Topic 1: Intro to Advanced Adult Health Nursing

• What is hemodynamic monitoring?

  Measurement of pressure, flow, and oxygenation within cardiovascular.
• What is the purpose of hemodynamic monitoring?

  Assess heart function, fluid balance, and effects of drugs on cardiac output (CO).
• What are non invasive forms of arterial oxygenation monitoring?

  Pulse oximetry.
• If accurate pulse oximetry is difficult, where can you measure SPO2?

  Forehead or earlobe.
• What is the quickest and easiest non invasive way to get a glimpse of a patient's oxygen status?

  Pulse oximetry.
• If someone is hypoxic on a pulse oximeter, is this a late sign or early sign?

  Late.
• What is cardiac output?


  Volume of blood pumped by the heart in 1 minute.
• What is cardiac index?

  Cardiac output per square meter of body surface area.
• What is stroke volume?

  Volume ejected with each heartbeat.
• What determines the stroke volume?


  Preload, afterload, and contractility.
• What is SVR?

  Systemic vascular resistance.
• What is systemic vascular resistance?

  Amount of force exerted on circulating blood.
• What is PVR?

  Pulmonary vascular resistance.
• What is pulmonary vascular resistance?

  Opposition to blood flow by systemic and pulmonary vasculature.
• What is preload?

  Volume of blood within ventricle at the end of diastole.
• What is CVP?

  It reflects right ventricular end-diastolic pressure.
• What is afterload?

  Forces opposing ventricular ejection.
• What influences left ventricular afterload?

  Body SVR.
• What influences right ventricular afterload?

  Lungs, pulmonary arterial pressure.
• What is vascular resistance?

  It is affected by vasoconstriction and vasodilation, reflects afterload.
• What is contractility?

  Strength of ventricular contraction.
• How does a pressure monitoring system work?

  A cannula is in the radial artery connected to a tube to a transducer which turns the pressure wave into an electronic signal for the monitor.
• What else does a pressure monitoring system do for the line?

  Continuously flushes the line with 1 - 3 mL of saline per hour which limits thrombus formation, maintains patency.
• What should you do for someone with a pressure monitoring system in place with a continuous flush irrigation system?

  Assess neurovascular status distal to insertion site hourly.
• What is the phlebostatic axis?

  An external landmark used to identify the level of the atria in a supine patient.
• How do you draw the phlebostatic axis?

  Draw an intersection of one line horizontally from the axilla, midway between the anterior and posterior chest walls, and the other line vertically through the fourth intercostal space along the lateral chest wall.
• What is referencing in regards to the phlebostatic axis?

  Placing the transducer so the zero reference point is at the level of the atria of heart or the phlebostatic axis.
• What is zeroing in regards to the phlebostatic axis?

  Confirms that when pressure within the system is zero, monitor reads zero.
• How do you zero the transducer for a phlebostatic axis?

  Open the reference stopcock to room air (off to patient).
• When do you zero the transducer for the phlebostatic axis?

  During initial setup, each shift and periodically thereafter.
• What is the Dynamic Response Test or Square Wave Test?

  A test to ensure that the equipment for pressure monitoring is accurate.
• How is the Dynamic Response Test done?

  Activate the fast flush to check if the equipment reproduces a distortion free signal.
• How do you know if the Dynamic Response Test is good?

  If a sharp upstroke occurs, followed by rapid downstroke extending past baseline with 1 or 2 oscillations within 0.12 seconds with a quick return to baseline.
• What does it mean if there are too many spikes or whipping for the dynamic response test?

  False high readings.
• What does it mean if there are no spikes or whipping with gradual return to normal in the dynamic response test?

  Blockage is present.
• What are the types of invasive pressure monitoring?

  • Arterial blood pressure monitoring
  • Central venous pressure monitoring
  • Systemic venous oxygen saturation
  • Pulmonary artery catheter monitoring
• What is arterial pressure monitoring?

  Measures arterial blood pressure continuously.
• How is the arterial blood pressure applied?

  Non-tapered teflon catheter used to cannulate the peripheral artery, the HCP sutures it into place, it is immobilized at the insertion site.
• What parameters does the arterial blood pressure alarm for?

  High and low pressure.
• What are risks or complications of arterial blood pressure?

  • Hemorrhage
  • Infection
  • Thrombus formation
  • Neurovascular impairment
  • Loss of limb