Learning Guide- Hemodynamic Monitoring F12
Complete the following statements: (Notes & Lewis text) and online for A&P review
#1 A&P review #2
1. The (cardiac) conduction system is specialized nerve tissue responsible for
creating and transporting the electrical impulse or ______ ________.
2.
During systole, the _______ and ______ valves are open and the ________
and ________ valves are closed.
3.
During diastole, the _______ and ________ valves are open and the _______
and __________ are closed.
4.
Atrial contraction is referred to as atrial _____ and is responsible for as much as
30% contribution to CO.
5. The left ventricle never ejects the entire volume it receives during systole. The
portion of blood the left ventricle ejects during systole is referred to as the
_______ ______. What amount is normal-_____%?
6. Preload is the volume of blood that is in the ventricle just before ejection occurs
and is called the ________ _____ _______ _______ pressure and when
measured is known as _______
7. What is the formula for calculating the MAP? At what point is perfusion to vital
organs compromised?
8. Define SVR and factors that would increase SVR and factors that would decrease
SVR.
9. Define preload. What conditions/factors affect preload? Notes,
etc.
10. Define afterload. What conditions/factors affect preload? Notes,
11. Describe CO and factors that effect CO.
Explain Stoke Volume as related to CO
Explain Heart Rate as related to CO
12. Define “contractility” and factors that influence cardiac contractility.
13. PAWP measures:
What influences PAWP?
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14. Describe the PA catheter as it advances through the heart and explain the
measurements/values that are obtained as the catheter is advanced. (Identify
normal values for each and nursing implications of altered values.)
15. What values are obtained from CVP monitoring? What are “normal” values?
16. What does the PA catheter measure? What are normal Pulmonary Artery
Pressures (PAP)
Hemodynamic Monitoring Study Questions (quick review---use to help answer
question above)
1. What does CVP measure and what is a normal CVP? What would
this mean in the care of my clients?
~ CVP is a measure of blood volume and venous return. It reflects RIGHTSIDED filling pressures. It is primarily used to monitor fluid volume
status.
~ Normal range for CVP is 2-8 cm H20 or 2-6 mmHg
~ Hypovolemia and shock DECREASE the CVP. Fluid overload,
vasoconstriction, and cardiac tamponade INCREASE CVP.
~ If CVP is decreased, client needs fluid to increase preload.
If CVP is increased, client needs diuresis, vasodilation to decrease
afterload, or treatment for cardiac tamponade!
2. What is a PA catheter; what does a PA catheter measure, and where
is it placed?
~ A PA catheter is a flow-directed, balloon-tipped catheter, a.k.a. the
Swan-Ganz. PA = pulmonary artery.
~ A PA catheter measures pressures in the right atrium, pulmonary artery,
and left ventricle. It is used to evaluate left ventricular and overall
cardiac function.
~ It is inserted into a central vein and threaded into the right atrium. A
small balloon allows the catheter to be drawn into the right ventricle and
from there into the pulmonary artery. Once in place, the balloon is
deflated and the multiple lumens of the catheter allow measurement of
pressures in the right atrium, pulmonary artery, and left ventricle.
3. What is a normal PA pressure and under what conditions would a PA
pressure be increased? What does it mean in the care of my
clients?
~ Normal PA is around 25/10 mmHg. Normal mean pulmonary artery
pressure is about 15 mmHg.
~ Pulmonary artery pressure is increased in left-sided heart failure.
Manifestations of left-sided heart failure result from pulmonary
congestion and decreased cardiac output. PA pressure measurement
allows restoration of fluid balance while avoiding overcorrection of the
problem. Nursing interventions for heart failure would be appropriate.
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4. What is PAWP (PCWP or PWP); what does it measure and what does
this value mean? How does it relate to the Left Ventricular End
Diastolic Pressure (LVEDP)?
~ PAWP is pulmonary artery wedge pressure. It measures pressures
generated by the left ventricle. It is used to assess left ventricular
function. Normal PAWP is 6-12 mmHg. PAWP is increased in left
ventricular failure and pericardial tamponade. It is decreased in
hypovolemia.
~ PAWP reflects LVEDP under normal conditions, that is, when LVEDP
(ventricular preload) is increased, PAWP is increased also.
5. How is PAWP obtained?
The measurement of PAWP is obtained by slowly inflating the balloon with
1.5 mL of air while observing the distal lumen pressure tracing. As the line
becomes “wedged,” the tracing changes shape and amplitude. When the
tracing changes from arterial to atrial, the catheter is said to be wedged and
PAWP is measured at the end of expiration.
6. What is cardiac output/cardiac index and what do these values
mean? What is normal cardiac output/cardiac index?
~ Cardiac output/cardiac index are used to assess the heart’s ability to
meet the body’s oxygen demands. Because body size affects overall
cardiac output, the cardiac index is a more precise measurement of heart
function.
~ The cardiac index is a calculation of cardiac output per square meter of
body surface area. The normal cardiac index is 2.2-4.0 L/min/m2. CO =
SV x HR. Normal resting CO is 4-8 L/min and varies with body size.
7. What is SVR; How is it determined? What is MAP?
~ SVR is systemic vascular resistance. SVR is primarily determined by
vessel diameter and distensibility (compliance.)
Factors such as SNS input, circulating hormones (epinephrine,
norepinephrine, atrial natriuretic hormone, and vasopressin) and the
renin-angiotensin system affect SVR.
~ SVR is calculated by: SVR = (MAP – CVP) x 80/cardiac output * MAP is
mean arterial pressure is the amount of arterial that is necessary to
maintain adequate perfusion of vital organs…usually 60 mmHg and is
calculated by Systolic BP + 2 (Diastolic BP) divided by 3
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