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Med Surg III Quiz 2: Pressure Monitoring Systems, Heart Failure, and Pacemakers, Exams of Nursing

A comprehensive overview of pressure monitoring systems, including arterial lines (a-lines), central venous pressure (cvp) monitoring, and pulmonary artery pressure (pap) monitoring. It delves into the indications, complications, and nursing management of each system. Additionally, the document covers heart failure, its causes, symptoms, and treatment, as well as the different types of pacemakers and their malfunctions. This resource is valuable for students and professionals in the medical field seeking to understand the principles and applications of pressure monitoring and cardiac care.

Typology: Exams

2024/2025

Available from 02/04/2025

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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
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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

  1. contractility (heart pump function) - damage to heart and therefore cannot move blood adequately to support perfusion
  2. preload (blood content function) - blood/plasma is lost and the volume in the container is not enough to support perfusion
  3. 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
  1. Initial
  2. Compensatory
  3. Progressive
  4. 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