NURS 546 Exam 2 Hemodynamics questions with complete solutions

NURS 546 Exam 2 Hemodynamics questions with complete solutions Arterial line complications - ANSWER-- Bleeding/hemorrhage - (loose connections/cath dislodgement- always use luer-lock), - thrombosis, - thromboembolism, - air embolism, - infection, (change tubing q96h) - vessel damage, - kinking - migration of catheter, - neurovascular compromise (6 p's- assess every hour) .Arterial Lines collaborative care and nursing management - ANSWER-- Monitor waveform per policy - "Zero" + phlebostatic axis each shift/per policy and prn (position changes, trouble shooting a-line waveform issues) - Compare values with noninvasive BP (A-line should be more accurate) - Difference of 10-20 mmHg is expected with ABP higher - Maintain intra-arterial system as closed system - Check site and circulation to extremities Q2 hrs (watch for hemorrhage and signs of neurovascular compromise) - Use arm board or wrist board if necessary - NEVER administer medications via arterial lines - Set alarms - Be sure to remove and apply pressure per policy (Common: 5 minutes of pressure to site after d/c) .Arterial Lines: insertion and removal techniques - ANSWER-Insertion: - Assess site for neurovascular compromise (check cap refill) - Proper patient positioning - place at phlebostatic axis - ensure pressure bag is pumped to 300 mm Hg & filled with saline - change tubing q96h - "Zero" arterial line - monitor waveform, check alarms - compare ABP with non-invasive BP cuff/measurement (should be within 10-20 mm Hg) Removal Techniques: Assess site first. Remove the catheter, place pressure for 5 minutes, assess the catheter and ensure the catheter is still intact and that there are no kinks. Ensure that all parts of the arterial line are the same as before insertion. .Central line indications - ANSWER-- To measure fluid volume status or Central Venous Pressure (CVP). - HF - Renal failure - Ventricular dysfunction - Shock - Hypervolemia - Hypovolemia .Describe types of hemodynamic monitoring systems: Arterial lines - ANSWER-Minimally invasive. Measures SVR, SV, CO, CI, and Arterial BP. Inserted in the radial, brachial, or femoral artery. Before placing catheter in the radial artery, perform the Allen Test to determine if the ulnar artery can perfuse the hand enough and prevent vascular compromise. When connected to the Vigileo or Flotrac, the arterial line can measure SV, CO, CI, SVR, and more. When connected to the ICU monitor, the arterial line can measure arterial BP, & MAP. .Describe types of hemodynamic monitoring systems: Central lines - ANSWER-Minimally invasive. Measures CVP or RAP and other oxygenation measures. It's inserted in the internal Jugular, Subclavian vein. It can indicate, right ventricular failure, fluid overload, or hypovolemia