Case NR 341 CASE STUDY~ Hemodynamic Monitoring 1 CHAMBERLAIN COLLEGE OF NURSING NR 341 Complex Adult Health Nursing CASE STUDY EXERCISE Hemodynamic Monitoring 1 CASE STUDY: Hemodynamic Monitoring 1 Mr J. is a 44 year-old man with no previous medical histo

Case NR 341 CASE STUDY~ Hemodynamic Monitoring 1 CHAMBERLAIN COLLEGE OF NURSING NR 341 Complex Adult Health Nursing CASE STUDY EXERCISE Hemodynamic Monitoring 1 CASE STUDY: Hemodynamic Monitoring 1 Mr J. is a 44 year-old man with no previous medical history who presents to the emergency department with a chief complaint of severe abdominal pain, fever, and chills. He is subsequently admitted to the critical care unit after an open exploratory laparotomy where it was found that he had a perforated appendix and diffuse peritonitis. Intraoperatively he had an estimated blood loss of 350 mL and he received 1 Liter of crystalloid solution in the OR. He arrives at the critical care unit intubated and sedated with a right radial arterial line, a five-lumen pulmonary artery catheter, and an indwelling urinary catheter in place. Subheia Ayyad CASE SCENARIO QUESTIONS: 1. The charge nurse and CCU nurse receiving the patient from the OR team had just finished getting the patient settled. The CCU nurse performs her admission assessment and documents vital signs. Before she records his arterial, pulmonary artery pressure and right atrial pressure readings, what should she do first? Why? The nurse should first level and zero at the insertion site. Zeroing is performed before insertion and readings, at the beginning of each shift, when the patient is disconnected, when the patient is moving, and with any significant changes in hemodynamic status. This is done to make sure the readings are accurate. 2. Right after recording the PAOP, what is most important nursing action to prevent complications of an indwelling PA line? To prevent any complications of an indwelling pa line, a nurse should assess and document the extremity for perfusion: color, temperature, sensation, pulse, and capillary refill. Position/ immobilize the patient’s wrist in a neutral position with arm board if needed. Apply adequate pressure to the site of insertion until hemostasis is obtained when the catheter is removed. The nurse should set alarms to be notified in any changes such as bleeding or disconnection. 3. The cardiologist asks the CCU nurse to obtain and notify her of the current CVP reading for Mr. J. Which port on the PA line will the nurse need to access in order to obtain these readings? What does the CVP reading measures? Cvp/rap is pressure created by volume of blood in right heart: used to guide assessment of fluid balance and responsiveness. Normal range for cvp is 2-8 cm H2O or 2-6mmHg. This will be the proximal blue port (right atrium)