critical care + invasive monitoring (complex exam three)

what are indications for arterial monitoring?

critically ill, mechanical ventilation, frequent lab draws

what are potential complications of arterial lines?

hemorrhage, clotting, infection

what test should be done to check for collateral circulation before placing an arterial line?

allen’s test

what does a dampening of the arterial line wave form indicate?

possible obstruction or clot

what is your first action when you suspect an obstruction or clot in an arterial line?

flush the line; reposition catheter

what pressure should the pressure bag be kept on?

300 mg

what should you check following the removal of an arterial line?

is the catheter tip intact and is there a radial pulse

what does the distal lumen of a PAC measure?

PA pressure

what dose the inflation lumen monitor in a PAC

estimates LV pressure

what does the proximal lumen of a PAC measure?

CVP (RAP)

what does the thermistor lumen measure in a PAC?

CO

what should be monitored for during the insertion of a PAC?

arrhythmias

what should mean RAP be?

2-5 mmHg

central venous pressure (CVP) =

RAP

what is the normal ranges for RVP?

systolic: 20-30 mmHg

diastolic: 2-5 mmHg

what is a normal PAP?

systolic: 20-30 mmHg

diastolic: 8-15 mmHg

what does a PCWP measure?

estimated LV function

what is a normal PCWP?

5-15 mmHg

what measures the function of the right heart?

RAP

what is a priority intervention when there is a suspected PA occlusion?

tell the patient to turn and cough

what complication do you suspect when an individual with a PAC is having arrythmias?

the catheter slipped back into the right ventricle

what is a common indication for dopamine?

hypotension

what are two complications to look out for when giving dopamine?

hypovolemia and tachyarrhythmias

what should you have prepared when planning on giving a dopamine drip?

fluid replacement

what drugs allow for increased blood flow to the renal system and increased urine output?

dopaminergic

what is the goal of giving a beta receptor?

stimulate cardiac contractility; increase CO

what is the goal of giving alpha receptors?

increasing blood pressure

what should you watch out for when giving a dobutamine drip?

tachyarrhythmias

what dose dobutamine stimulate?

beta 1 receptors

bradycardia, cardiac arrest, hypotension, and anaphylaxis are all indications for what medication?

epinephrine

what are possible complications associated with epinephrine administration?

myocardial ischemia, arrhythmias

what should always be checked before the administration of epinephrine?

correct drug concentration

what part of the body does norepinephrine mostly effect?

blood vessels

what is a big indicator for administration of norepinephrine?

septic shock (also hypotension, GI bleeding)

what should you look out for when administrating a norepinephrine drip?

arrhythmias, bradycardia, angina, pulmonary edema

what drug in indicated for hypertension and pulmonary congestion?

Nitroprusside

what should you be monitoring for while using a nitroprusside drip?

hypotension, thiocyanate toxicity

what are nursing considerations associated with nitroprusside administration?

protect for light, short-term use

what medication is indicated for acute ischemia?

nitroglycerine

what are you looking out for when giving a nitroglycerine drip?

hypotension, bradycardia, headache, nausea and vomiting

morphine is a -

vasodilator

what effects does morphine have on the cardiovascular system?

decrease SVR, preload, and myocardial oxygen consumption

what are indications to lower or stop a morphine drip?

decreased RR, LOC, or blood pressure

what is a common complication associated with morphine use?

constipation

what indicates the use of an amiodarone drip?

arrythmias

how is amiodarone administered?

IVP bolus followed by a drip

what is a complication associated with vasodilators like morphine?

venous pooling

what are the expected pressures in a patient with hypovolemic shock?

everything in decreased except systemic vascular resistance (the body compensates for fluid loss by vasoconstricting)

what is the first sign of hypovolemic shock?

decreased LOC (anxiety, restlessness, confusion)

what is the main fix for hypovolemic shock?

treat the underlying cause

what are the main medication treatments for hypovolemic shock?

volume replacement (PRCs and fluids) and vasopressors (dopamine)

what are the expected pressures associated with cardiogenic shock?

low CO and SV; high everything else

what is a hallmark cardiovascular sign of cardiogenic shock?

JVD

what is a hallmark respiratory sign of cardiogenic shock?

crackles

where does the balloon sit when correctly placed?

in the descending thoracic aorta

when is the balloon inflated?

diastole

when is the balloon deflated?

systole

what is the main purpose of a IABP?

increases coronary and cerebral perfusion

what medications are given for cardiogenic shock?

diuretics, vasopressors, vasodilators, inotropic agents

a patient has decreased CO and decreased CVP/PCWP - what do you suspect is causing this?

too little preload (heart is not stretched enough)

patient presents with decreased CO and increasing CVP/PCWP - what do you suspect?

too much preload

how is cardiac volume altered?

administering fluids or diuretics

patient presents with a drop in CO and a decrease in SVR - what do you suspect?

too little afterload

what are common interventions for low afterlaod?

administer fluids and vasoconstrictors (dopamine)

patient presents with a drop in CO and an increased in SVR - what do you suspect?

too much afterload

what would you give to an individual whose afterload is too high?

arterial vasodilators (nitro) or placement of IABP (cardiogenic shock)