NR 340 Critical Care Exam 2 Revised
updated version with complete
verified solutions already graded A+ |
GUARANTEED SUCCESS
Hemodynamic Monitoring: Chapter 8 pgs 140-169
• Goal of Hemodynamic monitoring is to maintain
adequate tissue perfusion. Safety issues and
troubleshooting with hemodynamic monitoring lines:
Arterial lines: sites= radial, femoral
Page 1
of 9
o Indications: indicated for hemodynamic instability, assess efficacy of vasoactive
meds, frequent ABG analysis o Complications:
1. Infection: infection may occur if the catheter is left in place for a prolonged
period; however, routine replacement of the catheter is not recommended,
unless infection is suspected.
2. Hemorrhage from the site of insertion: The nurse should apply direct pressure
and notify the provider.
3. Thrombosis in the cannula: A thrombosis in the cannula is usually suspected when
the waveform is damped. The nurse should aspirate and discard blood (and the
thrombus) from the cannula then fast flush to clear the tubing of blood.
4. Tissue ischemia in the cannulated extremity: Notify the provider. The nurse
should continue to assess for worsening of the ischemia indicated by delayed
capillary refill, pallor or cyanosis, reduction in pulses distal to cannula, and cool
temperature.
https://www.coursehero.com/file/52887028/exam-2-review-nr341-0000docx/
, NR 340 Critical Care Exam 2 Revised Study Guide Page 2 of 13
5.Disconnection/dislodgment: blood loss is usually due to sudden dislodgement
of the catheter from the artery or from a disconnection in the tubing.
6. Overdamping (BOX 8-3 pg 153) : patient has an occlusion
Blood clots left in the catheter after getting a blood sample, air bubbles at any
point between the catheter tip and the transducer.
Tx: flush the system or aspirate, disconnecting from the patient if needed
to adequately flush the system to remove clots or air bubbles
Compliant tubing: change to noncompliant tubing or commercially available
tubing system.
Loose connections: ensure all connections are secure
Kinks in tubing system: Straighten tubing
7.Underdamping (Box 8-3, page 153) –
Excessive tubing length (>36-48”)
Tx: remove extraneous tubing, stopcocks, or extensions
Small bore tubing
Tx: Replace small bore tubing with a large bore set
Cause unknown
Add a damping device into the system to reduce artifact
PA catheters: placed on the left midaxillary 4th intercostal space
(Phlebostic axis) o Indication
identify and treat cause of hemodynamic instability
assess pulmonary artery pressure
Assess mixed venous oxygen saturation SvO2
Directly measures CO o Complications:
Ventricular dysrhythmias: Notify the provider. If patient is unstable administer
anti-arrhythmic per standing orders.
Pulmonary capillary rupture, pulmonary infarction: S/S include blood-tinged or
frank bloody sputum; decreased SpO2; respiratory distress. Notify the provider
immediately. Provide supplementary oxygen and be prepared to support
ventilation if necessary.
Pneumothorax/hemothorax: S/S include dyspnea, tachypnea, tachycardia,
decreased breath sounds on affected side, possible hypotension, decreased
oxygen saturation, possible tracheal deviation away from affected side. Notify
This study source was downloaded by 100000887869336 from CourseHero.com on 07-03-2025 14:44:28 GMT -05:00
https://www.coursehero.com/file/52887028/exam-2-review-nr341-0000docx/
updated version with complete
verified solutions already graded A+ |
GUARANTEED SUCCESS
Hemodynamic Monitoring: Chapter 8 pgs 140-169
• Goal of Hemodynamic monitoring is to maintain
adequate tissue perfusion. Safety issues and
troubleshooting with hemodynamic monitoring lines:
Arterial lines: sites= radial, femoral
Page 1
of 9
o Indications: indicated for hemodynamic instability, assess efficacy of vasoactive
meds, frequent ABG analysis o Complications:
1. Infection: infection may occur if the catheter is left in place for a prolonged
period; however, routine replacement of the catheter is not recommended,
unless infection is suspected.
2. Hemorrhage from the site of insertion: The nurse should apply direct pressure
and notify the provider.
3. Thrombosis in the cannula: A thrombosis in the cannula is usually suspected when
the waveform is damped. The nurse should aspirate and discard blood (and the
thrombus) from the cannula then fast flush to clear the tubing of blood.
4. Tissue ischemia in the cannulated extremity: Notify the provider. The nurse
should continue to assess for worsening of the ischemia indicated by delayed
capillary refill, pallor or cyanosis, reduction in pulses distal to cannula, and cool
temperature.
https://www.coursehero.com/file/52887028/exam-2-review-nr341-0000docx/
, NR 340 Critical Care Exam 2 Revised Study Guide Page 2 of 13
5.Disconnection/dislodgment: blood loss is usually due to sudden dislodgement
of the catheter from the artery or from a disconnection in the tubing.
6. Overdamping (BOX 8-3 pg 153) : patient has an occlusion
Blood clots left in the catheter after getting a blood sample, air bubbles at any
point between the catheter tip and the transducer.
Tx: flush the system or aspirate, disconnecting from the patient if needed
to adequately flush the system to remove clots or air bubbles
Compliant tubing: change to noncompliant tubing or commercially available
tubing system.
Loose connections: ensure all connections are secure
Kinks in tubing system: Straighten tubing
7.Underdamping (Box 8-3, page 153) –
Excessive tubing length (>36-48”)
Tx: remove extraneous tubing, stopcocks, or extensions
Small bore tubing
Tx: Replace small bore tubing with a large bore set
Cause unknown
Add a damping device into the system to reduce artifact
PA catheters: placed on the left midaxillary 4th intercostal space
(Phlebostic axis) o Indication
identify and treat cause of hemodynamic instability
assess pulmonary artery pressure
Assess mixed venous oxygen saturation SvO2
Directly measures CO o Complications:
Ventricular dysrhythmias: Notify the provider. If patient is unstable administer
anti-arrhythmic per standing orders.
Pulmonary capillary rupture, pulmonary infarction: S/S include blood-tinged or
frank bloody sputum; decreased SpO2; respiratory distress. Notify the provider
immediately. Provide supplementary oxygen and be prepared to support
ventilation if necessary.
Pneumothorax/hemothorax: S/S include dyspnea, tachypnea, tachycardia,
decreased breath sounds on affected side, possible hypotension, decreased
oxygen saturation, possible tracheal deviation away from affected side. Notify
This study source was downloaded by 100000887869336 from CourseHero.com on 07-03-2025 14:44:28 GMT -05:00
https://www.coursehero.com/file/52887028/exam-2-review-nr341-0000docx/
