NURS 480 - Exam 1 NOTES
NURS 480
EXAM 1 NOTES
Hemodynamics/Critically Ill Patient
• Supporting the Caregivers
o Caregivers need to be supported as well, because they can do the
following for the patient:
▪ Linking the patient to the outside world
▪ Facilitating decision making and advising the patient
▪ Helping with activities of daily living
▪ Acting as liaisons to advise the healthcare team
▪ Providing safe, caring, familiar relationships
o The major needs of caregivers of critically ill patients include
providing
information , communication, and access
o During emergency situations ask the family if they wish to remain
at the bedside
• Hemodynamic Technology
o Systemic Vascular Resistance (SVR) (opposition encountered by
the left
ventricle)
o Pulmonary Vascular Resistance (PVR) (opposition encountered
by the right ventricle) is the resistance to blood flow by the
vessels
o Preload: Defined as the volume within the ventricle at the end of
diastole
o Afterload: Refers to the forces opposing ventricular ejection
o SVR is the resistance of the systemic vascular bed, could be
very high due to an inappropriate titration
o PVR is the resistance of the pulmonary vascular bed
o Both of these measures reflect afterload, and can be adjusted
for body size
o Positive inotropes such as dopamine should show increase in
systolic blood pressure as a desirable outcome for a
hypovolemic patient
▪ Positive inotropes such as epinephrine, norepinephrine,
digoxin, and dopamine increase or improve contractility
▪ Negative inotropes such as beta-blockers and calcium
channel blockers reduce contractility
• Positioning/Zero Referencing for Arterial Access Setup
o Mark the location of the phleobostatic axis on the patient’s chest
with a
permanent marker
o Re-check the leveling of the zero-reference stopcock to the
,NURS 480 - Exam 1 NOTES
phleobostatic axis with any change in the patient’s position
o Transducers placed higher will produce falsely lower BP readings
, NURS 480 - Exam 1 NOTES
o Transducers placed lower will produce higher BP readings
• Types of Invasive Pressure Monitoring:
o Arterial BP Monitoring
▪ Various complications can arise such as hemorrhage,
infection, thrombus formation, migration etc
▪ To limit complications, frequently inspect the insertion site
for local signs of inflammation, if bacterial infection is
suspected, remove line and culture tip!
▪ A-lines are not used for infusion of medications!!!
▪ A-lines are great for arterial blood gas collections
and continuous BP Readings
▪ Catheter migration may be indicated by a gurgling sound
o Pulmonary Artery Flow-Directed Catheter: PADP and PAWP
increase
with HF and fluid overload, and decrease with volume depletion
o Central Venous or Right Atrial Pressure Management (CVP): A
high CVP indicates right ventricular failure and a low CVP indicates
hypovolemia
• Noninvasive Ventilation
o Continuous Positive Airway Pressure: Often used to treat
obstructive
sleep apnea
o Bilevel Positive Airway Pressure: Used for COPD patients with HF
and acute respiratory failure and for patients with sleep apnea
o
NURS 480
EXAM 1 NOTES
Hemodynamics/Critically Ill Patient
• Supporting the Caregivers
o Caregivers need to be supported as well, because they can do the
following for the patient:
▪ Linking the patient to the outside world
▪ Facilitating decision making and advising the patient
▪ Helping with activities of daily living
▪ Acting as liaisons to advise the healthcare team
▪ Providing safe, caring, familiar relationships
o The major needs of caregivers of critically ill patients include
providing
information , communication, and access
o During emergency situations ask the family if they wish to remain
at the bedside
• Hemodynamic Technology
o Systemic Vascular Resistance (SVR) (opposition encountered by
the left
ventricle)
o Pulmonary Vascular Resistance (PVR) (opposition encountered
by the right ventricle) is the resistance to blood flow by the
vessels
o Preload: Defined as the volume within the ventricle at the end of
diastole
o Afterload: Refers to the forces opposing ventricular ejection
o SVR is the resistance of the systemic vascular bed, could be
very high due to an inappropriate titration
o PVR is the resistance of the pulmonary vascular bed
o Both of these measures reflect afterload, and can be adjusted
for body size
o Positive inotropes such as dopamine should show increase in
systolic blood pressure as a desirable outcome for a
hypovolemic patient
▪ Positive inotropes such as epinephrine, norepinephrine,
digoxin, and dopamine increase or improve contractility
▪ Negative inotropes such as beta-blockers and calcium
channel blockers reduce contractility
• Positioning/Zero Referencing for Arterial Access Setup
o Mark the location of the phleobostatic axis on the patient’s chest
with a
permanent marker
o Re-check the leveling of the zero-reference stopcock to the
,NURS 480 - Exam 1 NOTES
phleobostatic axis with any change in the patient’s position
o Transducers placed higher will produce falsely lower BP readings
, NURS 480 - Exam 1 NOTES
o Transducers placed lower will produce higher BP readings
• Types of Invasive Pressure Monitoring:
o Arterial BP Monitoring
▪ Various complications can arise such as hemorrhage,
infection, thrombus formation, migration etc
▪ To limit complications, frequently inspect the insertion site
for local signs of inflammation, if bacterial infection is
suspected, remove line and culture tip!
▪ A-lines are not used for infusion of medications!!!
▪ A-lines are great for arterial blood gas collections
and continuous BP Readings
▪ Catheter migration may be indicated by a gurgling sound
o Pulmonary Artery Flow-Directed Catheter: PADP and PAWP
increase
with HF and fluid overload, and decrease with volume depletion
o Central Venous or Right Atrial Pressure Management (CVP): A
high CVP indicates right ventricular failure and a low CVP indicates
hypovolemia
• Noninvasive Ventilation
o Continuous Positive Airway Pressure: Often used to treat
obstructive
sleep apnea
o Bilevel Positive Airway Pressure: Used for COPD patients with HF
and acute respiratory failure and for patients with sleep apnea
o
