Learning Guide- Hemodynamic Monitoring
for NUR222
Complete the following statements: and online for A&P review #1 A&P review #2
1. During systole, the aortic and pulmonary valves are open and the Tricuspid and Mitral
valves are closed. (p. 740; AP review)
2. During diastole, the Mitral and Tricsupid valves are open and the pulmonary and aortic
are closed.
3. Atrial contraction is referred to as atrial kick and is responsible for as much as 20%
contribution to CO. (P. 851)
4. The left ventricle never ejects the entire volume it receives during systole. The portion
of blood the left ventricle ejects during systole is referred to as the Ejection Fraction.
What amount is normal- 60% (p. 822)
5. Preload is the volume of blood that is in the ventricle just before ejection occurs and is
called the Left Ventricle End Diastolic pressure and when measured is known as _______
p. 1738
m
er as
6. What is the formula for calculating the MAP? At what point is perfusion to vital organs
compromised? SBP + 2 (DBP)/3 Normal range is 70-90 mm Hg
co
eH w
7. Define SVR and factors that would increase SVR and factors that would decrease SVR.
SVR is an estimate of LV afterload. It represents the average of resistence of all vascular
o.
beds. An SVR increases with vasoconstriction and hypovolemia. A SVR decreases with
vasodilation.
rs e
ou urc
8. Define preload. What conditions/factors affect preload? Preload is the amount of stretch
in the myocardial fibers at the end of diastole. It represents VOLUME. Volume overload
increases preload while fluid volume deficit decreases it.
o
aC s
9. Define afterload. What conditions/factors affect preload? Afterload is the RESISTANCE
vi y re
against which the ventricles pump blood. An increased afterload occurs with
vasoconstriction while a decreased afterload occurs with vasodilation.
10. Describe CO and factors that effect CO. (as above).
ed d
CO= HR x SV
ar stu
Explain Stoke Volume as related to CO
SV is affected by preload, afterload, and contractility. If SV decreases, HR increases to
compensate.
is
Explain Heart Rate as related to CO
Increased HR increases CO, vise versa.
Th
11. Define “contractility” and factors that influence cardiac contractility. The ability of the
muscle cell to become shorter given suitable stimulus.
sh
12. PAWP means Pulmonary Artery Wedge Pressure.
Left ventricular preload is called left ventricular end-diastolic pressure. PAWP, a
measurement of pulmonary artery capillary pressure reflects left ventricular end-
diastolic pressure under normal conditions (what are these conditions?
No mitral valve dysfunciton, intracardiac defect, or dysrhythmia
13. Describe how the PA catheter advances through the heart.
NUR 222 Sp 2016 1
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, What does “getting a “wedge” pressure” mean? It is inserted through a central vein and
floated into position in the pulmonary artery where a ballon is inflated that becomes
‘wedged’.
*a. Explain/identify the “normal” values obtained as the catheter is advanced
and implications of altered values.
Measurement Normal range Significance if altered
**CVP (RAP) 2-6 mmhg Changes in the levels indicate
changes in pressures and
may be related to fluid
volume deficit or excess
PAS 20-30 mmhg Elevated levels may indicate
inceased afterload of the RV
PAD 8-15 mmhg An elevated PAD may be
related to conditions that
affect the left heart
PAWP/LWEDP/ (pulmonary 4-12 mmhg Reflects LVEDP such as
capillary pressure under inadequare circulating blood
m
normal conditions) volume if PAWP is low
er as
CO 4-8 l/min If the CO is inadequate then
oxygenation needs are not
co
being met
eH w
CI 2.4-4 l/min If the CI is inadequate then
oxygenation needs are not
o.
being met
rs e
ou urc
b. (p. 1740) What measurements can an arterial pressure line provide? Minute to minute
changes in BP
What is an Allen test? a test for occlusion of radial or ulnar arteries
o
aC s
14. What is another name for a PA catheter (Pulmonary artery Flow Directed Catheter)?
vi y re
Swan-Ganz
15. Complete these Case Studies (From RNCEUS Hemodynaic Monitoring)
ed d
Case example 1 A resident of a skilled nursing facility, was found in her bed with a dec. level
ar stu
of consciousness, inc. respirations, and a temperature of 102 degrees F. The staff report that
she had been suffering from vomiting and diarrhea for the past week. The client was
transferred to the ICU. A subclavian central line was placed and the physician ordered vital
signs and CVP readings q2h, a fluid bolus of 500cc over 2 hours followed by a continuous IV of
D51/2NS at 125cc/hr. A foley catheter was in place already. Urine was strong smelling,
is
concentrated, and the hourly output was about 20cc/hr.
Th
The client’s initial vitals signs prior to the fluid bolus:
HR 120 B/P 84/40 mm Hg
sh
SaO2 90% on room air RR 24
CVP 1 mm Hg
and after the fluid bolus:
2 NUR 222 Sp 2016
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:23:33 GMT -05:00
https://www.coursehero.com/file/34559681/Answers-Week-3-HWdoc/
for NUR222
Complete the following statements: and online for A&P review #1 A&P review #2
1. During systole, the aortic and pulmonary valves are open and the Tricuspid and Mitral
valves are closed. (p. 740; AP review)
2. During diastole, the Mitral and Tricsupid valves are open and the pulmonary and aortic
are closed.
3. Atrial contraction is referred to as atrial kick and is responsible for as much as 20%
contribution to CO. (P. 851)
4. The left ventricle never ejects the entire volume it receives during systole. The portion
of blood the left ventricle ejects during systole is referred to as the Ejection Fraction.
What amount is normal- 60% (p. 822)
5. Preload is the volume of blood that is in the ventricle just before ejection occurs and is
called the Left Ventricle End Diastolic pressure and when measured is known as _______
p. 1738
m
er as
6. What is the formula for calculating the MAP? At what point is perfusion to vital organs
compromised? SBP + 2 (DBP)/3 Normal range is 70-90 mm Hg
co
eH w
7. Define SVR and factors that would increase SVR and factors that would decrease SVR.
SVR is an estimate of LV afterload. It represents the average of resistence of all vascular
o.
beds. An SVR increases with vasoconstriction and hypovolemia. A SVR decreases with
vasodilation.
rs e
ou urc
8. Define preload. What conditions/factors affect preload? Preload is the amount of stretch
in the myocardial fibers at the end of diastole. It represents VOLUME. Volume overload
increases preload while fluid volume deficit decreases it.
o
aC s
9. Define afterload. What conditions/factors affect preload? Afterload is the RESISTANCE
vi y re
against which the ventricles pump blood. An increased afterload occurs with
vasoconstriction while a decreased afterload occurs with vasodilation.
10. Describe CO and factors that effect CO. (as above).
ed d
CO= HR x SV
ar stu
Explain Stoke Volume as related to CO
SV is affected by preload, afterload, and contractility. If SV decreases, HR increases to
compensate.
is
Explain Heart Rate as related to CO
Increased HR increases CO, vise versa.
Th
11. Define “contractility” and factors that influence cardiac contractility. The ability of the
muscle cell to become shorter given suitable stimulus.
sh
12. PAWP means Pulmonary Artery Wedge Pressure.
Left ventricular preload is called left ventricular end-diastolic pressure. PAWP, a
measurement of pulmonary artery capillary pressure reflects left ventricular end-
diastolic pressure under normal conditions (what are these conditions?
No mitral valve dysfunciton, intracardiac defect, or dysrhythmia
13. Describe how the PA catheter advances through the heart.
NUR 222 Sp 2016 1
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:23:33 GMT -05:00
https://www.coursehero.com/file/34559681/Answers-Week-3-HWdoc/
, What does “getting a “wedge” pressure” mean? It is inserted through a central vein and
floated into position in the pulmonary artery where a ballon is inflated that becomes
‘wedged’.
*a. Explain/identify the “normal” values obtained as the catheter is advanced
and implications of altered values.
Measurement Normal range Significance if altered
**CVP (RAP) 2-6 mmhg Changes in the levels indicate
changes in pressures and
may be related to fluid
volume deficit or excess
PAS 20-30 mmhg Elevated levels may indicate
inceased afterload of the RV
PAD 8-15 mmhg An elevated PAD may be
related to conditions that
affect the left heart
PAWP/LWEDP/ (pulmonary 4-12 mmhg Reflects LVEDP such as
capillary pressure under inadequare circulating blood
m
normal conditions) volume if PAWP is low
er as
CO 4-8 l/min If the CO is inadequate then
oxygenation needs are not
co
being met
eH w
CI 2.4-4 l/min If the CI is inadequate then
oxygenation needs are not
o.
being met
rs e
ou urc
b. (p. 1740) What measurements can an arterial pressure line provide? Minute to minute
changes in BP
What is an Allen test? a test for occlusion of radial or ulnar arteries
o
aC s
14. What is another name for a PA catheter (Pulmonary artery Flow Directed Catheter)?
vi y re
Swan-Ganz
15. Complete these Case Studies (From RNCEUS Hemodynaic Monitoring)
ed d
Case example 1 A resident of a skilled nursing facility, was found in her bed with a dec. level
ar stu
of consciousness, inc. respirations, and a temperature of 102 degrees F. The staff report that
she had been suffering from vomiting and diarrhea for the past week. The client was
transferred to the ICU. A subclavian central line was placed and the physician ordered vital
signs and CVP readings q2h, a fluid bolus of 500cc over 2 hours followed by a continuous IV of
D51/2NS at 125cc/hr. A foley catheter was in place already. Urine was strong smelling,
is
concentrated, and the hourly output was about 20cc/hr.
Th
The client’s initial vitals signs prior to the fluid bolus:
HR 120 B/P 84/40 mm Hg
sh
SaO2 90% on room air RR 24
CVP 1 mm Hg
and after the fluid bolus:
2 NUR 222 Sp 2016
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:23:33 GMT -05:00
https://www.coursehero.com/file/34559681/Answers-Week-3-HWdoc/
