The nurse is caring for a patient who is being monitored with a Swan-Ganz catheter. Which of the following changes requires immediate intervention?
1. pulmonary artery wedge pressure of 10 mm Hg
2. systemic vascular resistance of 900 dynes/sec/cm5
3. appearance of an "a" wave on the pulmonary artery waveform
4. spontaneous development of a pulmonary artery wedge pressure waveform
4
Rationale: A permanent wedge waveform is an indication of catheter migration further into the pulmonary artery causing occlusion. Immediate intervention is needed to prevent pulmonary infarction. A pulmonary arterial wedge pressure of 10 mm Hg is within normal limits. A systemic vascular resistance of 900 is normal. The "a" wave is indicative of the rise in atrial pressure produced by left atrial contraction and is normal.
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