Hemodynamic Monitoring Case study PDF

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NUR 463 Hemodynamic Monitoring Case study Name: Date: September 27, 2017 Mrs. M., a 61-year-old female, is admitted to the critical care unit after emergency surgery for treatment of a perforated bowel. Intraoperatively she had an estimated blood loss of 300 mL, and she received 2.5 L of crystalloid solution. An arterial line, subclavian triple-lumen catheter, and indwelling urinary catheter are placed in the operating room. Upon admission to the critical care unit, Mrs. M. is intubated and sedated. She is placed on mechanical ventilation with the following settings: assist/control mode at 12 breaths/min; tidal volume, 650 mL; fraction of inspired oxygen, 1.0 (100%); and positive end-expiratory pressure, 5 cm H2O. Her initial postoperative vital signs and laboratory findings are:

Heart rate

140 beats/min

Blood pressure

88/49 mm Hg

Mean arterial pressure

62 mm Hg

Respiratory rate

12 breaths/min

Right atrial pressure

4 mm Hg

Temperature

39.2 C (102.6° F)

Lactate

1.1 mEq/L

The physician orders a 500-mL infusion of normal saline (NS) 0.9%, repeat of serum lactate level, and replacement of the triple-lumen catheter with a catheter that measures ScvO2. The nurse administers the fluids and assists with the placement of the ScvO2 catheter. After these interventions, the nurse reassesses vital signs and hemodynamic values, which are noted below:

Heart rate

118 beats/min

Blood pressure

96/52 mm Hg

Mean arterial pressure

66 mm Hg

Right atrial pressure

8 mm Hg

Cardiac index (CI)

2.8 L/min/m2

ScvO2

59%

Lactate

3.6 mEq/L

1. Discuss the rationale for placing the ScvO2 catheter. Scv02 monitoring is indicated for any critically ill or injured patient who has potential to develop an imbalance between oxygen delivery and oxygen consumption or demand. Patients with trauma, acute respiratory distress syndrome, sepsis and complex cardiac surgery may benefit from venous oxygen saturation monitoring. 2. What is the normal range for ScvO2? The normal range for Scv02 is 65% to 85%. 3. For Mrs. M., identify possible causes of a decreased ScvO2 (...