The nurse is caring for a patient with acute decompensated heart failure who has a pulmonary artery catheter. Which assessment indicates the patient’s condition is improving?A. Cardiac output (CO) is 3.5 L/min.B. Central venous pressure (CVP) is 10 mm Hg.C. Pulmonary artery wedge pressure (PAWP) is 10 mm Hg.D. Systemic vascular resistance (SVR) is 1500 dynes/sec/cm−5.
C. Pulmonary artery wedge pressure (PAWP) is 10 mm hgPAWP is the most sensitive indicator of cardiac function and fluid volume status. Normal range for PAWP is 6 to 12 mm Hg. PAWP is increased in heart failure. Normal range for CVP is 2 to 8 mm Hg. An elevated CVP indicates right-sided heart failure or volume overload. CO is decreased in heart failure. Normal cardiac output is 4 to 8 L/minute. SVR is increased in left-sided heart failure. Normal SVR is 800 to 1200 dynes/sec/cm−5.
Of the given options, the assessment that indicates the patient’s condition is improving is option C, which states that the Pulmonary artery wedge pressure (PAWP) is 10 mm Hg.
Pulmonary artery wedge pressure (PAWP) is used to determine how well the patient’s heart is pumping blood and can be a useful indicator of heart failure. A normal PAWP is around 8-12 mm Hg. In heart failure, the PAWP is usually elevated due to an increase in fluid within the lungs. In this case, a PAWP of 10 mm Hg suggests that the fluid in the lungs is decreasing, which is an indicator that the patient’s heart is improving.
Cardiac output (CO) is the amount of blood pumped by the heart per minute into the systemic circulation. Although 3.5 L/min is within the normal range, it does not necessarily indicate improvement in heart failure.
Central venous pressure (CVP) is the pressure measured in the large veins close to the heart. A CVP of 10 mm Hg is considered normal but cannot be used alone to assess heart failure.
Systemic vascular resistance (SVR) is the resistance offered against the flow of blood in the blood vessels. High SVR is usually associated with poor cardiac output, but the given value of 1500 dynes/sec/cm−5 cannot be used alone to assess heart failure.
Therefore, option C, Pulmonary artery wedge pressure (PAWP) being 10 mm Hg, is the best indicator of improvement in heart failure.
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