Critical Care Nursing Hemodynamic Monitoring

CRITICAL CARE NURSING: HEMODYNAMIC MONITORING Critical care nursing ● Concerned with human responses to life threatening problems (such as in trauma , comoborbid conditions) ● Focus of nurses: pt. and family responses to illness ● involves prevention and cure Competencies of nurses caring for the critically ill ● Clinical judgement and clinical reasoning skills. ● Advocacy and moral agency in identifying and resolving ethical issues.( refer for financial aids ( PCSO or social workers ) ● Caring practices that are tailored to the uniqueness of the patient and family .( Transcultural theory by Madeleine Leininger) ● Collaboration with patients, family,family members , and health care team members. ● Systems thinking that promotes holistic nursing care ● Response to diversity ● Facilitator of learning for patients and family members,team members, and the community. ● Clinical inquiry and innovation to promote the best patient outcome. CARDIOVASCULAR SYSTEM 1. Pulomonary artery : an only artery that carries de oxygenated blood 2. RIGHT SIDE : volume oriented: increase in volume will reflect on the right side 3. LEFT SIDE: pressure oriented: PMI SHOULD BE ON 4th to 5th if its in 6th to 7th ( it means it is enlarged( heart enlargement /cardiomegaly), since the pt. has hypertension, the pressure increases leading to the hypertrophy ) LAYERS OF THE HEART 1. Endocardium 2. Myocardiom 3. Pericardial space 4. Pericardiom ● If there is fluid accumulation on the percardial space (pericardial effusion ): Cardiac tamponade ● What makes your heart beats: Electrical signals Conduction System of the heart ● ELECTRICAL PRECEDES MECHANICAL Contraction-relaxation ( mechanical activity of the heart ( structural based )) Depolarization- repolarization( electrical impulses) IF THE AV NODE HAS NO ELECTRICAL IMPULSE leading to no ventricular contractions (mechanical activity); can be seen on the QRS ● The heart does not simultaneously ( if it pumps simultaneously it indicates heart failure) TWO MAIN: Right (supply the right side inferior and posterior)and left coronary artery (circumflex supplies lateral and posterior ; left anterior supplies anterior) POSTERIOR MI RARE TO HAPPENED - IT HAS TWO SUPPLIERS ( circumflex and right coronary artery ) ● Hemodynamic monitoring-use of pressure monitoring devices to directly measure cardiovascular function. ● NEGLIGENCE- you did what u needed to do but it is not right ● MALPRACTICE- neglect of the nursing standards ● Blood Pressure (BP= CO X SVR) ● Cardiac Output (CO= HR x SV)( N:48 per liter ) amount of blood pumped by each ventricle in liters per minute ● Pulse pressure (PP= SBP - DBP) ( N:40-60 mmhg) ● Mean Arterial Pressure (SBP +DBP (2) divided by 3) average mean arterial pressure (N: 80-100 mmhg) (decreased MAP indicates organ/brain perfusion leading to ischemia , necrosis, and failure ) Stroke volume is primarily determined by three factors: preload, afterload, and contractility. 1.Preload (filling pressure) -represents degree of ventricular stretch at the end of diastole and influenced by volume of blood in the ventricles ; preload in the right and left; the higher the volume , the greater the stretch by starling's law DETERMINANTS: 1. Circulating blood volume 2. Atrial contraction ATRIAL FIBRILLATION: ATRIA is fibrillating ( not contracting adequately) 2. Afterload-resistance against which the R (PA)or L(SC) ventricle has to pump ● Pulmonary vascular resistance (PVR)- the resistance against blood flow from the 4 pulmonary veins of the lung to the left atrium. increased pressure in the pulmonary system = increased PVR (r ventricle pumping blood should be greater in the pulmonary) ● Systemic vascular resistance (SVR)-the resistance against the systemic circulation; (L ventricle pump blood should overcome the pressure against aorta and systemic)