Question

Case Example 4

Mrs. Jones was admitted to the ICU after an MVA for observation. During the first 24 hours she developed an increased heart rate and decreased BP. Her level of consciousness started to decrease and she was placed on 02 40% by face mask. A PA catheter was placed for evaluation of her fluid status. The follow table contains some of the parameters:

HR	120	B/P	90/40 mm Hg
CO	2.06 L/min	PA	12/4 mm Hg
CI	1.14 L/min/m2	SVR	1540 DS/cm5
PAWP	3 mm Hg	PVR	549 DS/cm5
CVP	2 mm Hg

Interpretation:

1. What is the significance of the findings?

2. What other assessments should be performed on this patient?

3. What interventions may help to improve this patient’s condition?

4. What nursing interventions does the nurse need to perform to maintain accurate hemodynamic monitoring?

Identify one complication the nurse wants to prevent from happening to this     patient. How will the nurse prevent this complication?

Answer 1

Interpretation : -

Mrs. Jones is suffering from Hypovolemic shock. The PA pressure and BP demonstrate a low fluid volume and increased HR reflects the compensation for this low volume. The SVR is also elevated as the body tries to constrict the blood vessels in order to compensate for the low fluid volume. Mrs. Jones may be suffering from internal bleeding and needs fluids immediately.

Nursing Responsibility:-

Site Care and Catheter Safety :-

- A sterile dressing is placed over the insertion site and the catheter is taped in place. The insertion site should be assessed for infection and the dressing changed as per institutional policy.

- The placement of the catheter , stated in centimetres should be documented and assessed every shift.

- The integrity of the sterile sleeve must be maintained so the catheter can be advanced or pulled back without contamination.

- The Catheter tubing should be labelled and all the connections secure. The balloon should always be deflated and the syringe closed and locked unless you are taking a PCWP measurement.

Patient Activity and positioning :-

- Many physicians allow stable patients who have PA catheter , such as post CABG patients to get out of bed and sit . The nurse must position the patient in a manner that avoids dislodging the catheter.

- Proper positing during hemodynamic reading will ensure accuracy.

Dysrhythmia Prevention:-

- Continuous EKG monitoring is essential while the PA catheter is in place.

- Do not advance the catheter unless the balloon is inflated.

- Antiarrhythmic medications should be readily available to treat lethal Dysrhythmia.

Monitoring waveforms for proper catheter Placement:-

- The nurse must be vigilant in asssessing the patient for proper catheter Placement.

- If the PA waveform suddenly looks like the RV or PCWP waveform, the catheter may have become misplaced.

- The nurse must implant the proper procedures for correcting the situation.

a) If a RV waveform is seen, withdraw the catheter until a RA waveform is seen.

b) If a PCWP waveform is seen when the balloon is deflated ( overwedge waveform) , withdraw the PA catheter until a PA catheter waveform is seen.

Monitoring Hemodynamic Values for Response to treatment :-

The purpose of the PA catheter is to assist healthcare team member in assessing the patient's condition and response to treatment. Therefore accurate document of values before and after treatment changes is necessary.