NUR 2180 : PHYSICAL ASSESSMENT Stress Testing & Hemodynamic Monitoring COMPREHENSIVE STUDY GUIDE With Detailed Pictures & Diagrams UPDATED 2021

NUR 2180 PHYSICAL ASSESSMENT Stress Testing & Hemodynamic Monitoring Basic Components & Setup Basic components • Plumbing system • Set-up • Blood Pressure Monitoring • A-Line Waveform RA: RV: PAP: PAWP: VAMP System • Cardiovascular overview • T The Frank-Starling law of the heart • Calculating cardiac values • Preload • Factors influencing preload • Drugs affecting preload • Afterload • Factors influencing afterload • Drugs affecting afterload • Cardiac Output • ) o ↑ Cardiac output Contractility • Drugs affecting contractility • Hemodynamic Monitoring • Hemodynamic Monitoring Continued • Pulmonary Artery (PA) Catheter / Swan-Ganz Catheter • PA Catheter Indications • PA Catheter Insertion (Pre-procedure) • PA Catheter Insertion (Post-procedure) • Interpretation of Findings: Right Ventricular Pressure (RVP) Pulmonary Artery Pressure (PAP) Pulmonary Capillary Wedge Pressure (PCWP) Pulmonary Vascular Resistance (PVR) Systemic Vascular Resistance (SVR) 800 – 1200 dynes/sec/cm5 SVO2 60% – 80% Manifestations of Altered Hemodynamics: PRELOAD AFTERLOAD Right heart: CVP Left heart: PAWP Right heart: Left heart: ELEVATED DECREASED ELEVATED DECREASED C Dry mucus membranes Cool extremities Weak peripheral pulses Warm extremities Bounding peripheral pulses Hemodynamic Monitoring: Complications • Square Wave Test • The Natural Resonance Frequency o Overdamped Overdamped Physiologic Issues • Overdamped Troubleshooting • Underdamped Underdamped Technical Issues • Falsely higher systolic pressures • Underdamped Physiologic Issues • Underdamped Troubleshooting • Dampened waveform • le No waveform • Length of insertion • cm Central Venous Pressure (CVP): • Right ventricular waveform: • Pulmonary Capillary Wedge Pressure (PCWP) • Continuous Cardiac Output Monitoring • Arterial Based Cardiac Output • ……………………...........................DOWNLOAD FOR BEST STUDY GUIDE……………..........................