Introduction To Perfusion Flashcards
What is perfusion
The flow of the blood through the arteries and capillaries delivering nutrients and oxygen to tissues
What is the main goal of perfusion
Use the capillaries and arteries to deliver oxygen and nutrients to body tissues
What is peripheral perfusion
Blood flow to the extremities of the body. This is like the hands, feet, arms,legs etc
What is central perfusion
Blood flow to the major organs including the heart and lungs
What does adequate perfusion depend on:
Cardio-pulmonary system
Adequacy of circulatory blood volume (cardiac output)
Blood viscosity
What is the goal of perfusion
Is that the cells of the body receives essential nutrients that is required for functioning and metabolism
Efficiency of the cardio- pulmonary system
Pulse elasticity
Decreased blood pressure
Perfusion
Physiology of cardiovascular system
Altercations in cardiovascular syste,
Factors affecting cardiovascular system
Pulse elasticity
The normal artery should feel smooth, straight and resilient
What causes blood vessels to become less elastic
As you get older the blood vessels become less elastic becoming more rigid, less resilient and crooked arterial blood vessel
Hypertension
More than 130/80
This is a risk factor for cardiovascular disease, cva, mi, heart failure, peripheral vascular disease and aortic aneurysm
Decreased blood pressure: hypotension
Blood pressure below 90/60
The body is unable to maintain or return blood pressure back to normal or in the inability to do is quickly enough.
Vasodilation of the arterioles
Failure of the heart to function as an effective pump
Loss of blood volume (hemorrhage)
Medications
Signs and symptoms
Dehydration and hypotension
When you are dehydrated you have less water in your body, causing blood volume which decreases your blood pressure.
The heart will also pump harder to make up for the blood that is not there
Hypovolemia and hypotension
Hypovolemia is when there isn’t enough blood in the body which causes less blood circulating in the body. This causes lower venous return lowering the blood pressure
Hypokalemia and hypotension
This is when there is low potassium levels in the blood. This causes changes in the heart rhythm and function. Less blood flow low blood pressure
What medications affect hypotension
Blood pressure med (Antihypertensive)
Some antidepressants
Anti anxiety medication
Analgesics
Orthostatic hypotension
When the blood pressure drops when the patient stands up
Perfusion and lungs
The lungs is needed for gas exchange
Oxygen from the air is diffuses into the blood and carbon dioxide from the blood diffuses into the alveoli to be exhaled
Altercations in the respiratory system
Hypoxia
Dyspnea
Hypoventilation
Blood flow in the body
The blood enters through right atrium from the superior and inferior vena cava.
Blood flows through the tricuspid valve into the right ventricle.
The blood moves through the pulmonary valve into the pulmonary artery
The blood travels to th e lungs where it get oxygenated
The blood return to the heart through the pulmonary vein and enters the left atrium
The blood flow through the mitral valve to the left ventricle
The blood moves from through the aortic valve into the aorta
The blood is distributed throughout the body
Altercations in cardiovascular function
Dysthymia (arrhythmia)
Disturbance of the rate and or rhythm of the heart.
This is abnormal rate of the electrical implukses generation from the SA node
What do dysrhythmia affect
The pumping of the heart, the heart rate, rhythm, interferes with circulation which leads to oxygenation issues
What diseases dysthymia’s occur with
Hypertension
Heart disease Damage to the heart
Decreased o2
Ischemia
Decreased oxygen wholly to the heart because of insufficient blood supply
Commonly caused by atherosclerosis which is the accumulation of fatty substances in the lining and tub issues in the body which create blockage narrowing the vessels reducing blood flow
Adequacy of circulating blood volume: cardiac output
This is the volume of blood that is being pumped by the heart in one minute
What is cardiac output
The amount of blood that is pumped per minute and is measured in liters
What is the formula for cardiac output
Stoke volume x heart rate
When does cardiac output increase and when does it decrease
Increase: excerise
Decreases: sleep
What is usually the cardiac output in an adult
5-6 liters
What might cause too much of an increase of cardiac output
Increase sodium levels
Kidney not working
Increase cardiac output and increased sodium levels (hypernatremia)
Increased sodium levels is caused when there is dehydration. Dehydration reduces the blood volume in the body triggering the body to compensate by increasing cardiac output to maintain blood flow and pefusion
Increase cardiac output and kidney
When kidney is not working properly it causes decreased perfusion. With impaired kidney function there can be fluid retention causing sodium to stay in the body. As a result the heart will pump more blood to increase the blood volume and eleventh the blood pressure increaseimg cardiac output
Blood viscosity
Hyperglycemic:
Sickle cell anemia
Diabetes
Polythycemia
Atrial fibrillation
Sedentary lifestyle
Hyperglycemic and blood viscosity
High blood sugar causes the blood to be more thick
Sickle cell anemia and blood viscosity
The red blood cells are shaped odd making the blood ore likely to clump
Polythycemia and blood viscosity
This when there is are more red blood cells being created this makes the blood become thicker
Atrial fibrillation and blood viscosity
The heart quivers making the blood become more turbulent or stagnant making it pool more. Increase risk of clots
Sedentary lifestyle and clotting of the blood
Not moving a lot make you more prone to bloodclot
Factors affecting cardiopulmonary function
Heath
Developmental considerations
Medication
Lifestyle considerations
Social determinants of health
Psychological Health
Older adults and perfusion
Tissues and airways of the respiratory tract become less elastic.
The respiratory and abdominal muscles are reduced so the diaphragm moves less efficiently
Decline in maximum inspiration and expiration
Airways collapses more easily
Increase risk of disease
Infants and perfusion
The chest is small so the airways are short and there is aspiration problem
Respiratory rate is more rapid
If an infant is born before 3 weeks what might happen
May have not produced enough surfactant leading to collapsed alveoli and poor exchange.
Pulse rate is more rapid
Lifestyle considerations
Smoking.: COPD
Cultural influences can encourage or discourage healthy choices
Activity level
Social determinants
Unsafe air
Toxic levels
Air pollution
Occupational exposure
Language barrier
Literacy
Social isolation a
Access to physical activity
Psychological health considerations
High stress may experience hyperventilation
Anxiety
Respiratory problems hypoxia
Normal perfusion indicators
Neuro: alert and oriented x4, normal speech, vision, PERRLA
Musc: note strength and movement
Res: normal respirations, 02 and arterial blood gases
Cardiac/VS: normal bp, hr, pulse, electrolytes, capillary refill, normal huh, pt, d dimer
Gastrointestinal : normal bowel sounds, bowel movement and stool appearance
GENITOURINARY: normal urinary output, color, clarity, bun, creatinine
Skin: warm, dry, intact, color, no edema, hair distribution, wound healing, healthy nail
What is the normal urine output
30 ml per hour
BUN and Creatinine with kidney function
As they increase the kidney function is decreasing
How much urine output after 8 hour
240
What does D-dimer show
It increases with blood clot. It should be low
What does PT/PTT show
Blood clotting too quick or too slow
What are the 5 p’s you should check for adequate perfusion
Pain:
Pallor (perfusion): poor arterial perfusion
Peripheral pulses: assess capillary refill especially if pulses can’t be felt
Paresthesia (sensation): numbness and tingling
Paralysis (movement)
Pressure
Blood loss and oze
Factors that impact perfusion
Hypovolemia
Hypervolemia: fluid overload, edema
Ventricle contractility issues
Increased or critically decreased systemic vascular resistance
Vasoconstriction
Conditions that interfere with cellular gas and nutrient exchange: Hypoventilation, edema
High blood pressure
What is paresthesia
Numbness or tingling
Pins and needles
Hypervolemia and perfusion
This is when there is too much fluid in the body and can cause kidney function issues
Edema
Ventricle contractility issues
Loss of myocardial contractile force
Acute ischemia
Conduction abnormalities acute
Chronic ventricular contractility issues
Ventricular remodeling
Endocarditis
Pericarditis
Valvular disorder
Ventricular remodeling
The vessel becomes thicker and weaker
Increasing resistance
Increased or decrease systemic vascular resistance
Increase:
Decrease: Hypovolemia cause the vessel to vessel to enlarge and vasodilation
Conditions that impact cellular gas exchange and nutrient exchange
Hypoventilation
Edema
Pulmonary edema
Collapsed alveoli
What makes the source of the issue cardiac output
Hypovoleemic
Hylervolemic
What makes it a cardiopulmonary issue
Ventricle or heart issue
Issue with gas exchange
Ventricle contractility issues
Increased to decreased systemic vascular resistance
Vasoconstriction and blockage of the arteries or capillaries
Atherosclerosis
Thrombosis
Thickened blood due to hyperglycemia
Hyperglycemia and thickened blood
Fat deposits
Non modifiable risk factors for impaired perfusion
Age: older adults
-have decrease elasticity of the arterial vessels making them becoming stiff
Age: newborn
- those who have congenital heart abnormalities
Racial and ethic
- African American and Hispanics due to the increased risk of chronic diseases that can affect perfusion such as diabetes, hypertension, hyperlipidemia etc
Hypertension and systemic vascular resistance
Systemic vascular resistance causes the vessels to become more narrow and it increases with high blood pressure. The ventricle becomes thicker and gets weaker so the blood is not being pumped properly causing lack of perfusion
Narrow blood vessels are constricted
Modifiable risk factors
Cigarettes smoking
Obesity
Diabetes
Alcoholism
Sedentary lifestyle
Hyperlipidemia, Hdl, ldl. Total cholesterol, triglycerides
Hypertension or hypotension
Blood clots
Anemia
Dehydration
Cigarettes smoking and impaired perfusion
It constrict the blood vessels causing the blood flow to be reduced
Obesity and impaired perfusion
The heart begins to work harder because there is a fat build in the vessels from hyperlipidemia causing lack of perfusion
What does HgbA1C tells us
Blood glucose level over a 3 month period
Alcoholism and perfusion
Narrow blood vessels cause hormones are being release that constrict the blood vessels
HDL
LDL
Hdl is good
LDL is bad
Atherosclerosis
Impaired blood flow as it narrows and obstructs the blood vessels leading to ischemia or inadequate blood supply
Build up of plaque inside the arteries
Blood pressure and the normal range
The force if extended on the arterial walls by the blood flowing within the vessel
<120/80
Hypertension
Greater than 130/80
Hypotension
Less than 90/60
Mean arterial pressure
Maintain the blood flow to the tissues throughout the cardiac cycle
70-100
Hemoglobin
12-15
Hematocrit
35-45%
Platelet count
140,000 to 400,000
D dimer
Less than 0.5
Tells us about blood clot. If it High not good
Total cholesterol
Less than 200
LDL
Less than 100
HDL
More than 40
Triglycerides
Less than 150
HgbA1C
Less than 6.4 %
Glucose
70-99
Prothrombin time (PT)
11.5-15 sec
PTT
23-37.5 sec
Blood urea nitrogen (Bun
6-20
Creatinine
0.5-1.0
Complications related to impaired perfusion
Decrease perfusion
Inadequate peripheral perfusion
Inadequate central perfusion
Ischemia vs infarction and pain
Ischemia is decreased perfusion
Infarction is complete tissue death due to decrease perfusion that is severe
You’re going to have pain
Inadequate peripheral perfusion
Lower extremities
No pulses or weka pulse
Pale, cyanosis
Skin ulcers and so forth take a longer time to heal properly
Inadequate central perfusion
Can cause stroke, mi, heart failure, shock because of the lack of blood flow to the major organs
A narrowing of the blood vessel may cause
Weak pulses
Slow cap refill
Decresed venous return may cause
The blood is not being returned back to heart in time so it causes edema
Thrombocytopenia
Decrease platelet so the patient will bleed alot
Oxygenation
Gas exchange is dependent on perfusion the lungs
Nutrition
Healthy blood vessels, RBC, iron
Fluid and electrolytes
Altercations in the fluid and electrolytes may cause changes to cardiac function affecting perfusion
Mobility
Increases risk for blood clot
Mental health
Indicator of lack of perfusion to the brain
Vascular dementia
Interventions
Teach the patient healthy lifestyle habits
Monitor perfusion and oxygen exchange
Administer medication to improve blood flow
Monitoring patient worship and oxygenation status
Monitor the urine for BUN AND CREATININE
Observe for deep vein thrombosis
Monitor vitals
Review labs
Observe lower extremities for edema
Conduct neuro exam
Change in level of consciousness
Signs and symptoms of impaired tissue perfusion
Shortness of breath
Pain
Paralysis
No pulse
Pain
Numbness
How much fluid intake per day
2-3 liters
Ischemia is commonly caused by
Atherosclerosis
