Term
| Initial Post Op Assessment |
|
Definition
Connect to bedside monitor EKG, BP, HR, SpO2; assess rhythm and VS.
CI, CO. Hypovolemia, pain levels. Dysrhytmias, SV (preload, afterload, contractility). Bleeding, CTOP (notify MD is more than 100/hr for 3 hours, 200 ml/hr for 2 hrs, or 300 ml/hr for 1 hr).
Level transducers at phebostatic axis (4ICS), zero balance to establish
atmospheric pressure (guns up, caps off).
Square wave test to ensure responsiveness. |
|
|
Term
|
Definition
TO test Arterial line pressure waveform reflects the true pressure
overdampened: sluggish, exagerated or falsely high. Underestimates SBP. Causes are large bubbles, no or low fluid in flush bag, loose connections, kink in tubing
Underdamped: overresponse, narrow, artificial peak; overestimates SBP. Causes: small bubbles, tubing too long, defective transducer
SE: |
|
|
Term
| Assessment of chest drainage system |
|
Definition
Connect to suction
Note and record the amount of drainage from the OR. Correlate thses findings with the patients baseline hemodynamic profile. |
|
|
Term
| Assessment of fluid status |
|
Definition
| compare intraoperative intake and output with baseline hemodynamics and VS |
|
|
Term
| Complications of invasive monitoring arterial |
|
Definition
| Bleeding, infection, thrombosis, ischemia, nerve damage |
|
|
Term
| WHy monitor CVP in post CPB patients? |
|
Definition
CPB have systemic inflammatory responses for first 24-48 hours: fluid leak, vasodilation, and hypovolemia.
Decreased CVP = low volume/pressure, or decreased CO
Increased CVP = hypervolemia, vasoconstriction, ventricular dysfunction, pulmonary HTN, A Fib, tamponade, pneumothorax...any situation where blood flow backs up into the right side of the heart, increasing pressure at the end of filling (diastole) |
|
|
Term
| Parts of CVP waveform: A, C, X, V |
|
Definition
A: Atrial contraction (p wave); follows p wave on EKG, reflects the physical contraction folowing the electrical stimulus of the P wave. (Will be large in tricuspid stenosis)
C: bulging of the tricuspid into RA at start of ventricular systole. This physical action follows the electrical stimulus of the QRS wave.
X: Atrial relaxation
V: Filling of the atrium, follows the T wave; closed tricuspid, and so pressure begins to rise again. |
|
|
Term
| complications of CVP catheters |
|
Definition
pneumothorax
thrombus
ingfection
air embolism
vessel perforation
extravasation into pericardium, endocardium, pleural cavity
hemothorax
hematoma
uncontrollable venous bleeding |
|
|
Term
| Pulmonary Artery Pressure measures what? |
|
Definition
Hardin Page 151
with no impediment to blood flow, a PAC indirectly measures LA pressure and appx LV end diastolic pressure function (left sided preload) |
|
|
Term
PAS
Pulmonary Artery Systolic Pressure |
|
Definition
mesaure from tricuspid to the mitral valve, and is a good indicator of PAP.
Conditions such as COPD, ARDS, Pulm HTM are likely to increase PAS. |
|
|
Term
PAD
Pulmonary Artery Diastolic Pressure |
|
Definition
| Reflects pressure in the area between pulmonic and aortic valves. If no obstruction, is a good indicator of LV function |
|
|
Term
| Rsks of pulmonary arery Wedge pressure |
|
Definition
| PA rupture, embolism, infarction, hemorrhage |
|
|
Term
|
Definition
Bolus of NS is injected into RA (proximal port), fluid mixes with blood flow. As it passes the thermistor, the CO is calculated using the amount of time it took for the coolor liquid to reach the probe.
Less time to travel to probe = high CO
More time to travel to probe - low CO |
|
|
Term
|
Definition
65-75 Ideal
Amount of oxgyen remaining in blood as it returns to the right side of teh heart to be reoxygenated
More = less oxygen demand or increased supply
Less = more oxygen demand or less supply
Determined by
1. CO (how quickly the train moves)
2. Hgb (how many cars on the train)
3. SaO2 (how many passengers on the train)
If any decreased, SVO2 will be decreased |
|
|
