# A nurse is caring for a patient in the intensive care unit who has a pulmonary artery catheter in place. The nurse obtains the following hemodynamic readings: pulmonary artery pressure (PAP) 45/25 mmHg, pulmonary capillary wedge pressure (PCWP) 22 mmHg, cardiac output (CO) 3.2 L/min, and systemic vascular resistance (SVR) 1800 dynes/sec/cm⁵. What is the priority nursing assessment for this patient?

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## 문제

A nurse is caring for a patient in the intensive care unit who has a pulmonary artery catheter in place. The nurse obtains the following hemodynamic readings: pulmonary artery pressure (PAP) 45/25 mmHg, pulmonary capillary wedge pressure (PCWP) 22 mmHg, cardiac output (CO) 3.2 L/min, and systemic vascular resistance (SVR) 1800 dynes/sec/cm⁵. What is the priority nursing assessment for this patient?

## 보기

1. Assess for signs and symptoms of left-sided heart failure including dyspnea, crackles, and decreased oxygen saturation. **✔ 정답**
2. Monitor for signs of right-sided heart failure such as jugular venous distention and peripheral edema.
3. Evaluate for signs of hypovolemic shock including decreased urine output and altered mental status.
4. Check for manifestations of septic shock such as fever, increased white blood cell count, and hypotension.

**정답: 1**

## 해설

Elevated PCWP (22 mmHg) indicates left-sided heart failure with pulmonary congestion, requiring priority assessment for dyspnea and crackles. Other options do not align with the hemodynamic pattern of left heart failure.

## 심화 해설

Interpreting the Hemodynamic Profile

The patient's hemodynamic readings reveal a classic pattern of left ventricular dysfunction. The pulmonary artery pressure (PAP) is elevated at 45/25 mmHg (normal systolic 15–30 mmHg, diastolic 4–12 mmHg). The pulmonary capillary wedge pressure (PCWP), which reflects left atrial and left ventricular end-diastolic pressure, is significantly elevated at 22 mmHg (normal 4–12 mmHg). This indicates increased hydrostatic pressure in the pulmonary vasculature due to backward transmission from a failing left ventricle [1]. The cardiac output (CO) is low at 3.2 L/min (normal 4–8 L/min), and the systemic vascular resistance (SVR) is high at 1800 dynes/sec/cm⁵ (normal 800–1200 dynes/sec/cm⁵). The elevated SVR is a compensatory vasoconstriction in response to the low CO, a hallmark of cardiogenic shock.

Why Left-Sided Heart Failure is the Priority

The combination of an elevated PCWP and a low CO directly points to left ventricular pump failure. The left ventricle is unable to effectively eject blood forward, causing a decrease in cardiac output and a backup of blood into the pulmonary circulation. The elevated PCWP of 22 mmHg exceeds the threshold where fluid begins to transude from the pulmonary capillaries into the interstitial and alveolar spaces, leading to pulmonary edema. Therefore, the priority assessment is to detect the clinical manifestations of this pulmonary congestion, which are the direct consequences of the measured pressures [1].

Analysis of Incorrect Options

- Option 2: While right-sided heart failure can eventually develop secondary to left-sided failure, the primary acute insult indicated by the elevated PCWP and low CO is left ventricular dysfunction. The immediate threat is pulmonary edema, not peripheral congestion.

- Option 3: Hypovolemic shock would present with a low PCWP and low CO, not an elevated PCWP. The high PCWP here rules out hypovolemia as the primary cause.

- Option 4: Septic shock typically presents with a high or normal CO and a low SVR in its hyperdynamic phase, which is the opposite of this patient's low CO and high SVR profile.

The data obtained from the pulmonary artery catheter allows for direct measurement of these pressures, providing a definitive diagnosis of left ventricular failure and guiding the nurse to prioritize assessment for its most life-threatening complication: pulmonary edema [1].References (research sources)

- [1]Right Heart Catheterization: Best Practices and Specific Considerations.Research articleLee SH, Bae DH, Hong D, Kim IC, Yang JH. (2026) · DOI: 10.36628/ijhf.2026.0041

## 임상 시나리오

Interpreting a Cardiogenic Shock ProfileHigh PCWP + Low CO + High SVR
The classic hemodynamic pattern for left ventricular failure includes an elevated PCWP (>12 mmHg), a low cardiac output (< 4 L/min), and a compensatory high SVR (>1200 dynes/sec/cm⁵).

An elevated PCWP of 22 mmHg indicates increased hydrostatic pressure transmitted backward into the pulmonary capillaries, leading to pulmonary edema. The priority assessment focuses on detecting respiratory signs of this congestion.

CautionDo not confuse this profile with hypovolemic shock (low PCWP) or septic shock (low SVR, often high CO). Treating the elevated SVR with vasodilators without addressing the underlying pump failure can worsen hypotension.

## 핵심 개념

- **Pulmonary Capillary Wedge Pressure (PCWP)** — A pressure measured by a pulmonary artery catheter that reflects left atrial and left ventricular end-diastolic pressure; normal range is 4-12 mmHg.
- **Cardiac Output (CO)** — The volume of blood pumped by the heart per minute; normal range is 4-8 L/min. Low CO indicates pump failure or hypovolemia.
- **Systemic Vascular Resistance (SVR)** — The resistance the left ventricle must overcome to eject blood; normal range is 800-1200 dynes/sec/cm⁵. Elevated SVR is often a compensatory response to low CO.
- **Pulmonary Artery Pressure (PAP)** — Pressure in the pulmonary artery; normal systolic is 15-30 mmHg and diastolic is 4-12 mmHg. Elevated pressures can indicate left-sided heart failure or pulmonary hypertension.
- **Cardiogenic Shock** — A state of inadequate tissue perfusion due to cardiac pump failure, characterized by elevated filling pressures (PCWP), low CO, and compensatory vasoconstriction (high SVR).

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