MSN 377 CORE EXAM TEST QUESTIONS AND
SOLUTIONS RATED A+
✔✔Valvular Heart Disease: Collaborative Care: Surgical Therapy: Valve Replacement -
✔✔Prosthetic valves, either mechanical or biological
Mechanical (artificial) - last longer, risk of thromboembolism; long term anticoagulation
needed
Biological (tissue) - bovine, porcine, and cadaver; less durable, no anticoagulation
required
Decision based on age and risk for anticoagulation
✔✔Selection of Prosthetic Valve: Biologic - ✔✔Low rate of thrombosis
Types
-xenograft (porcine)
-homografts (cadaver)
Use if
-hx of bleeding
-can't take Coumadin
-desire to be pregnant
-age >65yrs
✔✔Selection of Prosthetic Valve: Mechanical - ✔✔Thrombogenic
Durable
For younger patients
Requires anticoagulants
✔✔Procedures and Prophylaxis - ✔✔Antibiotic prophylaxis recommended for high risk
procedures and some persons
Procedures
-dental that may involve bleeding
-respiratory
-some GU (cystoscopy, urethral dilation, surgery)
-GI surgery (intestinal mucosa)
✔✔Patient Education - ✔✔Anticoagulation therapy
-if on Coumadin, should known what INR goals are (2-3)
Tell providers that they have a prosthetic valve
,Should carry card with them that tells emergency responders they have a prosthetic
valve and are on anticoagulants
✔✔Valvular Heart Disease: Nursing Management - ✔✔Health promotion
-facilitate the diagnosis and treatment of strep infections
-patient teaching re medication compliance
-prophylactic antibiotics
Acute intervention and ambulatory and home care
-outpatient or inpatient management of HF
-assess cardiac and affects of anticoagulation
-interventions - optimize actiivty, monitor INR
✔✔Hemodynamic Monitoring: CVP - ✔✔Central Venous Pressure
Pressure measurement of RA or vena cava
Filling pressure of RV
Normally 2-6mmHg
CVP >6 = increased preload
CVP <2 = decreased preload
✔✔Hemodynamic Monitoring: Pulmonary Artery Pressure - ✔✔Pulmonary Artery
Pressure (PAP)
Evaluates - response to medical interventions, fluid status, and response to medications
PA catheter and pressure monitoring system
-inserted into large vein (subclavian, jugular, or femoral)
-catheter threaded into vena cava and RA where balloon is inflated
-catheter then carried (via balloon) through tricuspid valve into RV
-from RV, catheter advanced through pulmonic valve into branch of pulmonary artery
Pressures measured: RA, pulmonary artery systolic, pulmonary artery diastolic,
pulmonary artery wedge (PAWP or PCWP)
PA diastolic and PA wedge - reflective of LV filling pressures (LV preload)
Complications: PA rupture, pulmonary thromboembolism, pulmonary infarction,
dysrhythmias, air embolism
Swan Ganz catheter
, IMPORTANT: ensure balloon is inflated briefly and promptly deflated (note waveforms)
✔✔PAWP - ✔✔Balloon is inflated and catheter floats and wedges into part of the
pulmonary artery
The tip of the catheter can only see what is in front of it, so it reflects what the LV is
doing (aka LV filling pressure)
✔✔Swan Ganz Catheter - ✔✔PA pressure catheter
Is multifunctional
Has thermistor to measure temperature, openings to deliver medications, opening in
right atrium to measure CVP/preload
Tip sits in pulmonary artery to get continuous pulmonary artery pressure
Can give measurements of systemic vascular resistance (afterload)
Can tell you how quickly saline goes from RA to pulmonary artery (idea of what CO is)
✔✔Hemodynamic Monitoring: Intra-arterial BP monitoring - ✔✔Aka arterial line
Permits direct and continuous BP measurements in critically ill
Blood samples and ABGs
Arterial access - radial most common
Verify ulnar arterial competency via "Allen's Test" - raised arm, compress ulnar and
radial arteries, release ulnar compression and verify circulation return
Catheter flush solutions same as PA catheters
Transducer attached and pressures measured in mmHg
20 gage or larger intricate
RN monitors for distal ischemia, external hemorrhage, air embolism, pain, arteriospasm
✔✔IABP - ✔✔Intra-aortic balloon pump
Mechanical circulatory device that provides counter pulsation to augment myocardial
pump
Inflates during diastole and increases aortic pressure and coronary after blood flow
SOLUTIONS RATED A+
✔✔Valvular Heart Disease: Collaborative Care: Surgical Therapy: Valve Replacement -
✔✔Prosthetic valves, either mechanical or biological
Mechanical (artificial) - last longer, risk of thromboembolism; long term anticoagulation
needed
Biological (tissue) - bovine, porcine, and cadaver; less durable, no anticoagulation
required
Decision based on age and risk for anticoagulation
✔✔Selection of Prosthetic Valve: Biologic - ✔✔Low rate of thrombosis
Types
-xenograft (porcine)
-homografts (cadaver)
Use if
-hx of bleeding
-can't take Coumadin
-desire to be pregnant
-age >65yrs
✔✔Selection of Prosthetic Valve: Mechanical - ✔✔Thrombogenic
Durable
For younger patients
Requires anticoagulants
✔✔Procedures and Prophylaxis - ✔✔Antibiotic prophylaxis recommended for high risk
procedures and some persons
Procedures
-dental that may involve bleeding
-respiratory
-some GU (cystoscopy, urethral dilation, surgery)
-GI surgery (intestinal mucosa)
✔✔Patient Education - ✔✔Anticoagulation therapy
-if on Coumadin, should known what INR goals are (2-3)
Tell providers that they have a prosthetic valve
,Should carry card with them that tells emergency responders they have a prosthetic
valve and are on anticoagulants
✔✔Valvular Heart Disease: Nursing Management - ✔✔Health promotion
-facilitate the diagnosis and treatment of strep infections
-patient teaching re medication compliance
-prophylactic antibiotics
Acute intervention and ambulatory and home care
-outpatient or inpatient management of HF
-assess cardiac and affects of anticoagulation
-interventions - optimize actiivty, monitor INR
✔✔Hemodynamic Monitoring: CVP - ✔✔Central Venous Pressure
Pressure measurement of RA or vena cava
Filling pressure of RV
Normally 2-6mmHg
CVP >6 = increased preload
CVP <2 = decreased preload
✔✔Hemodynamic Monitoring: Pulmonary Artery Pressure - ✔✔Pulmonary Artery
Pressure (PAP)
Evaluates - response to medical interventions, fluid status, and response to medications
PA catheter and pressure monitoring system
-inserted into large vein (subclavian, jugular, or femoral)
-catheter threaded into vena cava and RA where balloon is inflated
-catheter then carried (via balloon) through tricuspid valve into RV
-from RV, catheter advanced through pulmonic valve into branch of pulmonary artery
Pressures measured: RA, pulmonary artery systolic, pulmonary artery diastolic,
pulmonary artery wedge (PAWP or PCWP)
PA diastolic and PA wedge - reflective of LV filling pressures (LV preload)
Complications: PA rupture, pulmonary thromboembolism, pulmonary infarction,
dysrhythmias, air embolism
Swan Ganz catheter
, IMPORTANT: ensure balloon is inflated briefly and promptly deflated (note waveforms)
✔✔PAWP - ✔✔Balloon is inflated and catheter floats and wedges into part of the
pulmonary artery
The tip of the catheter can only see what is in front of it, so it reflects what the LV is
doing (aka LV filling pressure)
✔✔Swan Ganz Catheter - ✔✔PA pressure catheter
Is multifunctional
Has thermistor to measure temperature, openings to deliver medications, opening in
right atrium to measure CVP/preload
Tip sits in pulmonary artery to get continuous pulmonary artery pressure
Can give measurements of systemic vascular resistance (afterload)
Can tell you how quickly saline goes from RA to pulmonary artery (idea of what CO is)
✔✔Hemodynamic Monitoring: Intra-arterial BP monitoring - ✔✔Aka arterial line
Permits direct and continuous BP measurements in critically ill
Blood samples and ABGs
Arterial access - radial most common
Verify ulnar arterial competency via "Allen's Test" - raised arm, compress ulnar and
radial arteries, release ulnar compression and verify circulation return
Catheter flush solutions same as PA catheters
Transducer attached and pressures measured in mmHg
20 gage or larger intricate
RN monitors for distal ischemia, external hemorrhage, air embolism, pain, arteriospasm
✔✔IABP - ✔✔Intra-aortic balloon pump
Mechanical circulatory device that provides counter pulsation to augment myocardial
pump
Inflates during diastole and increases aortic pressure and coronary after blood flow
