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NURS 134 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

what is the flow of blood through arteries and capillaries delivering oxygen and nutrients to cells

A

perfusion

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1
Q

what is the amount of blood pumped by the heart each minute

A

central perfusion

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2
Q

what is the volume of blood that flows through the target organs

A

tissue perfusion

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3
Q

what parts of the body require larger amounts of blood to function

A

brain and intestines

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4
Q

what are the normal physiological processes of central perfusion

A

force of blood movement generated by cardiac output
requires adequate cardiac function, blood pressure, and blood volume

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5
Q

what are the modifiable and non modifiable risk factors for impaired perfusion

A

MODIFIABLE:
Smoking- nicotine vasoconstricts
elevated serum lipids- contribute to atherosclerosis
Sedentary lifestyle- contributes to obesity
Obesity- increases risk for DM1&2 and atherosclerosis
Dm- increases risk of atherosclerosis
Hypertension- increases work of myocardium
NONMODIFIABLE:
Age- increases with age
Gender- men more than women
Genetics- some family history (htn, high cholesterol, sickle disease, hemophilia, vonwillibrans disease)

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5
Q

what are the normal physiological processes of tissue/local perfusion

A

Volume of blood that flows to target tissue
Requires patent vessels, adequate hydrostatic pressure, and capillary permeability

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6
Q

what is the stroke volume times heart rate
(how hard & fast the heart is beating)

A

cardiac output

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7
Q

when does impairment of central perfusion occur

A

When cardiac output is inadequate

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8
Q

what is impairment of tissue perfusion associated with?

A

loss of vessel patency or permeability, or inadequate central perfusion
Associated with DVT

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9
Q

What does reduced cardiac output result in? And what happens if it is severe or untreated?

A

A reduction of oxygenated blood reaching the body tissues (systemic effect)
If severe- associated with shock (death can occur)
If untreated- leads to ischemia (tissue death), cell injury, and cell death (death)

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10
Q

what does impairment of tissue perfusion result in?

A

impaired blood flow to the affected body tissue (localized effect)
Leads to ischemia and ultimately, cell death if uncorrected

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11
Q

Ex: when there is an injury to a vessel as soon as it is hurt the body created platelet plug. what is this?

A

clotting cascade?

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11
Q

What populations are at greatest risk of poor perfusion?

A

Older adults & lower income/ low educational level individuals
Although it can occur among all individuals

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12
Q

What is the assessment of perfusion?

A

History- baseline, health hx
Examination findings- chart findings physical exam
Diagnostic tests- analyze these results & figure out whats going on

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13
Q

what is the baseline history of perfusion?

A

functional health patterns
(healthy set of behaviors)

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14
Q

what is the problem based history of perfusion?

A

Pain- decreased o2 to parts of body (common)
Use old carts to ask about pain
Syncope- passing out because the perfusion to the brain slows down
Always ask what they were doing before they had an episode
Dizziness- most commonly from standing up too fast if it is not from that there could be
something wrong with carotids (they must be 80% blocked for surgeons to clean them out)
Check BP to see if its orthostatic hypotension
Dyspnea- shortness of breath (inadequate oxygenation to blood)
Edema- swelling (pitting or nonpitting) caused by poor perfusion
Bleeding & bruising- takes longer for blood to stop in one part of body
Intracranial bleeding (could be from trauma to brain)- can lead to stroke (most common stroke is hemorrhage stroke
Fatigue- tiredness
Most common from poor perfusion
Ask if it came on quick or not

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15
Q

What are the examination findings of perfusion?

A

vital signs- HYPO/HYPER PERFUSION, BRADY/ TACHY CARDIA, ASSESS BILATERAL PULSES (ARE THEY EQUAL?)
inspection- looking (at pt and lab results) inspect skin for color and temp
palpation- pulses (are the equal?) check skin turgor & tenting (fluid volume deficit) & edema
auscultation- listen with stethoscope
Listen for heart sounds
S1- lub
S2- dub
S3- something wrong with left ventricle
S4- possibly coronary artery disease
Listen for functional heart murmurs
Listen for atherosclerosis (listen for bruie)

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16
Q

What are different diagnostic tests for perfusion?

A

lab tests
Electrocardiogram (EKG)
Cardiac stress test
Radiographic studies

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17
Q

what are different types of laboratory tests for perfusion?

A

Cardiac enzymes/markers-troponin level drawn
Serum lipids- (every year)
Complete blood count- hemoglobin and hematocrit (h&h)
Blood coagulability- essential for clotting when cut
Bone marrow biopsy- usually after other tests if there’s a clotting disorder
d-dimer- assess thrombin in blood stream (if elevated they normally have a PE)

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18
Q

Why does someone normally have an EKG fro perfusion?

A

if they have chest pain

19
Q

what are different types of cardiac stress tests for perfusion?

A

Exercise cardiac stress test- get on treadmill w med and see if there’s stress on the heart
Pharmacologic stress test- more for those who can’t walk/ run

20
Q

what are different types of radiographic studies for perfusion?

A

Chest x ray
Ultrasound
Arteriogram (av gram)- test perfusion with lung & heart how they go back and forth
Venogram
Cardiac ct- cat scan of heart to see if there’s any blockages
Cardiovascular MRI- more detailed pic bc Ct might not be as good

21
Q

What are the two parts of clinical management in perfusion?

A

Primary prevention- prevents from happening
Secondary prevention (screening)- early diagnosis/ treatment

22
Q

What are different kinds of collaborative interventions with perfusion?

A

Nutrition therapy- heart healthy diet, weight management
Smoking cessation- how to quit and stay quit
Activity & exercise- how to w what they have
Pharmacotherapy- most common are pills

23
Q

What are interventional & invasive studies/procedures for perfusion?

A

Defibrillation- emergency treatment for cardiac arrest/ when tachycardia is present/ used to change rhythm
Pacemaker- used to keep heartbeat at certain rate
Heart valve replacement- replacement of heart valve
Synchronized cardioversion- use of dfib on nonemergent basis/ to convert nonryhtm to regular
Cardiac catheterization- put wire into heart and inject dye to see where the blockage is (goes through the wrist so you can see it
Arterial bypass graft- open heart surgery (use vessel from leg or an artificial to bypass vessel)
Angioplasty with stent placement- inflate balloon then insert stent (filter to help blood clots)
Endarterectomy- in caradid artery/ clean it out/ help perfusion to the brain
Thrombectomy- removal of throbis to create perfusion to where it needs to go
Cardiac transplant- heart transplant from donor

24
Q

what are vasodilators? and which are used for perfusion?

A

increase diameter of blood vessels
Used to treat HTN, angina !!!!Angiotension- converting enzyme inhibitors (ACE inhibitors)
!!!!Nitrates- nitroglycerine, nitroprusside

25
Q

what are vasopressors and which are used for perfusion?

A

decrease or vasoconstrict the diameter of the blood vessel
(the body can’t get enough blood to the organs so they can function)
used to treat hypotension resulting from hemorrhage, MI, sepsis, or drug reactions
Epinephrine
Norepinephrine
Dobutamine

26
Q

what are diuretics and which are used for perfusion?

A

promote the formation & excretion of urine by preventing the reabsorption of sodium in the kidneys
used to reduce blood volume to treat HTN
!!!!Loop- inhibit electrolyte absorption
!!!!Thiazide- geriatrics water pill/ helps excrete excess fluid off body
!!!!Potassium-sparing- helps you keep potassium/ acts directly on tubules to increase sodium excretion

27
Q

what are antidysrhythmic and which are used for perfusion?

A

correct erratic electrical impulses to create regular cardiac rhythms
Used to prevent premature ventricular contractions (PVCs), tachycardia, HTN, and a-fib
They work by blocking electrolytes that affect electrical conduction of the heart
Amiodarone- blocks potassium
Diltiazem- blocks calcium
Atenolol- blocks beta-adrenergic receptors

28
Q

what are cardio glycosides and which are used for perfusion?

A

have a positive inotropic effect with a lowering heart rate to increase cardiac output
Used in the treatment of heart failure, a-fib, and cardiogenic shock
Digoxin (old & cheap)
When given you have to count apical heart rate for a full minute

29
Q

what are anticoagulants and which are used for perfusion?

A

prevent blood clotting at several locations in the clotting cascade
most effective in preventing venous thrombosis
require close monitoring (narrow therapeutic ranges)
heparin
warfarin
lovanox

30
Q

what is heparin and what is its antidote?

A

group of carbohydrates that combines with the plasma heparin cofactor (ATHIII)
Inhibits the conversion of fibrinogen to fibrin, prevents formation of the fibrin clot, and inhibits thrombin
Has an immediate effect so it is used to DVTs, PE, and embolisms
Given iv or subq
Ptt- blood test that determines how many seconds it takes for a clot to form in a blood vessel
Protamine sulfate is the antidote

31
Q

what is warfarin and its antidote?

A

(coumadin)
works by blocking an enzyme called vit K epoxide reductase that reactivates vit k1 available in the body
Depletes functional vit k reserves
Monitor pt- time for a clot to form in a sample
Phytonadione is the antidote

32
Q

what is lovanox and its antidote?

A

low molecular weight heparin
Binds and accelerates the activity of antithrombin III
Antithrombin III is an enzyme which causes blood to clot by acting on a blood protein called fibrinogen
Protamine sulfate is the antidote

33
Q

what are anti platelets and which are used for perfusion?

A

prevent platelets from aggregating to form clots
most effective in preventing arterial thrombosis
!!!!Platelet aggregation inhibitors- aspirin & clopidogrel

34
Q

what are thrombolytics and which are used for perfusion

A

disrupt blood clots that are impairing perfusion by lysing fibrin
Alteplase- only drug used for ischemic strokes

35
Q

what are antilipidemics and which are used for perfusion?

A

decrease the levels of lipids that contribute to atherosclerosis and result in blood vessel occlusion by reducing the synthesis of cholesterol
statins

36
Q

what refers to the individual’s ability to perform the normal daily activities required to meet basic needs

A

functional ability

36
Q

what refers to degrees of inability to perform Activities of Daily living (adls)

A

functional impairment

37
Q

what is the act of carrying out the actual daily actives

A

functional performance

38
Q

what are internal variables that influence personal hygiene practices?

A

Developmental stage- how to teach different ages
Intellectual background- people from different places have different education
Perceptions of functioning – how they see their functioning
Emotional factors- support, afraid of things
Spiritual factors- religious beliefs

39
Q

what are external variables that influence personal hygiene practices?

A

Family role and practices- can’t take care of family if you aren’t taking care of yourself
Social determinants of health- peers, cultural, education level, rural location (no access)

40
Q

What are functional ability life span considerations?

A

Infants/ children- expected development is indicated by achievement of developmental milestones
Specialized age-appropriate tests- used if developmental delay is suspected
Young/middle adult- identification problems require careful assessment of developmental milestones
Older adults- refers to safe, effective performance of ADLs essential for independent living

41
Q

what are basic ADLs

A

relate to mobility and personal care
Bathing, grooming, eating, dressing, toileting, and ambulation

42
Q

what are instrumental ADLs

A

complex skills important to living in a community
Shopping. Laundry, cooking, managing money, taking medication, using the phone

43
Q

what are the dimensions of functional ability people should know about?

A

Risk recognition- essential to early identification (fall risk)
Functional assessment- time-intensive, interprofessional effort requiring multiple assessment tools (do they need a walker/lift?)
Care delivery- knowledge of functional ability is essential to provide effective patient care (mobility/ cognitive assessments)

44
Q

What are the different types of health promotion?

A

Optimization of health- holistic wellbeing of individuals & communities
Evidence- health promotion is based on evidence
Patient/community centered- needs, preference & values, engage pt & community as active partners
Enculturation- integrating cultural values beliefs, norms, & practices into health promotion effort

45
Q

what is the process of enabling people to increase control over, and to improve, their health

A

health promotion

Requires the adoption of a healthy living practices and often necessitates a change in behavior
Health promotion is ongoing and dependent on adaption to change

46
Q

what is healthy people 2030 and what do they do?

A

aims to promote health for all people throughout lifespan to achieve full potential
Promote oral health
Cancer- prevention, detection
Adolescent health- health development child to adult (drug abuse, sexual reproductive health)
Dementia- awareness & education & detection & care giver support
Immunizations- vaccine coverage, safety, monitoring, and prevention of covid
Mental health- prevention, early detection, now in primary care (reduce stigma

47
Q

what are the three levels of prevention ?

A

primary prevention- vaccine, immunizations, disease prevention
Secondary prevention- curing/ managing disease
Tertiary prevention- reducing complications

NURS 134 (1 decks)

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