E2 Perfusion Cardiovascular & Peripheral Vascular Flashcards
Afterload
the pressure that the heart must work against to eject blood during systole
Cardiac Output =
Stroke volume (mL/beat) x heart rate (beats/min)
Volume of blood pumped by the heart in one minute
Ejection fraction
The % of blood pumped out of left ventricle with each contraction
Normal = >50%
Heart Failure = <40%
Ex. 100mLs of blood sitting in left ventricle on diastole contract 50% ejected (Normal)
Infarction/ necrosis
Obstruction of the blood supply to an organ or region of tissue, typically by a thrombus or embolus, causing local death of the tissue
Ischemia
Blood flow decreased leading to insufficient O2 (hypoxia)
Myocardial contractility
How hard the heart contracts regardless of stretch factor
Preload
the amount of stretch during diastole
Pulmonary embolism
Embolism travels to superior vena cava, right atrium, right ventricle, and finally the lungs (gets stuck here)
Can Kill You
Pulse pressure
Difference btwn systolic and diastolic pressure
Normal= 1/3 of Systolic
High in older people, atherosclerosis, exercise
Low in severe heart failure, hypovolemia (low blood volume)
Pulsus alternans
Regular rhythm but strength of pulse varies with each beat
Ex. Heart failure
Stroke
Damage to the brain from interruption of its blood supply
Stoke volume
Amount of blood ejected from the left ventricle every pump (mL/beat)
Venous thromboembolism (VTE)
Obstruction of a blood vessel by a blood clot that has become dislodged from another site in circulation
Who is at risk for a VTE?
- Venous stasis (Blood pooling in vein)
- Hypercoagulability (Thickened blood)
- Endothelial damage (Blood vessel wall)
VTE S/S
-localized redness, tenderness, swelling over vein sites
-Warmth, tenderness, firmness of muscle in calf
-Complaints of calf pain with ambulation
-Usually unilateral
Assessment for VTE
Palpation for s/s of inflammation/ phlebitis
VTE- Diagnosis (detection)
-Obtain history
-Physical assessment
-vascular ultrasound studies
-Ultrasound is the only reliable tool to detect
What can we do as a nurse to prevent/ assess for VTEs?
-Assess for symptoms
-Measure calf circumference
-Calf tenderness/phlebitis checks
-Early ambulation
-Thromb-embolic deterrent (TEDS)
-Sequential compression device (SCDs)
-Calf pumps
VTE treatment
-Prevention is KEY
-Anticoagulation (levonox or heprin)
-Thrombolytic (lyses a thrombus)
-IVC filter (Vena cava device to catch clots before they get to lungs)
Placement of telemetry leads
Snow over grass
Smoke over Fire
Chocolate close to the heart
Murmurs
Swooshing sound, problem with valve
Clicks
pt has had mechanical valve so hear click on close
Rubs
rub of pericardial sac, stratchy
5 P’s of Peripheral vascular checks
Pain (0-10)
Pulse (0-4+)
Pallor (color)
Paresthesia (feel)
Paralysis (movement)
Nursing implementation for cardiovascular system
-Strict I&O
-Oxygen PRN
-Telemetry
-Administer Meds
-Monitor labs (CBC, Lipid panel)
-Implement heart healthy diet (DASH)
-Limit stress
-Prevent thrombus formation
Nurse care: Patient teaching for Cardiovascular system
-Patient centered
-Set goals and provide resources
-Avoid smoking & Alcohol consumption
- Limit stress
-Control HTN, HLP, DM
-Nutrition
-Exercise
Flow of blood into heart
-Blood comes into Right atrium
-Right ventricle
-Pulmonary arteries in lungs
-Picks up O2 in lungs
-Pulmonary vein back to heart
-Left atrium
-Left ventricle
-Aorta
-Body tissue
Perfusion
Passage of fluid through circulatory system or lymphatic system to an organ or tissue
Tissue would die w/o perfusion
Alterations in cardiac output:
- Heart rate
- Stroke Volume
- Myocardial contractility
What are examples of things that can alter Cardiac Output
-Medications
-Disease Processes
-Activity
Blood Pressure
Force exerted by the blood against the blood vessel walls
120/80
Cardiopulmonary Resuscitation
Compressions-Airway-Breathing
1st Check for pulse then call for help
Rate: 100-120 BMP
Depth: 2 in
Breaths 10-12 Breaths per min
Ratio: 30-2
High blood pressure definition not number
Pressure in your arteries is higher than it should be
Daily variation of BP
0000-0300: Lowest
0300-0600: Slow Rise
Wake Up: surge
1000-1800: Highest
Modifiable risk factors of HTN
-Diabetes Mellitus
-Elevated serum lipids
-Excess Na+ intake
-Obesity
-Sedentary lifestyle
-Stress
-Tobacco & Alcohol Use
Nonmodifiable risk factors of HTN
-Family History
-Race/Ethnicity
-Increasing age
-Gender
-Chronic kidney disease
-Obstructive sleep apnea
Hypertensive pts have increased
Cardiac output, peripheral resistance, hematocrit
Diagnosis of HTN
Average of 2 or more readings on at least subsequent health care visits is above 120/80
might check EKG or CXR
Hypertension symptoms
-Dizziness
-Headache
-Heart palpations
-nosebleed
-short breath
-anger
-red face
-visual problems
-fatigue
-insomnia
-sore knee
-raised temp
Hypertensive crisis
BP > 180/110
Severe headache
Dyspnea or chest pain
Dizziness, numbness, weakness
Loss of vision
Difficulty speaking
Nosebleeds
Severe anxiety
Unresponsive
What foods have a high sodium content
-Cheese
-Condiments (BBQ)
-Soy sauce
-Pickles
-Seasoning salt
Hypotension
SBP falls below <90mmHG
-Is pt symptomatic? Don’t treat if no
Causes of hypotension
-Dilation of arteries
-Loss of blood volume
-Failure of heart muscles
Symptoms of Hypotension
-Skin: pallor, skin mottling, clamminess
-Decreased perfusion to brain: Lightheadedness, dizziness, syncope, confusion
-Blurred vision
-Chest pain: Angina
-increased HR: rapid or weak
-Decreased Urine Output
-N/V
Treatment of hypotension
Treat the cause
-Vasodilation
-Loss of blood volume
-Failure of heart muscle to pump
What type of people get orthostatic hypotension
-Those that don’t have hypotension
-Elderly
-Immobilized or bedrest
-Pregnant
Diagnosis of orthostatic hypotension
-SBP decrease of 20mmHG or more
-DBP decrease pf 10mmHG or more
Nursing care for orthostatic patients
-Change position slowly/ dangle at bedside
-Don’t cross legs when sitting
-Early ambulation
-If immobile, balance rest and activity
-Perform isometric exercises
-Wear compression hose
-Avoid standing for long periods of time
Describe lipids
fat-like particles in blood stream
Describe cholesterol
waxy-fat-like substance found in all cells of body
Where is cholesterol made?
Liver mainly and diet
What is the most common fat in the body?
Triglycerides
Why do we care about hyperlipidemia?
It forms hard deposit inside of arteries called atherosclerosis
Worry about it building up on the arterial walls causing it to narrow and less elastic/ flexible (prevent perfusion)
Normal Cholesterol
<200mg/dL
Normal LDL (Bad guys)
<130mg/dL
Normal HDL (Good guys)
Male >45mg/dL
Females >55mg/dL
Hyperlipidemia: Diagnostic Test
Test at age 20. Test every 4-6 years
At age 40, assess 10 year risk for experiencing CVD or Stroke
Dietary modifications of Hyperlipidemia pt
-Reduce saturated and trans fats
-Increase in complex carbohydrates & fiber (whole grains, fruits, veggies)
-Limit major source of cholesterol (red meat, egg yolk, whole milk)
-If you have high triglycerides limits alcohol
-eat fatty fish weekly
-Eat foods other than fatty fish high in OMEGA-3 FATTY ACIDS (soy bean, canola, walnuts, flax seeds)
Common perfusion concerns
- Hypertension
- Hypotension
- Hyperlipidemia
- Venous Thromboembolism (VTE)
