regurgitation, LV failure, high PEEP heart failure
- inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
- cannot pump volume needed to maintain the body's needs causes of HF
- any condition that impairs the ability of the ventricles to fill or eject blood
- post MI, infection, cardiomyopathy, uncontrolled HTN left sided ventricular HF
- disturbance of LV
- results in low CO
- leads to vasoconstriction and raises SVR and afterload LSHF patient findings
- decreased peripheral perfusion (pulses, cap refill, color)
- pulmonary edema (wheezing, crackles)
- dyspnea, hypoxemia
- eventually RSHF as well S/S of LSHF tachypnea tachycardia cough
crackles gallop rhythms increased PAP hemoptysis cyanosis pulm edema fatigue dyspnea orthopnea right sided ventricular heart failure
- right ventricle cannot empty completely
- fluid overload S/S of RSHF peripheral/sacral edema hepatomegaly splenomegaly ascites jvd increased CVP pulmonary HTN weakness anorexia indigestion weight gain mental changes
- control symptoms
- diuretics, morphine, vasodilators, nitrates, inotropes/indoilators
- cath/echo to determine cause
- palliative care BNP
- released from cardiac ventricles in response to increased wall tension
100 = dyspnea r/t cardiac vs pulmonary failure
400 = cardiac failure
- <100 = pulmonary cause
- degree of HF increases with BNP nursing management for HF pt
- assess often
- optimize O2 delivery
- monitor for dysrhythmias
- monitor labs
- assess urine output
- aggressive pharm interventions
- monitor body weight
- activity restrictions
- nutrition -> decreased Na and fluid
- patient education
- palliative care possible pacemaker
- device used to pace the heart when the normal conduction pathway is damaged or disrupted
- consists of power source, one or more conducting leads, and myocardium
- can be temporary or permanent temporary pacemaker types External (transcutaneous) Epicardial (transthoracic) Endocardial (transvenous) external (transcutaneous) pacemaker
- pads on the patient
- energy delivered through the thoracic musculature of the heart through two electrode patches placed on the skin
- requires large amounts of electricity and can be very painful
- used only in emergency resuscitation when pacing wires are not already inserted epicardial (transthoracic) pacemaker
- energy delivery through the thoracic musculature of the heart through lead wires
- can pace atria, ventricles, or both
- commonly used during and after open heart surgery Endocardial (transvenous) Pacemaker
- phrenic nerve, diphragmatic
- cardiac perforation 3 types of pacemaker malfunctions
- failure to pace
- failure to capture
- failure to sense failure to pace malfunction
- pacemaker mechanical problem
- NO pacer spikes at all failure to capture malfunction
- pacer fires but fails to initiate myocardial depolarization
- pacer spikes are present but no depolarization (or wave) afterwards failure to sense malfunction
- pacer fails to recognize spontaneous atrial or ventricle activity
- fires inappropriately
- pacer spikes are present but are inappropriate so they don't cause depolarization where necessary S/S of pacemaker malfunctions
- decreased CO
- symptoms depend on severity of malfunction and patient's underlying condition
- diagnosed through ECG analysis
atrial pacing Sharp spike before the P wave ventricular pacing spike before QRS complex AV sequential pacing will see pacing spikes before QRS and P waves. shock inadequate delivery of oxygen and nutrients to the peripheral tissue bed (body's cells) perfusion triangle
- contractility (heart pump function) - damage to heart and therefore cannot move blood adequately to support perfusion
- preload (blood content function) - blood/plasma is lost and the volume in the container is not enough to support perfusion
- afterload (container function) - if all vessels dilate at once, normal amount of blood volume is not enough to fill the system and provide adequate perfusion systemic inflammatory response syndrome (SIRS)
- Widespread, uncontrolled acute inflammatory response to a severe insult
o GI and GU bleeding o Hemoptysis o Mental status changes o Hypotension, tachycardia o pain DIC treatment
- minimize needle sticks, BP measurements with cuff
- administer IV heparin
- administer platelet concentrate and fresh frozen plasma
- call RRT
- identify and reverse trigger types of shock Hypovolemic Distributive (anaphylactic, septic, neurogenic) Cardiogenic Obstructive stages of shock
- Initial
- Compensatory
- Progressive
- Refractory initial stage of shock
- CO decreased
- tissue perfusion threatened
- lactic acid rises > 4 compensatory stage of shock
- SNS triggered
- epi/norepi increase HR, SVR and contractility
- shunt blood to heart and brain
- glucocorticoids progressive stage of shock
- drop in CO = decreased perfusion
- lactic acid levels rise
- increased vascular permeability
- cell death refractory stage of shock
- further decline
- MODS
- death hypovolemic shock
- fluid/volume loss
- preload issue
- usually from sudden blood loss or severe dehydration hemodynamics of hypovolemic shock
management of hypovolemic shock o Early identification o Correct cause! o Expand intravascular volume o Isotonic crystalloids - 1-2 L over 10-15 mins or 30mL/kg (LR or NSS) o Blood products, albumin o COMBO of all the above o Caution with HF pts how to know if hypovolemic shock treatment is effective o CVP is increasing o MAP of at least 60 o Adequate urine output o Listen to lungs (crackles?) hypovolemic shock - nursing o PREVENTION is key o Identify at-risk pts EARLY o I&O, monitor fluids o Minimize fluid loss with procedures, etc. o Administering fluid replacement (IV, NG) o Continuous assessment o Comfort and support o Early identification and treatment reduces mortality cardiogenic shock
- failure of heart to effectively pump blood forward (weak heart)
- careful with fluid resuscitation Hemodynamics of cardiogenic shock
- decreased: CO/CI
- increased: PAOP/PCWP, CVP/RAP, SVR nursing management of cardiogenic shock o Limit myocardial O2 demand (stay calm, possible sedation, etc.) o Enhance myocardial O2 supply o Provide comfort and emotional support o Maintain surveillance for complications cardiogenic shock treatment
- inotropic agents (increase contractility)
- vasopressors (maintain BP)
- diuretics (decrease preload)
- antidysrhythmics
- possible intubation/mechanical ventilation
- intra-aortic balloon pump (IABP)
- treat underlying cause distributive shock
- problem with pipes
- septic, anaphylactic, neurogenic
