Hemodynamic Monitoring Systems

Question 1 

Interpret the physical assessment data at 2200 compared to the readings in 1800. What is Mr. Smith’s priority problem? 

Mr. Smith’s increased heart rate is attributed to low blood pressure at 82/60. Initially, his blood pressure was optimal at 114/82, a pressure that maintained his heart rate at 90. However, due to his left heart failure, his Systematic Vascular Resistance surpasses the standard rate of 700-1500 dynes/second/cm-5. The reduced cardiac output from 4.8 to 2.6 is a result of a reduced volume of blood pumped into the heart ( Wagner & Hardin-Pierce, 2018) . Cardiac output is primarily influenced by stroke volume and heart rate. The same applies to decreased stroke volume that has reduced from 40 to 22. With only the right side of his heart functioning normally, Mr. Smith is experiencing reduced heart functionality leading to reduced circulation of blood, increased SVR, and RAP. 

Question 2 

Write a brief analysis of the hemodynamic values and state what the changes in values indicate. State the pathophysiologic processes that are occurring in Mr. Smith to cause these changes.   

The hemodynamic values have significantly changed in Mr. Smith’s case study due to the reduced functionality of the heart. With his left heart not pumping effectively, his right ventricle cannot sustain the recommended stroke volume and heart rate, leading to reduced cardiac output. It puts pressure on the pulmonary arteries increasing the pulmonary wedge pressure from 20 to 28. Normal PAWP should be 15-25mmHG, but in Mr. Smith’s case, his PAWP has risen to 28 a clear sing of increased insufficiency of his left ventricle. The blood pumped into the right ventricle has also significantly reduced from 40 to 22, due to over-reliance on the right ventricle only. 

The processes leading to Mr. Smith’s condition include overloading of the right ventricle, reduced cardiac output, reduced stroke volume, and increased systematic vascular resistance. Increased SVR and reduced cardiac output increase the heart rate to keep up with oxygen supply in the body. With only one ventricle in use, the overall blood pressure is reduced, leading to reduced SV. 

Question 3 

Mr. Smith is experiencing acute heart failure. Explain how a pulmonary artery catheter will help the nurses and physicians plan interventions to enhance cardiac functioning. 

Pulmonary artery catheters can be used to measure cardiac output and intracardiac pressures helping in the treatment plans of oxygen delivery through the body. It can help in improving drug therapy and fluid prescription towards enhancing and reduce a patient’s perioperative risks. The catheter is useful in providing critical information about oxygen delivery, cardiac output, or hypoxemia ( Wagner & Hardin-Pierce, 2018) . It mainly measures pulmonary artery pressure, right ventricular end-diastolic pressure, and right atrial pressure. These measurements can help nurses enhance cardiac functioning. 

Question 4 

Define CO. What is the equation for determining CO? What does this CO measurement indicate? 

Cardiac output (CO) refers to the resulting sum multiplication of the stroke volume and the heart’s beat per minute or heart rate. The formula is; 

CO = HR*SV 

Where HR is the heart rate, and SV is the stroke volume ( Taylor et al. 2017) . 

The measurement indicates the heart’s efficiency and the amount of blood supplied to all the body parts. 

Question 5 

Mr. Smith has clinical evidence of elevated left ventricular preload.  

Elevation of which of the hemodynamic readings would indicate left-sided failure with no right-sided pathology? 

The left part cardiac filling pressures 

Question 6 

What is the teaching client indicated for this client and his wife? 

Mr. Smith and his wife should be trained and made aware of the present condition. The training should be family-centered, given that the two are a couple.   

Question 7 

Based on the assessment data provided, write three nursing diagnoses for Mr. Smith. 

Three nursing diagnoses can be used to diagnose Mr. Smith. They include arrhythmia, cardiogenic shock, and increased cardiac output ( Taylor et al. 2017) . For the arrhythmia, the nurse will examine the cardiovascular functionality and continuing threat of arrhythmia ( Wagner & Hardin-Pierce, 2018) . The nurse will also observe the regularity and frequency of the heartbeat. For the cardiogenic shock, the nurse will study any disparities in orthostatic hypotension. The nurse will also check on oliguria. 

Question 8 

What problems are expected, and what are three evidence-based nursing interventions for each problem.   

Mr. Smith may experience shortness of breath due to inadequate oxygen reaching the lungs and the body. He may also experience fluid build-up in the body and swelling of legs. For shortness of breath, the nurse can apply pharmacological interventions such as oxygen therapy ( Wagner & Hardin-Pierce, 2018) . For the build-up of fluids and swelling legs, the nurse can help the patient exercise and walk around to reduce the swelling and fluid build-up. 

References 

Taylor, C. J., Rutten, F. H., Brouwer, J. R., & Hobbs, F. R. (2017). Practical guidance on heart failure diagnosis and management in primary care: recent EPCCS recommendations.  Br J Gen Pract ,  67 (660), 326-327. https://bjgp.org/content/67/660/326           

Wagner, K.D., & Hardin-Pierce, M. G. (2018). High acuity nursing (7th ed.). Boston, MA: Pearson Ed.