Hemodynamic Monitoring - Nursing Case Study

Pathophysiology

• Primary mechanism: Hemodynamic monitoring tracks the blood pressure inside the veins, heart, and arteries. It also measures blood flow and how much oxygen the body is using or getting. Monitoring these parameters helps assess the heart's functionality and the body's overall well-being.

• Secondary mechanism: The data from hemodynamic monitoring helps in assessing the balance between oxygen supply and demand in the body. A mismatch can lead to organ dysfunction. Therefore, the monitoring can warn about potential organ failure or shock.

• Key complication: Hemodynamic monitoring, if not done correctly, may lead to infection due to invasive procedures like inserting catheters. It can also cause bleeding or damage to blood vessels. Nurses need to ensure aseptic technique to prevent these complications.

Patient Profile

Demographics:

54, Female, Office Administrator

History:

• Key past medical history: No significant past medical history

• Current medications: Daily multivitamin

• Allergies: No known allergies

Current Presentation:

• Chief complaint: Feeling of occasional lightheadedness over the past week

• Key symptoms: Mild lightheadedness, no fainting or loss of consciousness, no chest pain or shortness of breath

• Vital signs: Blood pressure: 120/80 mmHg, Heart rate: 72 bpm, Respiratory rate: 16 breaths per minute, Oxygen saturation: 98%, Temperature: 98.6°F

Section 1

Initial Assessment Findings:

Upon further assessment, an EKG was performed which showed a regular sinus rhythm. The patient’s cardiovascular assessment revealed a regular rate and rhythm with no extra heart sounds or murmurs. Her pulses were strong and equal bilaterally in the upper and lower extremities. The skin was warm and dry with good capillary refill and there was no peripheral edema noted. Her lungs were clear to auscultation bilaterally. Neurologically, the patient was alert and oriented to person, place, and time. Cranial nerves were intact and strength was equal and full bilaterally.

The nurse's initial assessment indicated that the patient's hemodynamic status was within normal limits, and there were no immediate signs of cardiovascular distress. However, the patient's complaint of intermittent lightheadedness raised concerns about possible underlying cardiovascular issues or imbalance in her oxygen supply and demand. It was decided that the patient should undergo a more comprehensive hemodynamic monitoring to better understand her symptoms and rule out any potential risks. This would include tracking her blood pressure, heart rate, and oxygen saturation over time, and possibly more invasive procedures like arterial line placement for continuous pressure monitoring, depending on her upcoming results and physician's judgment.

Section 2

New Diagnostic Results:

The patient's blood pressure and heart rate were monitored every hour, which showed a consistent blood pressure reading of approximately 120/80 mmHg and a heart rate within the range of 60-75 beats per minute. Her oxygen saturation levels remained between 95-98% on room air. These results were indicative of a stable hemodynamic status. However, the patient's 12-lead EKG showed occasional premature ventricular contractions (PVCs) which, although not immediately life-threatening, could explain her intermittent lightheadedness.

Given these findings, the physician ordered a Holter monitor to record the patient's heart rhythms over a 24-hour period. This would provide a more comprehensive understanding of the frequency and timing of the PVCs and any possible correlation with her symptoms. The patient was also scheduled for a complete metabolic panel (CMP) and a complete blood count (CBC) to rule out electrolyte imbalances or anemia that might be contributing to her symptoms.

This new diagnostic information required the nurse to evaluate the patient's understanding of the findings and the plan of care, as well as to monitor her response to the Holter monitor placement and her comfort during the process. The nurse also needed to prepare the patient for the upcoming labs, ensuring she understood why they were being done and what to expect during the procedure.

Section 3

New Diagnostic Results:

The patient's Holter monitor results showed sporadic PVCs throughout the 24-hour period, with a slightly increased frequency during the late afternoon and evening hours. This pattern seemed to align with the patient's reported instances of lightheadedness. The CMP and CBC results came back largely normal, with a slightly low potassium level of 3.3 mEq/L (normal range: 3.5-5.0 mEq/L). The patient's hemoglobin level was 12 g/dL, which was within normal range, and effectively ruled out anemia.

Given these results, the physician prescribed a potassium supplement to address the slight hypokalemia, which can sometimes contribute to the occurrence of PVCs. The nurse discussed the new medication with the patient, ensuring she understood the reason for the prescription and the importance of adherence. The nurse also continued to monitor the patient's vital signs closely and reassess her comfort and understanding of the plan of care. The patient was encouraged to report any changes in symptoms, particularly any increase in the frequency or intensity of her lightheadedness. The nurse also informed the patient's family about her condition and updates to her treatment plan, to ensure they were well informed and able to support the patient effectively.

Section 4

Three days into the potassium supplementation, the nurse noted a slight decrease in the frequency of the patient's PVCs. The patient also reported a reduction in her lightheadedness episodes, especially during the late afternoon and evening hours. Vital signs were stable with a blood pressure of 120/80 mmHg, heart rate of 80 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation at 98%. The patient's comfort level also appeared improved, and she seemed more engaged and participative in her care.

New lab results indicated a rise in the patient's potassium level to 3.8 mEq/L, a significant improvement from the previous 3.3 mEq/L, which was suggestive of a positive response to the potassium supplementation. The nurse educated the patient on the importance of a potassium-rich diet and provided a list of foods high in potassium. The patient's family was also engaged in the education session, and they committed to supporting the patient in maintaining a balanced diet. The nurse reinforced the need for regular follow-up and monitoring to ensure the patient's potassium levels stay within the normal range and prevent recurrence of the PVCs.

Section 5

On the fourth day of the patient's admission, the nurse arrived for her shift and began with a review of the overnight events and lab results. It was noted that the patient's potassium level had slightly dropped to 3.6 mEq/L. This fluctuation was a concern, however, the patient's EKG continued to show a decrease in PVCs and her vital signs remained stable: blood pressure at 125/85 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute and oxygen saturation at 98%.

During the physical assessment, the patient reported feeling less fatigued and more alert. Her skin was warm and dry, with good turgor. The patient's heart sounds were regular with no extra heart sounds or murmurs present. Her lungs were clear to auscultation bilaterally. The nurse also probed about the patient's dietary intake and found that while she had started incorporating more potassium-rich foods, she was still struggling with consistent consumption. The nurse emphasized the importance of maintaining a steady potassium intake and discussed different strategies to incorporate these foods into her daily meals. The nurse also reinforced the importance of regular follow-up lab work to monitor her potassium levels closely.