Advanced Medical Surgical Nursing Course Pre-Work N480

Part 1: Critical Care Define the following Key Terms 1.2.3.4.5.6.7.8.9.Arterial Pressure-Based Cardiac Output (APCO)  Monitoring is a minimally invasive technique to determine continuous CO (CCO)/ continuous CI (CCI). Circulatory Assist Devices (CADs)  It is used to decrease cardiac work and improve organ perfusion in patients with heart failure when conventional drug therapy is no longer adequate. Hemodynamic Monitoring  It is the measurement of pressure, flow, and oxygenation within the cardiovascular system. Intraaortic Balloon Pump (IABP)  It provides temporary circulatory assistance to the sick heart by reducing afterload (via reduction in systolic pressure) and augmenting the aortic diastolic pressure. Ventricular Assist Devices (VADs)  It provides short- and long-term support for the failing heart and allows more mobility than the IABP. Central Venous Pressure (CVP)  It is a measurement of right ventricular preload and reflects fluid volume status. Pulmonary Artery Wedge Pressure (PAWP)  It is a measurement of pulmonary capillary pressure, reflects left ventricular end- diastolic pressure under normal conditions (ex. When there is no mitral valve dysfunction, intracardiac defect, or dysrhythmia). Pulmonary Vascular Resistance (PVR)  It is the resistance of the pulmonary vascular bed. Systemic Vascular Resistance (SVR)  It is the resistance of the systemic vascular bed. Part 2: Critical Care - Hemodynamic Monitoring and Circulatory Assist Devices 1.Apply the principles of hemodynamic monitoring to the nursing and interprofessional management of patients receiving this intervention.  Assessment of hemodynamic status requires integrating data from many sources and trending these data over time. Nursing observation will provide important clues about the patient’s hemodynamic status. Obtain baseline data regarding the patient’s general appearance, LOC, skin color and temperature, vital signs, peripheral pulses, capillary refill, and urine output. Abnormalities to any of the data will help direct you to the patient’s problem. For example, if the patient is 2.Differentiaterelatedskin is cool, pallor, and diminished pulses may indicate decreased CO. If the patient’s urine output is irregular in the volume or content, there might be a problem with the patient’s kidney. There are invasive and noninvasive hemodynamic monitoring, depending on the patient’s condition you will be prompted to use one or the other. the purpose of, indications for, and function of circulatory assist devices and nursing and interprofessional management. Circulatory assist devices (CADs) are used to decrease cardiac work and improve organ perfusion in patients with heart failure when conventional drug therapy is no longer adequate. CADs provide interim support in three types of situations (1) the left, right, or both ventricles require support while recovering from acute injury (2) the patient must be stabilized before surgical repair of the heart (ex. Ruptured septum) and (3) the heart has failed, and the patient is awaiting heart transplantation. It decreases cardiac workload, increase myocardial perfusion, and augment circulation. Indications for the devices are patients that have refractory unstable angina (when drugs have failed), short-term bridge to a heart transplantation, acute myocardial infarction, preoperative, intraoperative, and postoperative cardiac surgery, or high-risk interventional cardiology procedures. Patient’s that requires any of the CADs requires highly skilled care. They must perform frequent and thorough cardiovascular assessments, measurement of hemodynamic parameters, auscultation of the heart and lungs, and evaluation of the ECG. Assess for adequate tissue perfusion at regular intervals. They must observe for any type of bleeding, cardiac tamponade, ventricular failure, infection, dysrhythmias, renal failure, hemolysis, and thromboembolism. With the IABP, patients must remain in bed with limited position changes that may need skin breakdown assessment, like pressure ulcers. VAD patients may be mobile and require an activity plan and in some cases are sent home. Patients with CADs will recover, undergo heart transplantation, or receive an artificial heart. Many patients do die or the decision to terminate the device is made and death is followed afterwards. The patient and caregivers require emotional support and should consult other team members like a social worker or clergy, as appropriate. Part 3: Critical Care - Hemodynamic Monitoring and Circulatory Assist Devices 1.Which hemodynamic parameter best reflects the effectiveness of drugs that the nurse gives to reduce a patient’s left ventricular afterload? A. Mean arterial pressure (MAP) B. Systemic vascular resistance (SVR) C. Pulmonary vascular resistance (PVR) D. Pulmonary artery wedge pressure (PAWP) 2.While waiting for heart transplantation, a patient with severe cardiomyopathy has a ventricular assist device (VAD) implanted. When planning care for this patient, the nurse should anticipate A. preparing the patient for a permanent VAD.