What would you do in these scenarios?
What would you do in these scenarios?
Hemodynamics studies are part of cross training
Kathy Fox, RN, cardiac service line director at St. Francis Hospital and Health Centers in Beech Grove, IN, and a member of Cost Management in Cardiac Care’s editorial advisory board, performed special training in hemodynamics so her cardiac team would be cross-trained.
"Some nurses merely needed re-education," says Fox, "but, if you don’t use it, you lose it."
Post open-heart scenarios studied
The training covered some case studies based on hemodynamic profiles of post open-heart surgery patient scenarios. Staffers are asked to review the following profiles and decide what interventions would be most effective:
Your patient is six hours post-CABG. Hemodynamic parameters are as follows:
BP 78/50
HR 90
CVP 10
PCWP 15
CI 4.3
SVRI 1200
What numbers reflect pre-load? ______ Is it high, low, or normal?
What numbers reflect after-load? ______ Is it high, low, or normal?
What number reflects contractility? ______ Is it high, low, or normal?
What interventions might be effective for this patient?
The same questions are asked concerning these additional hemodynamic profiles:
BP 90/50 MAP 63
HR 100
CVP 10
PCWP 20
CI 1.2
SVRI 2080
—————
BP 100/60
HR 96
CVP 20
PCWP 26
CI 1.8
SVRI 2800
U/O 10cc/hr
—————
BP 148/98
HR 88
CVP 15
PCWP 20
CI 1.8
SVRI 4214
__________
BP 138/90
HR 90
CVP 8
PCWP 11
CI 2.9
SVRI 2703
—————
BP 140/80
HR 120
CVP 3
PCWP 7
CI 2.1
SVRI 3885
In addition, these questions are asked:
• Your patient is four hours post-CABG. He has been in sinus rhythm with no ectopy. Your monitor alarms, and he is now having frequent premature ventricular contractions (PVCs). So far, he is hemodynamically stable with a blood pressure of 120/78. What action would you take?
• You are caring for a post-CABG patient who returned from the OR two hours ago. She is currently on dopamine at 5 mcg/kg/min and NeoSynephrine at 25 cc/hr due to hypotension. Suddenly her BP begins to fall from 100 to in the 60s range. Her volume status is fine. What medication is covered to give per CSU policy while we are contacting the physician?
• You are caring for a post-op patient who is just beginning to regain consciousness. His BP quickly rises to 170. You attempt to reassure him with no luck. While another nurse is getting some pain medication for the patient, what drip would you mix and hang?
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