Vascular Pressure Monitoring

¡Supera tus tareas y exámenes ahora con Quizwiz!

Occurs with atrial contaction

"a" wave

occurs with movement of AV vlave back toward the atrium during systole

"c" wave

occurs with atrial filling during systole

"v" wave

-Reduced circulating blood volume -Vasodilation (reduced venous return) -Leaks in the pressure system -Spontaneous inspiration

-Causes of decreased CVP

-Fluid overload -Right/left heart failure -Pulmonary hypertension -Tricuspid valve stenosis -Pulmonary embolism -Increased venous return

-Causes of increased CVP

PA diastolic pressure

-Normally reflects left heart filling pressures -Does not reflect left heart filling pressures when pulmonary vascular resistance elevated

all of the above

A difference between the pulmonary artery diastolic pressure and the pulmonary capillary wedge pressure greater than 5 mm Hg is seen in which of the following conditions?

Pneumonia

A patient with what condition is least likely to need placement of an indwelling arterial catheter?(septic shock, cardiogenic shock, ARDS, pneumonia)

c: large pleural effusion

A patient with which of the following conditions is least likely to need placement of a CVP catheter? a. Cardiogenic pulmonary edema b. Noncardiogenic pulmonary edema c. Large pleural effusion d. Major trauma

all of the above

A shift to zone I or II may occur if which of the following conditions is present?

Which of the following will cause a tall, narrow arterial pressure waveform? A stiff aorta b. Vasodilation c. Mitral valve stenosis d. Ventricular hypertrophy

A. stiff aorta

2

According to West, which zone is dominant in the supine position?

peripheral vasodilation

All of the following cause an increase in the CVP except 1:

spontaneous inspiration

All of the following cause an increase in the CVP except:

Tricuspid regurgitation

An exaggerated v wave would be found in which of the following conditions?

a mechanical breath

An increase in CVP during inspiration most likely is caused by:

right ventricular failure

An increase in pulmonary artery systolic pressure is seen in patients with all of the following conditions except

Swan-Ganz catheter

Another name for a Pulmonary Artery Catheter

determining cardiac output

Arterial cannulation is indicated for all of the following except:

waves a, c, and v.

Both the CVP and the pulmonary artery wedge pressure waveforms have three waves for each cycle, namely:

a: Right ventricular filling volume

CVP is a reflection of which of the following? a. Right ventricular filling volume b. Left ventricular filling volume c. Left atrial pressure d. Pulmonary artery diastolic pressure

brief disconnection of the ventilator unless PEEP is being applied

CVP monitoring during MV requires?

West Zone 3

Catheter tip must be placed in what zone where the blood flow is continuous?

60

Circulation to the vital organs (kidneys, coronary arteries) may be compromised if the MAP falls to below _____ mm Hg.

atrial septal puncture

Complications involving the use of CVP catheters include all of the following except:

During placement -Bleeding -Pneumothorax Over time -Infection (main potential problem) -Embolus -Air embolus

Complications of CVP monitoring

-During cannulation, hemothorax, pneumothorax, and damage to blood vessels are possible -Dysrhythmias can occur as catheter passes through the heart and during monitoring -Catheter source of infection, thrombus, embolism, bleeding, and hematoma -Pulmonary infarction possible

Complications of PA Monitoring

hypotension

Complications of direct arterial monitoring include all the following except:

-Severe cardiogenic pulmonary edema -Patients with ARDS who are hemodynamically unstable -Patients who have had major thoracic surgery -Patients with septic or severe cardiogenic shock

Conditions for using the PA catheter

When the catheter enters the superior vena cava and right atrium.

During insertion of a pulmonary artery catheter, when is the balloon inflated?

an incompetent tricuspid valve

During systole, the CVP v waveform is exaggerated and the CVP increases. This most likely is due to:

3

For the pulmonary capillary wedge pressure to reflect pulmonary venous and left atrial pressures, blood flow must be uninterrupted between the catheter tip and the left heart. This condition exists only in West zone:

pressure and flow that occurs when the heart contracts and pumps blood throughout the body

Hemodynamics

-Intravascular fluid volume -Cardiac function -Vascular Findings -Identify sudden changes in the patient's hemodynamic status

Hemodynamics monitoring is preformed to evaluate?

>140/90 mm Hg

Hypertension

-Excessive contraction of the left ventricle -Vasoconstriction -Administration of vasopressors -Sympathetic stimulation (as occurs with fear and stress

Hypertension is caused by what?

-Low Blood Volume -Poor Cardiac Function -Low Vascular Resistance

Hypotension is caused by...

left heart failure or mitral stenosis

If the wedge pressure is increased what does that indicate?

continue the insertion because the catheter now has entered the right ventricle.

If, when the pulmonary artery catheter is inserted, there is a rapid increase in the height of the pressure waveforms with the downstroke dropping near zero, the respiratory therapist should:

increase to above normal range

In left ventricular failure, the pulmonary capillary wedge pressure is expected to:

c: Cor pulmonale

In which of the following conditions would an elevated CVP be expected? a. Pneumonia b. Hypovolemia c. Cor pulmonale d. Pleural effusion

d. Reposition the catheter while observing the waveform.

Just after insertion of a radial arterial catheter, you note that the pressure waveform appears dampened. All connecting tubing is secure and free of air. Which of the following actions is appropriate at this time? a: Remove the catheter and cannulate the other wrist. b: Increase the sensitivity setting on the monitor. c: Withdraw and then reinject 5 mL of blood. d: Reposition the catheter while observing the waveform.

...

Know how to fill in this chart

First half PAP second half PAWP top strip ECG

Know where the PAP and PAWP waveforms begin and end

all of the above

Monitoring of the CVP is indicated when there is a need to assess:

120/80 mm Hg

Normal Arterial Pressure

25/8

Normal Pulmonary Artery Pressure

4-12mmHg

Normal Pulmonary Capillary Wedge Pressure

2-6 mmHg

Normal right atrium pressre?

Hemorrhage

Occurs if line becomes disconnected

-Subclavian or internal jugular -Right Atrium -Air placed in balloon -Flow through right atrium -tricuspid valve Right Ventricle -Pulmonary Valve -Pulmonary artery -Into wedge position -Balloon then deflated

Pathway of PA Catheter insertion?

pulmonary embolus

Pulmonary artery catheter monitoring is likely to be considered for patients with any of the following conditions except:

25/0 mmHg

Right Ventricle Normal Pressure

True

T/F: RT' Set up and place Arterial Lines

0.50

The CVP can be used to estimate left ventricular filling pressures if there is no left ventricular dysrhythmia and the ejection fraction is greater than:

subclavian

The CVP catheter insertion site that provides both stability after placement and accurate hemodynamic information is the _____ vein.

female, age 25

The CVP is most likely to correlate well with left ventricular filling pressure in which of the following patients?

all of the above

The CVP represents:

Atrial fibrillation

The a wave would be absent in which of the following dysrhythmias?

b: ventricular contraction

The c-wave of a CVP waveform represents which of the following? a. Atrial contraction b. Ventricular contraction c. Atrial filling d. Ventricular filling

b. Aortic

The dicrotic notch on the arterial pressure waveform represents closure of which of the following heart valves? a. Pulmonic b. Aortic c. Tricuspid d. Mitral

radial

The most common site for arterial catheterization is the _____ artery.

4-12

The normal pulmonary capillary wedge pressure is _____ mm Hg.

8 to 15

The normal range for pulmonary artery diastolic pressure is _____ mm Hg.

20-30

The normal range for pulmonary artery systolic pressure is _____ mm Hg.

d. Measuring stroke volume

The proximal port of a pulmonary artery catheter can be used for all of the following except: a. Measuring the CVP b. Withdrawing blood samples c. Injecting medications d. Measuring stroke volume

all of the above

The pulmonary artery catheter allows assessment of:

left ventricular stroke volume.

The pulse pressure is important hemodynamically because it is an indication of:

obtain wedge pressure measurements

The purpose of the balloon at the tip of the pulmonary artery catheter is to:

Femoral Artery

What A-Line placement is less affected by vasoconstriction but is more difficult to monitor for bleeding?

-Severe hypotension or hypertension -Patients who need frequent ABG assessment -Patients in shock or respiratory failure

What are indications for arterial pressure monitoring?

-To assess circulating blood volume and filling pressures of the heart -To assess right ventricular function -Patients who have had major surgery or trauma need a CVP catheter -Patients with pulmonary edema often benefit from CVP monitoring

What are indications for monitoring CVP measurements?

a, c, v

What are the three normal CVP waveforms?

Low diastolic pressure

What can compromise coronary artery perfusion?

Ischemia

What can occur with embolism, thrombus, or arterial spasm and can result in tissue necrosis?

-Increases with high pulmonary vascular resistance -Decreases with poor right heart function and pulmonary vasodilation

What causes PA systolic pressure increase and decrease?

Minimal changes with inspiration and expiration.

What change in the arterial pressure waveform is normally seen with respiration?

the waveform falls to below baseline

What change is seen on the CVP waveform when the patient takes a spontaneous deep breath?

venous return to Right side of the heart

What does a CVP catheter monitor

-Left ventricular filling pressure -Pulmonary vascular resistance -Arteriovenous oxygen difference -Mixed venous oxygen levels

What does pulmonary artery pressure monitoring allow us to assess?

aortic valve closure

What does the dicrotic notch represent on an arterial pressure waveform?

the dicrotic notch The aortic valve closing

What is important to see on this waveform?

Invasive Monitoring

What is needed to obtain an accurate evaluation of hemodynamics?

1.5 mL

What is the approximate amount of air required to fill the balloon on a pulmonary artery catheter?

7 French with a triple lumen

What is the most popular CVP catheter, depicted in this image?

internal jugular

What is the popular site for CVP catheter insertion?

radial artery

What is the preferred site for insertion of an arterial catheter for continuous pressure monitoring?

to float the catheter in place and to measure left ventricular filling pressures

What is the purpose of the balloon?

allows infusion of medications and port from which to obtain blood samples

What is the triple lumen allow?

PA catheter

What is this an image of?

CVP catheter placement

What is this image showing?

Ischemia

What is this image showing?

Pulmonary artery pressure monitoring

What is this image showing?

- it is normally 4 to 12 mm Hg- it reflects left ventricular preload

What is true about pulmonary artery wedge pressure?

Inotropic Phase

What point in the Arterial Pressure Waveform is Systole-Ventricles are contracting

d. 7 French

What size catheter typically is used for adults to monitor pulmonary artery pressures?

Low blood volume and high alveolar pressures

What two things can cause the wedge pressure readings to be inaccurate?

<60 mm Hg

What value of MAP compromises functions of vital organs?

100mmHg

What will the MAP be if the systolic blood pressure is 140 mm Hg and the diastolic blood pressure is 80 mm Hg?

end of exhalation

When do you measure wedge pressure?

during insertion and pressure readings

When is the balloon inflated?

allow the catheter to float

When the pulmonary artery catheter is inserted, the balloon is inflated in the right atrium before it is inserted further. This is done to:

the end of expiration with the patient in the supine position.

When the water manometer is used to measure the CVP, the reading usually is taken at:

decrease blood flow to the coronary arteries

When vasodilators such as sodium nitroprusside are administered, it is important to monitor the fall in blood pressure because low blood pressure can:

Radial Artery

Where is a arterial line most often placed?

below patients right atrium and phlebostatic axis

Where is the placement of the transducer?

1, 2 and 3

Which of the following are possible complications of arterial cannulation? 1. Infection 2. Arterial spasm 3. Thromboembolism

c. Fluid overload

Which of the following causes the CVP to increase? a. Vasodilator therapy b. Spontaneous inspiration c. Fluid overload d. Air in the pressure-sensing line

Tubing is more stable and is less likely to kink in a patient who is awake.

Which of the following is not an advantage of using the internal jugular vein as the insertion site for the central venous catheter?

c: At end-expiration on the vent.

Which of the following is the correct method of measuring CVP in a patient receiving mechanical ventilation with PEEP? a. At end-inspiration on the vent b. At end-inspiration off the vent c. At end-expiration on the vent d. At end-expiration off the vent

1 and 3

Which of the following is true about MAP? 1. It normally ranges between 70 and 105 mmHg 2. It is the arithmetic average of the systolic and diastolic pressures. 3. Organ perfusion is reduced if MAP is less than 60 mmHg.

1 and 2

Which of the following is true about the CVP catheter? 1. It is commonly inserted by way of the subclavian vein. 2. The catheter can have multiple lumens. 3. A balloon is located on the distal end.

Seldinger technique

Which of the following techniques is used most commonly to insert an arterial pressure monitoring catheter?

a. A stiff aorta.

Which of the following will cause a tall, narrow arterial pressure waveform? a. A stiff aorta b. Vasodilation c. Mitral valve stenosis d. Ventricular hypertrophy

1, 2 and 3

Which of the following will cause the arterial pressure to decrease? 1. Vasodilators 2. Cardiac failure 3. Hypovolemia

1, 2, and 3

Which of the following would increase pulmonary artery pressure? 1. Severe hypoxemia 2. Thromboembolism 3. Acidosis

The first waveform (167/69)(Red-ART) and it should match patients HR

Which waveform is the Arterial Pressure and what should it match with?

Physician

Who places CVP catheters?

COPD

With a properly inserted and positioned pulmonary artery catheter, a systolic pressure reading in the pulmonary artery of 50 mm Hg could be due to:

Which of the following is true about the CVP catheter? 1. It is commonly inserted by way of the subclavian vein. 2. The catheter can have multiple lumens. 3. A balloon is located on the distal end. a. 1 and 2 b. 2 and 3 c. 1 only d. 1, 2, and 3

a. 1 and 2

Which of the following is true about MAP? 1. It normally ranges between 70 and 105 mm Hg. 2. It is the arithmetic average of the systolic and diastolic pressures. 3. Organ perfusion is reduced if MAP is less than 60 mm Hg. a. 1 and 3 b. 2 and 3 c. 1 only d. 1, 2, and 3

a. 1 and 3

What is the normal value for CVP? a. 2 to 6 mm Hg b. 6 to 8 mm Hg c. 8 to 12 mm Hg d. 12 to 18 mm Hg

a. 2 to 6 mm Hg

When obtaining an arterial blood sample from an arterial line, you note that the patient complains of significant tenderness at the insertion site. You should recommend which of the following to the patient's nurse? a. Removal of the dressing and inspection of the site b. Immediate removal of the catheter c. Replacement of the catheter with a new one d. Application of an antibiotic cream to the insertion site

a. Removal of the dressing and inspection of the site

CVP is a reflection of which of the following? a. Right atrial pressure b. Left ventricular filling volume c. Left atrial pressure d. Pulmonary artery diastolic pressure

a. Right atrial pressure

INCREASE

anything that causes pressures in the lungs and R side of the heart will_____ CVP pressure

Which of the following statements is true about pulmonary artery wedge pressure? 1. It is normally 6 to 12 mm Hg 2. It is normally higher than PADP 3. It reflects left ventricular preload a. 1 only b. 1 and 3 c. 2 and 3 d. 1, 2, and 3

b. 1 and 3

What is the approximate amount of air required to fill the balloon on a pulmonary artery catheter? a. 0.5 mL b. 1.5 mL c. 2.5 mL d. 3.5 mL

b. 1.5 mL

The dicrotic notch on the arterial pressure waveform represents closure of which of the following heart valves? a. Pulmonic b. Aortic c. Tricuspid

b. Aortic

What clinical condition is most likely to cause the PAWP to be elevated? a. ARDS b. Left-sided heart failure c. Cor pulmonale d. Pneumonia

b. Left-sided heart failure

Your patient has a pulmonary artery catheter in place and suddenly starts coughing up bloody sputum. What is the most likely cause of this? a. Pneumothorax b. Pulmonary infarction c. Mitral valve stenosis d. Myocardial infarction

b. Pulmonary infarction

The c wave of a CVP waveform represents which of the following? a. Atrial contraction b. Ventricular contraction c. Atrial filling d. Ventricular filling

b. Ventricular contraction

During insertion of a pulmonary artery catheter, when is the balloon inflated? a. Immediately after insertion into the venous site b. When the catheter enters the superior vena cava and right atrium c. When the catheter passes through the tricuspid valve and enters the right ventricle d. When the catheter passes through the pulmonic valve and enters the pulmonary artery

b. When the catheter enters the superior vena cava and right atrium

What would be considered a normal value for pulmonary artery pressure? a. 15/4 mm Hg b. 18/10 mm Hg c. 25/12 mm Hg d. 36/22 mm Hg

c. 25/12 mm Hg

Which of the following is the correct method of measuring CVP in a patient receiving mechanical ventilation with PEEP? a. At end-inspiration on the ventilator b. At end-inspiration off the ventilator c. At end-expiration on the ventilator d. At end-expiration off the ventilator

c. At end-expiration on the ventilator

In which of the following conditions would an elevated CVP be expected? a. Pneumonia b. Hypovolemia c. Cor pulmonale d. Pleural effusion

c. Cor pulmonale

Which of the following causes the CVP to increase? a. Vasodilator therapy b. Spontaneous inspiration c. Fluid overload d. Air in the pressure-sensing line

c. Fluid overload

The proximal port of a pulmonary artery catheter can be used for all of the following except: a. Measuring the CVP b. Withdrawing blood samples c. Injecting medications d. Measuring stroke volume

c. Injecting medications

A patient with which of the following conditions is least likely to need placement of a CVP catheter? a. Cardiogenic pulmonary edema b. Noncardiogenic pulmonary edema c. Large pleural effusion d. Major trauma

c. Large pleural effusion

What is the preferred site for insertion of an arterial catheter for continuous pressure monitoring? a. Femoral artery b. Brachial artery c. Radial artery d. Ulnar artery

c. Radial artery

Which of the following are possible complications of arterial cannulation? 1. Infection 2. Arterial spasm 3. Thromboembolism a. 1 and 2 b. 2 and 3 c. 1 only d. 1, 2, and 3

d. 1, 2, and 3

Which of the following could cause PAWP to be overestimated? 1. PEEP or CPAP greater than 10 cm H2O 2. Mitral valve stenosis 3. Reduced left ventricular compliance a. 1 only b. 2 only c. 1 and 3 d. 1, 2, and 3

d. 1, 2, and 3

Which of the following will cause the arterial pressure to decrease? 1. Vasodilators 2. Cardiac failure 3. Hypovolemia a. 1 and 2 b. 2 and 3 c. 2 only d. 1, 2, and 3

d. 1, 2, and 3

Which of the following would increase pulmonary artery pressure? 1. Severe hypoxemia 2. Thromboembolism 3. Acidosis a. 1 and 2 b. 2 and 3 c. 1 and 3 d. 1, 2, and 3

d. 1, 2, and 3

What complication is most likely to occur during removal of a pulmonary artery catheter? a. Pneumothorax b. Pulmonary infarction c. Pulmonary embolism d. Dysrhythmias

d. Dysrhythmias

What change in the arterial pressure waveform is normally seen with respiration? a. A large decrease with inspiration b. A large increase with inspiration c. A large increase with expiration d. Minimal changes with inspiration and expiration

d. Minimal changes with inspiration and expiration

A patient with which of the following conditions is least likely to need placement of an indwelling arterial catheter? a. Septic shock b. Cardiogenic shock c. ARDS d. Pneumonia

d. Pneumonia

Just after insertion of a radial arterial catheter, you note that the pressure waveform appears dampened. All connecting tubing is secure and free of air. Which of the following actions is appropriate at this time? a. Remove the catheter and cannulate the other wrist b. Increase the sensitivity setting on the monitor c. Withdraw and then reinject 5 mL of blood d. Reposition the catheter while observing the waveform

d. Reposition the catheter while observing the waveform

Hypovolemia

decreased wedge pressure is indicative of?

Pulse Pressure

difference between systolic and diastolic pressures

Spontaneous inspiratory

efforts cause CVP to decrease and are seen on the waveform

<90/60 mm Hg

hypotension

Hypotension

late sign of low cardiac output

subclavian and internal jugular veins

most common sites for PA catheter insertion?

30 to 40 mm Hg

normal pulse pressure

pulmonary capillary wedge pressure

only way to get an idea of whats going on with the left side of the heart

CVP to increase

what do Positive pressure breaths cause?


Conjuntos de estudio relacionados

Mental Health Chapters 14, 16, 18-21

View Set

(P) Hand/Wrist/Digit Anatomy and Positioning

View Set

Module Knowledge Check Questions

View Set

NCLEX-PN INFECTION CONTROL, NURING PROCESS

View Set

Pierrot lunaire, Part III, No. 18 (Der Mondfleck)

View Set