RAMILO, SHEENA PATRICIA M.

NCENH06

1. The critical care nurse is mentoring a new nurse on

hemodynamicmonitoring at the bedside of a critically ill patient. The patient
has a rightradial intra-arterial line, and a right subclavian pulmonary artery
pressuremonitoring system with a thermodilution catheter. The critical care
nursedemonstrates proper management of the invasive hemodynamic
monitoringlines to the new nurse and obtains the ordered parameters
(mean arterialpressure [MAP], central venous pressure [CVP], pulmonary
artery systolic[PAS], pulmonary artery diastolic [PAD], pulmonary artery
wedge pressure[PAWP],cardiac output [CO], and cardiac index [CI]
measurement). Thecritical care nurse meets with the new nurse afterward
at the nurses’ stationand encourages the new nurse to share what the new
nurse understands inregard to invasive hemodynamic monitoring. The new
nurse is currentlytaking critical care classes on hemodynamic monitoring.

A. What are the indications for the various hemodynamic monitoringmethods

(intra-arterial line) and the pulmonary artery pressuremonitoring system?

Intra-arterial lines are important for facilitating constant control of blood

pressure for chronically ill patients, which ensures that intermittent
measurement is avoided. They are also vital in easing blood draws for
various lab works as well as determining the arterial blood gas values. The
system for controlling pulmonary artery pressure is primarily seen in
patients with underlying comorbidities, such as cardiogenic shock or
chronic heart disease. It will have a timely diagnosis of lung defects.
Hemodynamic monitoring promotes client diagnosis and evaluation

B. What are the various ordered parameters used for in the case study?

-Mean arterial pressure(MAP)-the average blood pressure in a single

cycle.
-Central Venous pressure(CVP)-blood pressure of the venacava. It reflects
blood returning to the heart.
-Pulmonary artery systolic(PAS)- Blood pressure in the pulmonary artery
when the ventricles contract
-Pulmonary artery Diastolic(PAD)- Blood pressure in the pulmonary artery
when the ventricles relax.
-Pulmonary artery wedge pressure(PAWP)-it is the pressure measured by
wedging a pulmonary catheter with an inflated balloon into a small
pulmonary arterial branch. It estimates the left atrial pressure.
-Cardiac Output (CO)- volume of blood pumped out of the heart per unit
time(L/min)
 -Cardiac Index(CI)- is an assessment of the cardiac output value based on
the patient's size. To find the cardiac index, divide the cardiac output by
the person's body surface area (BSA).

C. What are the nursing responsibilities when caring for the patient with
hemodynamic monitoring?

-Assist with inserting and removing invasive hemodynamic lines, and

Monitoring of heart rhythm, heart rate, and blood pressure.
-Monitoring of blood pressure specifically includes the systolic blood
pressure, diastolic blood pressure, mean blood pressure, central
venous/right atrial pressure, pulmonary artery pressure, and pulmonary
capillary/artery wedge pressure.
-Monitor hemodynamic waveforms for changes in cardiovascular function.
Their responsibilities also include monitoring hemodynamic waveforms for
changes in cardiovascular function and comparing hemodynamic
parameters with other clinical signs and symptoms.
-Maintain sterility of ports and monitoring pulmonary artery and systemic
arterial waveforms. if dampening occurs, check the tubing for kinks or air
bubbles, check connections. If damping happens, search for kink tubing or
air bubbles, check the connections.

D. Of what potential complications should the nurse be aware when

caring for the patient with hemodynamic monitoring?

-Thrombosis

-Accidental injection of intravenous drugs.

-Infection

-Nerve trauma

-Vascular trauma
2. The nurse working in the cardiac procedures area receives a patient who
has undergone a cardiac catheterization via the right femoral artery for
evaluation of unstable angina. Prior to the procedure, the patient was NPO
for 12 hours, and received a sedative. An IV catheter was placed for
administration of the contrast agents and for access in case of an
emergency situation.

a. What is the rationale for assessing distal pulses immediately after

thecatheterization?

- to clotting complications. If pulses are absent, this can indicate that there
is an arterial occlusion.

b. What other assessments should the nurse perform to check for

arterialinsufficiency?

-Ask the patient if there is any discomfort, numbness and tingling in

that limb.
-Check the patient's vital signs every 15 min for one hour, every 30
min for an hour, then hourly for 4 hours, or until discharge
-Assess for bradycardia, dysrhythmias, hypotension, and hypoxemia;
assess heart and respiratory rate for 1 full minute
-Assess for equality and symmetry, test pulses and temperature and
color assessment (a cold skin extremity that may be white to suggest
arterial obstruction); injection site assessment (femoral or antecubital
area) for bleeding and/or hematoma;
-Compare the unaffected side with the affected side-colour,
temperature, and capillary refill proof.

c. The patient asks why he needs to stay in bed with the leg extended for2 to
6 hours. How should the nurse respond?

Holding the injured leg in a straight line for 4-8 hours to avoid
bleeding. The heart catheterization had to be implanted into the
right femoral artery because of the dysfunctional angina. Assess at
the site of catheterization for bleeding problems as well as
occlusions and hematoma formations. Keep leg straight and bed
elevated no greater than 30 degrees.

d. After the procedure, why is it important to assess the patient’s BUN,creatinine,

and fluid volume status?

During the treatment, it is due to a contrast being injected. This is

from the agent used during the catheterization process which
induces acute kidney dysfunction that may also be reversed, but
temporary dialysis may be required. Baseline serum creatinine
increases by 25% or more within two days of the procedure.Monitor
I&O to assess for adequate urine output, hypovolemia, or
dehydration; monitor for hypoglycemia, IV fluids with dextrose;
encourage oral intake, starting with clear liquids; encourage the
child to void to promote excretion of the contrast medium.