The ICU nurse is caring for a patient following insertion of Intra aortic balloon pump for cardiogenic shock. Which hemodynamic parameter best indicates an appropriate response to therapy?
The physician is preparing to insert a PA cath, the nurse should ensure that
ANSWER?? Allay anxiety. Ensure sterile field. Inflate the balloon (after in RA). Monitor cardiac rhythm (PACs, V Tach). over tricuspid valve, systolic pressure increases. level and zero the system, measure pressures at end expiration. prime tubing, prepare kits, connect system, place sterile occlusive dressing. doc waveforms and values, cxr for placement, caps on flush, 300mmHg, alarms
Pulses paradoxes may be seen on arterial pressure waveform monitoring when?
The mean arterial pressure is calculated by
Adding thesystolic pressure and two diastolic pressures and then dividing by 3
A lactate level of 8.0mmol/L is a reliable indicator of
The nurse notices that a patient with an arterial line has an elevated PTT and is not on anticoagulation therapy, the nurse should
Change the heparinized saline solution in the pressure bag for the arterial line to a normal saline solution. (heparin contraindicated in pts with coagulation deficiencies or thrombocytopenia)
Prior to insertion of arterial line in the radial artery which assessment needs to be performed?
When observing a wave form on an arterial line the nurse notes the presence dicrotic notch, the nurse know this is due to
The nurse suspects that a patient is experiencing cardiogenic shock. Which hemodynamic parameter indicates that the nurse's suspicion is correct?
Vasopressors will increase blood pressure but are contradicted in low volume state. (T/F)
Which medication is effective preventing left ventricular remodeling in acute MI
While carrying for a patient with pulmonary artery catheter the nurse notes pulmonary artery wedge pressure is significantly higher than previously recorded values, what is the priority nursing action?
Which of the following is not a finding with cardiogenic shock ?
ANSWER?? cardiogenic shock/acute decomp HR with pulmon edema signs of deterioration: dyspnea at rest, tachycardia, reduced o2 sat, crackles, hypotension, worse cough, new dysrhythmias, elevated PAWP, reduced CO/CI...cardiogenic shock signs: CI <2, systolic BP <90, PAWP >18
A patients SVO2 measurement is 50%what condition would not cause this reading?
The nurse should explain to patient in decompensated heart failure that an aldactone antagonist works by
A patient in shock is to be started on infusion on IV Norepinephrine which is an effect
A 35 y/o female is admitted to ICU after developing DIC following a vaginal delivery what is the pathophysiological mechanism of DIC
Which of the following is not included as a Evidence based guideline for the treatment of septic shock?
Which is a nursing intervention for underdamped pressure monitoring waveform?
ANSWER?? TB for damped: kinks, blood, air (aspirating or fixing kinks can solve problem)
OVERdamped: reduced patency, air/blood in tubing, kinks
UNDERdamped: excess tubing, multiple stopcocks
The nurse is caring for a patient who is being monitored with a Swan-Ganz pa catheter. Which of the following changes requires immediate intervention?
afterload elevations: HTN, vasopressors, aortic stenosis, hypothermia, pulmon HTN, hypoxia, pulmon embolism, pulmon stenosis
afterload decreases: shock, vasodilators, medication side effects
A patient diagnosed with acute MI is given altaplase/tPA/fibrinolytic, a reliable indicator of reperfusion after therapy
The nurse caring for a patient with hypovolemic shock is concerned that which of the following could occur with this patients pulmonary gas exchange?
In sepsis the systemic release of TNF (tumor necrosis factor) has stimulatory effect on intravascular coagulation leading to DIC. (T/F)
Which of the following criteria is not included in the diagnosis of SIRS (systemic inflammatory response syndrome)?
Which is the most common source of infection,which leads to sepsis in a patient over the age of 65?
UTI for geriatric (also, pneumonia is other most common source)
Which hemodynamic parameters would the nurse expect to see in a patient with septic shock?
Norepinephrine is often used in the treatment of sepsis this medication is used because?
It will increase the patient’s MAP while not affecting HR or CO. It reverses hypotension better than dopamine when fluid resuscitation was unsuccessful. Effects are seen within 1-2 min
The overall goal of providing vasopressin to a patient in septic shock is to?
Which of the following is the best description of SVO2 monitoring in septic shock?
Which of the following are used inthe treatment DIC?
Platelet replacement, cryoprecipitate, Fresh Frozen Plasma, heparin
Serum creatinine level 2.0 md/dL (elevated). Absent bowel sounds. Onset of confusion. (also, tachycardia, hypotension
10mins following admin of antibiotic the nurse assess the patient to have edematous lips, and hoarseness and expiratory stridor. Vital signs include b/p 70/40, HR130, RR36. What is the priority medication intervention.
epinephrine 1:1000 0.5 mg sq (then NS, benedryl, o2)
Nursing care specific to a patient with an intraortic balloon pump includes monitoring
Which of these approaches would be most appropriate for the nurse to take when performing a pulmonary artery wedge pressure reading?
use no more than 1.25ml?? of air to inflate the balloon (reduce risk of rupture, use passive deflation, no more than 15 sec inflated)
While assessing a patient who has an arterial catheter in place, the patient complains of numbness and tingling in the fingers. Which of the following would be the most important for the nurse to determine?
The nurse is caring for a patient with sepsis. On completing the hemodynamic assessment, the nurse notes that the patient’s afterload, measured by the systemic vascular resistance, is 400 dynes/sec/cm-5. These findings are most likely a result of which of the following?