Concordia University Saint Paul: NUR 417 (NUR417) Exam 1 MAJOR CONCEPTS OF COMPLEX CARE (Chapters 31, 39 & 65), A+ Guide 2025/26.

Module 1 MAJOR CONCEPTS OF COMPLEX CARE
(Chapters 31, 39 & 65)


Calculating stroke SV= CO/HR
volume (math Normal range = 4-8 L/min
calculation)

Hemodynamic -​ Purpose of hemodynamic monitoring is to assess heart function, fluid balance, and
parameter the effects of fluid and drugs on CO
reflecting afterload -​ Preload is the volume within the ventricle at the end of diastole
-​ ***CVP
-​ Afterload refers to the forces opposing ventricular ejection
-​ SVR and arterial pressure are indices of left ventricular afterload
-​ PVR and pulmonary arterial pressure are indices of right ventricular
afterload




Action of RN -​ CVP is a measurement of right ventricular preload and reflects fluid volume status
based on CVP -​ Normal range = 2-8 mmHg
reading -​ High CVP indicates right ventricular failure or volume overload
-​ Low CVP indicates hypovolemia
-​ Nursing action
-​ If CVP was high
-​ Placing the patient in the Trendelenburg posture
-​ Administering diuretics or vasodilators
-​ Limiting the infusion speed
-​ If CVP was low
-​ Administer more fluid therapy

Evaluation of -​ Check BP q15 minutes
norepinephrine -​ Monitor EKG
infusion -​ Urine output - prerenal
-​ CVP
-​ Monitor for HA, tachycardia, dizziness, chest pain, tissue necrosis-extravasation

Intervention based Table 16.20
on findings of -​ Assessment
client’s CVP (p. -​ Dressing changes and cleansing
294) -​ Injection cap changes (scrub the hub!)
-​ Maintenance of catheter patency

, -​ Consider the PCs:
-​ Air embolism - clamp or pinch tube, turn pt on L side, call RRT (rapid
response team)
-​ Infection - antibiotic therapy or removal from line
-​ Thrombus

Signs and All the LOCO man s/s:
symptoms of -​ Neuro: decreased LOC, dizziness, syncope, anxiety, sense of impending doom,
decreased cardiac agitation, and confusion
output -​ Heart: chest pain and tachycardia
-​ Respiratory: SOB and tachypnea
-​ GI: N/V
-​ Renal: Low urine output (<0.5 mL/kg/hr) - oliguria
-​ Muscles: weakness and fatigue
-​ Peripheral: pale, cool, and clammy, slow cap refill, edema
-​ On auscultation may find wheezing, S3 sounds

Assessment for MAP!!!!!!
decreased cardiac Assess
output (p. 1544) -​ Note any changes in mental status
-​ Strength and quality of peripheral pulses
-​ Cap refill
-​ Urine output (<0.5 mL/kg/hr)
-​ Skin color and temperature
-​ Remember: SvO2 measures the % of tissue perfusion​

PA catheter -​ Continuously monitors CO/ SvO2
tracings; What -​ Measures the pressures in the pulmonary artery, right atrium, and left ventricle,
would you expect right ventricle
to see on the -​ Assess to monitor left ventricular filling pressure
monitor -​ PIW wave 2-8 or 10

Evaluation of intra -​ *improve cardiac output
aortic balloon -​ Reduction of afterload (through reducing systolic pressure) and augmenting aortic
pump diastolic pressure, which improves coronary artery perfusion pressure
effectiveness (p. -​ Decrease in cardiac workload
1545) -​ Improved organ perfusion
-​ Decreased SVR (systemic resistance is down)
-​ Diminished s/s of MI (no chest pain, or ST elevations)
-​ Increase in SV and CO
-​ Monitor radial and pedal pulses
-​ Monitor for ischemia
-​ Monitor BP and ECG
-​ Urine output

Plan of care Per Table 65.7
intervention for (managing complications of IABP therapy)
client with intra -​ Balloon leak or rupture: prepare for emergency removal and possible reinsertion
aortic balloon -​ Atrial trauma caused by insertion or displacement of balloon: Assess and mark
pump (p. 1546) peripheral pulses before inserting balloon to use as baseline for assessing pulses
after insertion; Assess perfusion to both upper and LE q 1hr; Measure urine output
at least q1hr (occlusion of renal arteries cause severe decrease in urine output);
observe arterial waveforms for sudden changes; keep HOB no higher than 45º; DO
NOT flex cannulated leg at the hip; immobilize cannulated leg to prevent flexion