Altered Perfusion Flashcards
Forcing blood or other fluid to flow through a vessel and into the vascular bed tissue to provide oxygen
Perfusion
What are the requirements for effective perfusion?
▫️adequate ventilation and diffusion ▫️intact pulmonary circulation ▫️adequate blood volume and components ▫️adequate cardiac output ▫️intact cardiac control center and receptors ▫️intact parasympathetic and sympathetic nervous systems ▫️intact cardiac circulation ▫️intact coronary circulation ▫️intact systemic circulation ▫️adequate tissue uptake of oxygen
The inability to adequately oxygenate tissue at the capillary level
Altered Perfusion
Factors that could alter perfusion include:
▫️ventilation-perfusion mismatching
▫️impaired circulation
▫️inadequate cardiac output
▫️excessive perfusion demands
A condition of circulatory failure and impaired perfusion of vital organs- often equated with hypotension
Shock
Ineffective cardiac pumping
Cardiogenic shock
decreased blood volume
Hypovolemic shock
Sources of impaired perfusion by massive systemic vasodilation:
▫️septic shock - infection
▫️neurogenic shock - lack of SNS from brain or spinal cord injury
▫️anaphylactic shock - large release of histamine
Shock manifestations
▫️tachycardia, tachypnea
▫️cool, clammy extremities with poor peripheral pulses
▫️decreased arterial blood pressure (a late sign indicative of decompensation)
▫️cyanosis and/or pallor
▫️restlessness, apprehension, decreased mental function
▫️poor urinary output
Occurs when the body is unable to maintain homeostasis with the compensations mechanisms
Decompensation
Hypertension- Manifestation
▫️often asymptomatic
▫️when advanced, causes CNS changes;
▫️CV changes
- pulmonary edema
▫️renal insufficiency
- poor urinary output - problems with eliminating urinary waste - hematuria - proteinuria
Hypertension when advanced, causes CNS changes;
▫️headache ▫️new-onset blurred vision ▫️confusion ▫️mental status changes ▫️fatigue ▫️nausea ▫️weakness ▫️vomiting
Risk factors of hypertension
▫️family history of hypertension ▫️diabetes mellitus ▫️excessive dietary sodium intake ▫️excessive alcohol intake ▫️gender ▫️aging ▫️obesity ▫️smoking ▫️sedentary lifestyle ▫️race
Classification of High blood pressure in adults
systolic Diastolic
Stage 1 140-159 90-99
Stage 2 150-179 100-109
Stage 3 180 or > 110 or >
What are the causes of Altered Perfusion?
- Perfusion ventilation mismatch
- Impaired circulation
- Inadequate cardiac output
- Excessive perfusion demand
Ventilation perfusion mismatch would lead to:
- Respiratory disease
2. Pulmonary embolus
Impaired circulation would cause:
- Hemorrhage
- Obstruction or disruptions in blood flow
- Inadequate blood composition or volume
An inadequate cardiac output will lead to:
- Inadequate blood composition or volume
- Impaired ventricular pumping
- Structural defects
- Excessive peripheral vascular resistance
- Conduction defects
Excessive perfusion demands can cause:
- Prolonged exertion
- Metabolic exertion
- anemia
General manifestations of Altered perfusion:
▫️cyanosis, pain, pallor, coolness, edema, shortness of breath, impaired growth, tachycardia, tachypnea and fatigue
▫️hypotension and hypertension
▫️bleeding, bruising
▫️heart murmur
Application of the concepts of Altered Perfusion:
- Hypertension
- Shock
- Arterio-, arteriolo- and athero-sclerosis
- Aneurysms
- Varicose veins
- Deep Vein Thrombosis (DVT)
- MI (includes Angina)
- HF (LHF; RHF)
- Stroke
- DIC (disseminated intravascular coagulation)
degenerative loss of elasticity, thickening, hardening and calcification of the walls of arteries and arterioles
🔺cause of ⬆️ BP
Arterio And arteriolo-sclerosis
Presence of fatty plaques causing thickening inside the walls of large and medium arteries (aorta, iliac, coronary, carotid) particularly at points of bifurcation
Atherosclerosis
▫️localized dilation or out-pouching of a vessel wall
▫️typically caused by atherosclerosis, hypertension, congenital weakness in vessel walls, trauma, infections (e.g. syphilis)
Aneurysm
▫️distended, bulging and tortuous (winding) superficial or deep veins
▫️mostly found in legs but also in esophagus or rectum
Varicose veins
development of a thrombus in a vein - common cause of pulmonary embolisms
Thrombophlebitis or DVT
total occlusion of one or more coronary arteries resulting in ischemia and death of MI
- atherosclerosis is most common cause
MI
MI manifestation:
▫️gender variability ▫️chest pain or a crushing pressure, often radiating to the left arms, shoulder, or jaw ▫️fatigue, weakness, syncope, anxiety ▫️dizziness, shortness of breath ▫️sweating, pallor ▫️indigestion ▫️nausea, vomiting
reflects an inadequacy of heart pumping such that the heart fails to maintain the circulation of blood
HF
▫️congestion of peripheral tissues
⬇️
Dependent GI tract. Liver
Edema Congestion. Congestion
and as cites. ⬇️. ⬇️
anorexia, GI. signs related to
distress, wt loss. Impaired liver
function
Right Heart Failure
Right sided heart failure
Causes: infarction of right ventricle, pulmonary valve stenosis, pulmonary disease (cor pulmonale)
Causes : infarction of left ventricle, aortic valve stenosis, hypertension, hyperthyroidism
Left sided CHF
▫️Any clinical event that leads to the impairment of cerebral circulation
▫️leads to inflammation, ischemia, death of neurons ➡️ characterized as death of brain tissue due to loss of blood supply; scar tissue and loss of function are left behind as neurons cannot regenerate
Stroke
Fatty plaque or blood clot (embolism) breaks away and flows to brain where it blocks artery
▫️Embolic Stroke
Blood clot (thrombus) blocks flow of blood in brain.
thrombotic stroke
Break in blood vessels (aneurysm) in brain
Cerebral hemorrhage
uncontrolled activation of clotting factors resulting in widespread thrombi formation, followed by depletion of coagulation factors and platelets leading to massive hemorrhage
Disseminated Intravascular Coagulation
Hereditary bleeding disorder (X-linked) causing deficiency or absence of clotting factor VIII
Hemophilia A
is caused in a reduction in O2 delivery to the tissues due to a decrease in hemoglobin content
Anemia’s
Major causes of Anemia:
▫️inadequate iron intake or high iron demands
▫️chronic hemorrhage
▫️iron malabsorption
4 main categories of anemia:
- Iron deficiency anemia
- Pernicious Anemia- vit B12 deficiency
- Aplastic Anemia
- Hemolytic Anemia
An Anemia caused by decreased dietary intake, malabsorption, blood loss
Iron deficiency anemia
A type of anemia caused by deficit of intrinsic factor owing immune reaction
Pernicious Anemia
A type of Anemia that is caused by bone marrow damage or failure
▫️add’l effect: excessive bleeding and multiple infections
Aplastic Anemia
Is a recessive inheritance Anemia
Sickle cell anemia
Consists of group of neoplastic disorder involving the WBC’s
▫️Leukemia
4 types of leukaemias:
- Acute lymphocytic leukaemia
- affects B-cells
- Chronic lymphocytic leukaemia
- affects B-cells
- Acute myelogenous leukemia
- affects RBC, platelets, non-lymphocytic WBCs
- Chronic myelogenous leukemia
- affects RBC, platelets, non-lymphocytic WBCs
Manifestations of leukemia:
▫️Anemia ▫️Bruising ▫️bleeding ▫️bone pain ▫️weight loss ▫️fever ▫️headache/vomiting
