NR 331 CASE STUDY HEMODYNAMIC CRITICAL CARE 2.

NR 331 CASE STUDY HEMODYNAMIC CRITICAL CARE 2. CHAMBERLAIN COLLEGE OF NURSING NR 341 Complex Adult Health Nursing CASE STUDY EXERCISE Hemodynamic Monitoring 1 Reference: Sole, M. L., Klein, D. G., & Moseley, M. J. (2013). Introduction to critical care nursing. St. Louis, Missouri: Saunders. 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. 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 zero and level the transducer to ensure reliability. This will eliminate the effects of pressure alterations. 2. Right after recording the PAOP, what is most important nursing action to prevent complications of an indwelling PA line? The most important nursing action to prevent complications of an indwelling PA line is to hook the patient up to the monitor and check for ventricular arrhythmias. 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? The CVP port is the proximal port on the PA line and the CVP reading measures right atrial pressure. 4. The RAP is reading 1 mmHg. What does this mean? What may have caused this? Which nursing interventions do you expect Mr. J needs? (be thorough) The right atrial pressure (RAP) should equal 2-6mmHg. 1mmHg is a low reading. This may be due to blood loss during surgery. The patient needs fluid replacement. 5. The night CCU nurse is now performing her beginning of the shift assessment. She zeroes her arterial and PA line via the transducer to phlebostatic axis. What level does the stopcock needs to be positioned in relation to the patient in order for the pressure readings to be accurate? What pressure reading on the monitor indicates successful zeroing?