Studydroid is shutting down on January 1st, 2019
Cloned from: RT-150 Test 2



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Indications for PAP Monitoring
  • Complicated MI
  • Cardiogenic Shock (pump failure)
  • Severe CHF
  • Structural Defects
  • Acute RV dysfunction
  • Cardiac Tamponade (restricted contraction)
  • Pre-op montoring
General Design of PA catheter
  • 60-110 cm in length
  • 5 and 7 French
  • .5-1.5 balloon inflation
  • 8-13 mm balloon diamter
  • 2-5 lumens
2 methods of gaining vascular access
  • cutdown
  • percutaneous
Site for PA catheterization
Insert into large vein
Insertion and Flotation of catheter
  • Inflate balloon and submerge in sterile H2O
  • Flush prox&distal ports with hep. solution
  • wet outside of cath with saline or H2O
  • monitor for sterility
  • instert into large vein
  • advance into RA
  • observe waveform and doc. pressures
  • inflate balloon/ advance into RV
Insertion and flotation (cont'd)
  • observe waveform and doc. pressures
  • advance into PA
  • observe waveform and doc. pressures
  • advance to wedge pos.
  • observe waveform and doc. pressures
  • deflate balloon and suture into place
  • confirm placement with CXR
Characteristics of a true wedge position
  • PAP waveform flattens to characteristic LAP waveform immediately on balloon reinflation
  • Mean PCWP is lower than the mean PAP or PAd pressure
  • Blood withdrawn is highly oxygentated and resembles arterial blood
Normal PA diastolic pressure
Normally 1-4mm Hg higher than LAP
PAd-PWCP greater than 4-5
Indicative of pulmonary vascular resistance
Complications of catheter being advanced too far
  • Cardiac output measurements may be in error
  • Damage to the pulmonary vasculature may occur
  • Catheter may wedge spontaneously
  • Mixed venous samples can be contaminated by arterial blood
Complications associated with  PA catheters
  • Arrhythmias
  • Balloon rupture
  • Knotting
  • Trauma
  • Infection
  • Thromboemboli
  • Pneumo
  • Pulmonary Ischemia or infarction
Dye -Dilution method of measuring CO
  • dye injected into right side of heart
  • continous dye/blood sample is withdrawn form a systemic artery
  • Concentration of dye in the sample is plotted against time to calculate QT
Fick method of measuring CO
  • Gas exchange metabolic monitor measures inhaled & exhaled gas content and displays CO every 20 min
  • Pulse-ox and mixed venous oximetry  #'s are used to determine O2 content and O2 extraction ratio.
Thermodilution Method of measuring CO
  • Cold (known volume 10cc) injectate introduced into RA
  • passes into the RV and then ejected into PA
  • cooled blood flows into PA circulation and past the thermistor bead near tip of the PA catheter, and reads the change in pt's blood temp
  • graphic curve is produced
Equip for Thermodilution Method

  • bag of injectate solution
  • Syringe
  • Cardiac Output Computer
Cardiac Index
  • relates cardiac output to body surface area, relating heart performance to the size of the person
  • normal values 2.5-4.2
SVO2 monitoring
  • Reflects on the ability of the cardiopulmonary unit to transport sufficient O2 to meet the body needs
Electrical Conduction System of Heart (in order)
  • SA node
  • Bachmans bundle
  • Internodal atrial conduction tracts
  • AV node
  • Bundle of His
  • right and left bundle branches
  • Purkinje fibers (20-40 bpm)
Types of Myocardial cells
  • Pacemaker-have ability to generate electrical impulse
  • Working-property of contractility
Automacity
Ability to initiate an electrical impulse
Excitability
Ability to respond to an electrical impulse
Conductivity
Ability to transmit an electrical impulse
Contractility
Ability to respond with a pumping action
Depolarization
Change in the electrical charge across the cell membrane. Results from influx of Na+ and Ca+
Repolarization
Return of the membrane potential to resting state.
P-wave
Atrial depolarization
QRS complex
Depolarization of Ventricles
T wave
Late repolarization
PR interval
time of transmission from the atria to the ventricles (usually less than 20 seconds)
ST segment
early phase of ventricular repolarization
ECG rate
  • count the QRS complexes in one minute
  • count the QRS complexes withing 3 markers and multiply by ten
  • divide 300 by the # of thick lines between the QRS complexes
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