Chapter 9, Case Study, Hemodynamic Monitoring
1. What are the main concerns associated with the initial assessment findings?
Main concerns:

The electrocardiogram changes are consistent with an anterior myocardial infarction.

The presence of S
3
and S
4
heart sounds indicates development of heart failure that is affecting the patient’s oxygenation status.

Assessment of level of consciousness indicates poor cerebral perfusion; poor peripheral perfusion is also present.
The patient has a metabolic acidosis that is compensated by hyperventilation.
2. What is the significance of the first set of hemodynamic data?
Interpretation of first set of hemodynamic data:

Severe left ventricular failure. Sympathetic nervous system stimulation provides compensatory mechanisms to maintain blood pressure and increase heart rate in an effort to perfuse vital organs.

Very low venous oxygen saturation (SvO
2
). This is an indication that oxygen delivery is insufficient and that organ function may deteriorate even though the maximum amount of oxygen is extracted from the blood.
3. How did the interventions affect Ms. J.’s hemodynamic status and oxygen delivery?
Effectiveness of the interventions:


Improved left ventricular emptying, related to afterload reduction and inotropic support, facilitates blood flow through the pulmonary vasculature, lowering the pulmonary artery and wedge pressures. However, the cardiac index is still slightly low.

Upward trending SvO
2
indicates that oxygen delivery has improved, negating the compensatory increased oxygen extraction by the tissues and organs.