Question

Mary is a 50 year old who has an ST elevation in her anterior leads. PMH: 2 MI’s. Her blood pressure has reduced and has developed crackles and has a PA catheter inserted. BSA is 1.90

HR – 120; BP – 94/76; CVP – 8; PAP – 42/30; PAOP – 30; CO – 3.86

a) Calculate MAP; SVRI; CI; SI

b) identify the appropriate indicator and determine if the value is high, normal or low

c) if high or low, correlate with assessment findings and pathophysiology

-HR

-Preload

-Contractility

-Afterload

d) which component is the primary problem

e) what interventions are needed to improve his hemodynamic status?

Answer 1

a) MAP = (2XDBP)+ SBP/ 3 =

(2x76) + 94 /3 = 82

CI = CO/ BSA = 3.86/1.90 = 2.03

SVRI = ( MAP - CVP) X 80 / CI

= (82-8) X 80 / 2.03 = 2916

SV = CO/HR X 1000 = 3.86/120 X 1000

= 32.1

b) Normal MAP = 70-100 mmHg

So MAP normal

Normal CI = 2.5-4.0

CI decreased

Normal SVRI = 1970-2390

SVRI Increased

Normal SV = 60-100 ml/beat

SV decreased

c) SV is decreased here.

Heart rate is 120 increased

CI decreased

SVRI Increased

Preload will be high

Preload and contractility will decrease

d) Dangerous problem is st elevation in anterior leads. A finding of acute anterior wall MI.

e) Measures to improve hemolytic status including,

Reperfusion therapy in particular coronary angioplasty and pharmacological interventions with antiplatelet and antithrombin agents , beta blockers, angiotensin converting enzyme inhibitors.

Thankyou