NSG 430 Intro to Unstable RRTs
afterload - ANS -◦Forces opposing ventricular ejection
◦Bodyà SVR and arterial pressure influence left ventricular afterload
◦Lungsà pulmonary arterial pressure influence right ventricular afterload
\Arterial Blood Pressure (ABP) - ANS -◦Various indications when continuous BP measurements useful
◦Non-tapered Teflon catheter used to cannulate peripheral artery
◦HCP sutures in place
◦Immobilize insertion site
\Arterial Pressure-Based Cardiac Output (APCO) Monitoring - ANS -qCalculates continuous CO and CCI every 20
seconds
qUses multiple readings from monitors
qArterial BP + Pulse + Stroke Volume + BSA = CCO/CCI, and SV/SVI
qAssesses patient's ability to respond to fluids
\cardiac index - ANS -CO adjusted for body surface area
\cardiac output - ANS -volume of blood pumped by heart in 1 minutes
\Central Venous Pressure (CVP) monitoring - ANS -Measurement of right ventricular preload that reflects fluid volume
Obtained from:
◦Central venous catheter
◦PICC line-open ended
◦PA (pulmonary artery) catheter
◦TIP MUST be in the SVC to be accurate
◦TIP MUST be in the SVC to be considered CENTRAL
\Complexities of unstable patients - ANS -1st Physiologically unstable
◦Critical Analysis and Decision making
2nd Risk of complications
, ◦Frequent assessment and treatments
3rd IV polypharmacy-titration
◦Vasoactive, thrombolytics, sedation, insulin, nutrition
4th Advanced technology/devices
◦Vents, ICP, SvO2, CCRT
\Continuous flush irrigation system - ANS -à Delivers 1 to 3 mL of saline per hourà Maintains line patencyà Limits
thrombus formationà Assess neurovascular status distal to insertion site hourly
\contractility - ANS -◦Strength of ventricular contraction
◦No direct clinical measures
\Dynamic Response Test Square Wave Test- Waveform shows - ANS -accuracy of response by creating a "Square Wave"
◦Flushing system creates wave
◦Assess waves after
◦Too many spikes or whipping—False HIGH reading
◦No spikes or whipping with gradual return to normal--BLOCKAGE
\Examples of PCU clients - ANS -◦Awaiting stent placement
◦awaiting heart transplant
◦receiving stable doses of vasoactive IV drugs (e.g., diltiazem [Cardizem])
◦being weaned from prolonged mechanical ventilation
\Failure to recognize problems, assess and reassess - ANS -◦Physiologic changes
◦Diagnostic information
◦Clinical deviations from normal
◦Lack of nurse intuition
\hemodynamic monitoring - ANS -Measurement of pressure, flow, and oxygenation within cardiovascular system
Assesses heart function, fluid balance, and effects of drugs on cardiac output (CO)
\Identifying the Phlebostatic Axis - ANS -Equipment must be zero balanced to environment and response reflected
accurately on monitor
§Referencing: placing transducer so zero-reference point is at level of atria of heart or phlebostatic axis
§Zeroing: confirms that when pressure within system is zero, monitor reads zero
§Done by opening reference stopcock to room air (off to patient)
afterload - ANS -◦Forces opposing ventricular ejection
◦Bodyà SVR and arterial pressure influence left ventricular afterload
◦Lungsà pulmonary arterial pressure influence right ventricular afterload
\Arterial Blood Pressure (ABP) - ANS -◦Various indications when continuous BP measurements useful
◦Non-tapered Teflon catheter used to cannulate peripheral artery
◦HCP sutures in place
◦Immobilize insertion site
\Arterial Pressure-Based Cardiac Output (APCO) Monitoring - ANS -qCalculates continuous CO and CCI every 20
seconds
qUses multiple readings from monitors
qArterial BP + Pulse + Stroke Volume + BSA = CCO/CCI, and SV/SVI
qAssesses patient's ability to respond to fluids
\cardiac index - ANS -CO adjusted for body surface area
\cardiac output - ANS -volume of blood pumped by heart in 1 minutes
\Central Venous Pressure (CVP) monitoring - ANS -Measurement of right ventricular preload that reflects fluid volume
Obtained from:
◦Central venous catheter
◦PICC line-open ended
◦PA (pulmonary artery) catheter
◦TIP MUST be in the SVC to be accurate
◦TIP MUST be in the SVC to be considered CENTRAL
\Complexities of unstable patients - ANS -1st Physiologically unstable
◦Critical Analysis and Decision making
2nd Risk of complications
, ◦Frequent assessment and treatments
3rd IV polypharmacy-titration
◦Vasoactive, thrombolytics, sedation, insulin, nutrition
4th Advanced technology/devices
◦Vents, ICP, SvO2, CCRT
\Continuous flush irrigation system - ANS -à Delivers 1 to 3 mL of saline per hourà Maintains line patencyà Limits
thrombus formationà Assess neurovascular status distal to insertion site hourly
\contractility - ANS -◦Strength of ventricular contraction
◦No direct clinical measures
\Dynamic Response Test Square Wave Test- Waveform shows - ANS -accuracy of response by creating a "Square Wave"
◦Flushing system creates wave
◦Assess waves after
◦Too many spikes or whipping—False HIGH reading
◦No spikes or whipping with gradual return to normal--BLOCKAGE
\Examples of PCU clients - ANS -◦Awaiting stent placement
◦awaiting heart transplant
◦receiving stable doses of vasoactive IV drugs (e.g., diltiazem [Cardizem])
◦being weaned from prolonged mechanical ventilation
\Failure to recognize problems, assess and reassess - ANS -◦Physiologic changes
◦Diagnostic information
◦Clinical deviations from normal
◦Lack of nurse intuition
\hemodynamic monitoring - ANS -Measurement of pressure, flow, and oxygenation within cardiovascular system
Assesses heart function, fluid balance, and effects of drugs on cardiac output (CO)
\Identifying the Phlebostatic Axis - ANS -Equipment must be zero balanced to environment and response reflected
accurately on monitor
§Referencing: placing transducer so zero-reference point is at level of atria of heart or phlebostatic axis
§Zeroing: confirms that when pressure within system is zero, monitor reads zero
§Done by opening reference stopcock to room air (off to patient)
