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NURS 480 EXAM 1 NOTES
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NURS 480EXAM 1 NOTES
Hemodynamics/Critically Ill Patient
• Supporting the Caregivers
o Caregivers need to be supported as well, because they can do the
following for the patient:
▪ Linking the patient to the outside world
▪ Facilitating decision making and advising the patient
▪ Helping with activities of daily living
▪ Acting as liaisons to advise the healthcare team
▪ Providing safe, caring, familiar relationships
o The major needs of caregivers of critically ill patients include
providing
information , communication, and access
o During emergency situations ask the family if they wish to remain
at the bedside
• Hemodynamic Technology
o Systemic Vascular Resistance (SVR) (opposition encountered by
the left
ventricle)
o Pulmonary Vascular Resistance (PVR) (opposition encountered
by the right ventricle) is the resistance to blood flow by the
vessels
o Preload: Defined as the volume within the ventricle at the end of
diastole
o Afterload: Refers to the forces opposing ventricular ejection
o SVR is the resistance of the systemic vascular bed, could be
very high due to an inappropriate titration
o PVR is the resistance of the pulmonary vascular bed
o Both of these measures reflect afterload, and can be adjusted
for body size
o Positive inotropes such as dopamine should show increase in
systolic blood pressure as a desirable outcome for a
hypovolemic patient
▪ Positive inotropes such as epinephrine, norepinephrine,
digoxin, and dopamine increase or improve contractility
▪ Negative inotropes such as beta-blockers and calcium
channel blockers reduce contractility
• Positioning/Zero Referencing for Arterial Access Setup
o Mark the location of the phleobostatic axis on the patient’s chest
with a
permanent marker
o Re-check the leveling of the zero-reference stopcock to the
phleobostatic axis with any change in the patient’s position
o Transducers placed higher will produce falsely lower BP readings
, o Transducers placed lower will produce higher BP readings
• Types of Invasive Pressure Monitoring:
o Arterial BP Monitoring
▪ Various complications can arise such as hemorrhage,
infection, thrombus formation, migration etc
▪ To limit complications, frequently inspect the insertion site
for local signs of inflammation, if bacterial infection is
suspected, remove line and culture tip!
▪ A-lines are not used for infusion of medications!!!
▪ A-lines are great for arterial blood gas collections
and continuous BP Readings
▪ Catheter migration may be indicated by a gurgling sound
o Pulmonary Artery Flow-Directed Catheter: PADP and PAWP
increase
with HF and fluid overload, and decrease with volume depletion
o Central Venous or Right Atrial Pressure Management (CVP): A
high CVP indicates right ventricular failure and a low CVP indicates
hypovolemia
• Noninvasive Ventilation
o Continuous Positive Airway Pressure: Often used to treat
obstructive
sleep apnea
o Bilevel Positive Airway Pressure: Used for COPD patients with HF
and acute respiratory failure and for patients with sleep apnea
o
, Hemodynamics/Critically Ill Patient
NCLEX Questions:
• A patient who has been in the intensive care unit for 4 days has disturbed
sensory perception from sleep deprivation. Which action should the
nurse include in the plan of care?
a. Administer prescribed sedatives or opioids at bedtime to promote
sleep.
b. Cluster nursing activities so that the patient has uninterrupted rest
periods.
c. Silence the alarms on the cardiac monitors to allow 30- to 40-minute
naps.
d. Eliminate assessments between 2200 and 0600 to allow
uninterrupted sleep.
o ANS: B
Clustering nursing activities and providing uninterrupted rest
periods will minimize sleep-cycle disruption. Sedative and
opioid medications tend to decrease the amount of rapid eye
movement (REM) sleep and can contribute to sleep disturbance
and disturbed sensory perception.
Silencing the alarms on the cardiac monitors would be unsafe in
a critically ill patient, as would discontinuing all assessments
during the night.
• While close family members are visiting, a patient has a respiratory
arrest, and resuscitation is started. Which action by the nurse is best?
a. Tell the family members that watching the resuscitation will be very
stressful.
b. Ask family members if they wish to remain in the room during the
resuscitation.
c. Take the family members quickly out of the patient room and remain
with them.
d. Assign a staff member to wait with family members just outside
the patient room.
o ANS: B
Evidence indicates that many family members want the option
of remaining in the room during procedures such as
cardiopulmonary resuscitation (CPR) and that this decreases
anxiety and facilitates grieving. The other options may be
appropriate if the family decides not to remain with the patient.
• After surgery for an abdominal aortic aneurysm, a patient's central
venous pressure (CVP) monitor indicates low pressures. Which action
should the
nurse take?
a. Administer IV diuretic medications.
b. Increase the IV fluid infusion per protocol.
c. Increase the infusion rate of IV vasodilators.
d. Elevate the head of the patient's bed to 45 degrees.
o ANS: B
A low CVP indicates hypovolemia and a need for an increase
in the infusion rate. Diuretic administration will contribute to
hypovolemia and elevation of the head or increasing
vasodilators may decrease cerebral perfusion
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