NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
1. BiPAP resp support, POSITIVE airway pressure (forcing air in)
-external ventilation: used to reverse pt quickly without the use
of a vent
2. how much O2 do high flow over 6L
NC provide?
3. potential insufficient secre- -RR, ABGs, spO2, ETCO2
tion removal/decreased gas -assess for hypoxemia (restless, confusion, agitation)
exchange: NI -auscultate breath sounds
-cough/deep breathe/IC if not intubated (if ET - suction)
4. f/e imb: NI -daily weights, strict I&Os, admin meds
-diuretics, e- replacements (check labs)
5. tissue perfusion: NI -assess LOC/HR/BP
-skin color, moisture, temp
-peripheral pulses (cap refill)
-assess UO hourly
6. ROI in vented pt: NI -elevate HOB > 30 degrees
-antiseptic oral care
-prophylactic VTE/peptic ulcer disease
-PPIs - reduce gastric acid secretions, reduce risk of aspiration
leading to VAPs
-ET tube: suction
7. purpose of A-line -invasive, continuous hemodynamic monitoring
-assess efficacy of vasoactive meds
-obtain labs (ABGs, etc.)
8. 5 parts to basic hemodynam- 1. invasive catheter (inserted into artery, heart, vein)
ic monitor system 2. noncompliant pressure tubing (minimize artifact, accurate
, NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
transfer of pressure changes to transducer and monitoring sys-
tem)
3. transducer and 3-way stopcock
4. pressurized flush system
5. bedside monitoring system
9. transducer and 3-way stop- part of invasive hemodynamic monitoring system
cock !! translates intravascular pressure to waveforms and numerical
data
!! must be zeroed at the phlebostatic axis to eliminate the effect
of atm pressure on the system
-3-way stopcock (aka air-fluid interface) attached to transducer
as a reference point for zeroing and leveling the system
10. pressurized fluid system: he- maintains patency of the tubing and catheter, minimize clot
modynamic monitoring formation
-arteries are HIGH pressure, if pressure bag is not set up cor-
rectly, blood will spurt out of artline (want pressure in the system
to be higher than the pressure in the artery)
11. how to zero an artline 1. turn stopcock off towards pt
2. pull off cap
3. push zero on the hemodynamic monitoring system
12. how to eliminate the effect -at sea lvl, atm pressure exerts force of 760mmHg on any object
of atm pressure in hemody- on earth's surface
namic monitoring and why -atm pressure can impact hemodynamic values
its imp !!! must zero (calibrate) the stopcock in the transducer system at
the level of the phlebostatic axis (for a-lines) to get rid of atm
pressure
13. the phlebostatic axis (4th IC space (level of the atria) at the
midway pt of the AP diameter of the chest)
, NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
what level should the stop- (!!! diff lines, have diff levels of positioning)
cock be zeroed at FOR AN
ARTLINE once phlebo axis is identified, secure transducer and zeroing
stopcock to IV pole near pt or on chest wall (if secured on chest
wall, assess for skin breakdown)
14. another name for zeroing leveling the air-fluid interface
the stopcock
15. anatomical positioning of 4th IC space (level of the atria) at the midway pt of the AP
the phlebostatic axis diameter of the chest
16. what if the transducer is too transducer too high: low numbers
high? too low? transducer too low: high numbers
1 cm off will change values by 0.73 mmHg
17. 4 major cmpts for validating 1. positioning the pt (can be measured with pt supine, HOB up
the accuracy of hemodynam- or down...as long as transducer is at phlebo axis)
ic monitoring systems -positioning can change BP values with a BP cuff!
2. leveling the air-fluid interface (zeroing the stopcock) at the
phlebostatic axis
3. zeroing the transducer (stopcock turned off to the pt, cap
taken off, hit zero on system)
4. assessing hemodynamic responsiveness (square-wave test)
, NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
18. when should zeroing be 1. when the catheter is inserted
done on the transducer sys- 2. beginning of the shift
tem 3. repositioning the pt
4. when there are significant hemodynamic changes
19. square-wave test verify the transducer is actively translating waveforms/cardio-
vascular pressures
-record pressure waveform while activating the fast flush valve
on the pressure tubing system (flush the line) for at least 1
second
!! you should see an upstroke from the baseline with a plateau
(square wave) before returning to baseline
!! system is optimally "damped" with 1-2 oscillations
20. optimally damped meaning !! 1-2 oscillations are noted within 0.12 seconds after the square
wave
means that the transducer is working accurately in the hemody-
namic monitoring system
21. !! underdamped vs over- square-wave test abnormalities
damped and how we fix it can be affected by the positioning of the line, or occlusions
1. underdamped: falsely high systolic pressure and falsely low
diastolic pressures (> 2 oscillations)
2. overdamped: falsely low systolic pressures and falsely high
diastolic pressures (< 1 oscillations)
how do we tx? FLUSH THE LINE
Study online at https://quizlet.com/_efk8gz
1. BiPAP resp support, POSITIVE airway pressure (forcing air in)
-external ventilation: used to reverse pt quickly without the use
of a vent
2. how much O2 do high flow over 6L
NC provide?
3. potential insufficient secre- -RR, ABGs, spO2, ETCO2
tion removal/decreased gas -assess for hypoxemia (restless, confusion, agitation)
exchange: NI -auscultate breath sounds
-cough/deep breathe/IC if not intubated (if ET - suction)
4. f/e imb: NI -daily weights, strict I&Os, admin meds
-diuretics, e- replacements (check labs)
5. tissue perfusion: NI -assess LOC/HR/BP
-skin color, moisture, temp
-peripheral pulses (cap refill)
-assess UO hourly
6. ROI in vented pt: NI -elevate HOB > 30 degrees
-antiseptic oral care
-prophylactic VTE/peptic ulcer disease
-PPIs - reduce gastric acid secretions, reduce risk of aspiration
leading to VAPs
-ET tube: suction
7. purpose of A-line -invasive, continuous hemodynamic monitoring
-assess efficacy of vasoactive meds
-obtain labs (ABGs, etc.)
8. 5 parts to basic hemodynam- 1. invasive catheter (inserted into artery, heart, vein)
ic monitor system 2. noncompliant pressure tubing (minimize artifact, accurate
, NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
transfer of pressure changes to transducer and monitoring sys-
tem)
3. transducer and 3-way stopcock
4. pressurized flush system
5. bedside monitoring system
9. transducer and 3-way stop- part of invasive hemodynamic monitoring system
cock !! translates intravascular pressure to waveforms and numerical
data
!! must be zeroed at the phlebostatic axis to eliminate the effect
of atm pressure on the system
-3-way stopcock (aka air-fluid interface) attached to transducer
as a reference point for zeroing and leveling the system
10. pressurized fluid system: he- maintains patency of the tubing and catheter, minimize clot
modynamic monitoring formation
-arteries are HIGH pressure, if pressure bag is not set up cor-
rectly, blood will spurt out of artline (want pressure in the system
to be higher than the pressure in the artery)
11. how to zero an artline 1. turn stopcock off towards pt
2. pull off cap
3. push zero on the hemodynamic monitoring system
12. how to eliminate the effect -at sea lvl, atm pressure exerts force of 760mmHg on any object
of atm pressure in hemody- on earth's surface
namic monitoring and why -atm pressure can impact hemodynamic values
its imp !!! must zero (calibrate) the stopcock in the transducer system at
the level of the phlebostatic axis (for a-lines) to get rid of atm
pressure
13. the phlebostatic axis (4th IC space (level of the atria) at the
midway pt of the AP diameter of the chest)
, NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
what level should the stop- (!!! diff lines, have diff levels of positioning)
cock be zeroed at FOR AN
ARTLINE once phlebo axis is identified, secure transducer and zeroing
stopcock to IV pole near pt or on chest wall (if secured on chest
wall, assess for skin breakdown)
14. another name for zeroing leveling the air-fluid interface
the stopcock
15. anatomical positioning of 4th IC space (level of the atria) at the midway pt of the AP
the phlebostatic axis diameter of the chest
16. what if the transducer is too transducer too high: low numbers
high? too low? transducer too low: high numbers
1 cm off will change values by 0.73 mmHg
17. 4 major cmpts for validating 1. positioning the pt (can be measured with pt supine, HOB up
the accuracy of hemodynam- or down...as long as transducer is at phlebo axis)
ic monitoring systems -positioning can change BP values with a BP cuff!
2. leveling the air-fluid interface (zeroing the stopcock) at the
phlebostatic axis
3. zeroing the transducer (stopcock turned off to the pt, cap
taken off, hit zero on system)
4. assessing hemodynamic responsiveness (square-wave test)
, NUR 4257 - Exam 1
Study online at https://quizlet.com/_efk8gz
18. when should zeroing be 1. when the catheter is inserted
done on the transducer sys- 2. beginning of the shift
tem 3. repositioning the pt
4. when there are significant hemodynamic changes
19. square-wave test verify the transducer is actively translating waveforms/cardio-
vascular pressures
-record pressure waveform while activating the fast flush valve
on the pressure tubing system (flush the line) for at least 1
second
!! you should see an upstroke from the baseline with a plateau
(square wave) before returning to baseline
!! system is optimally "damped" with 1-2 oscillations
20. optimally damped meaning !! 1-2 oscillations are noted within 0.12 seconds after the square
wave
means that the transducer is working accurately in the hemody-
namic monitoring system
21. !! underdamped vs over- square-wave test abnormalities
damped and how we fix it can be affected by the positioning of the line, or occlusions
1. underdamped: falsely high systolic pressure and falsely low
diastolic pressures (> 2 oscillations)
2. overdamped: falsely low systolic pressures and falsely high
diastolic pressures (< 1 oscillations)
how do we tx? FLUSH THE LINE
