Perfusion Flashcards
Potassium Lab Value
3.5-5
Hematocrit Lab Value
37-52 %
Magnesium Lab Value
1.5-2.5
Calcium Lab value
9-10.5
Sodium Lab Value
135-145
Hemoglobin Lab Value
12-18
Platelets Lab Values
150,000-400,000
Bun Lab Values
10-20
Creatinine Lab Value
0.5-1.2
Phosphorus Lab Value
2.8-4.5
Chloride Lab Value
98-106
Afterload Definition
The amount of resistance to ejection of blood from the ventricle.
Cardiac Output
The amount of resistance to ejection of blood from the ventricle.
Contractility
Ability of the cardiac muscle to shorten in response to an electrical impulse.
Diastole
Period of ventricular relaxation resulting in ventricular filling.
Preload
Degree of stretch of the cardiac muscle fibers at the end of diastole.
Stroke Volume
Amount of blood ejected from one of the ventricles per heartbeat.
Systole
period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta
A Pt is being discharged with a scrip for warfarin. Which test does the nurse instuct the pt to routinely have done for follow up monitoring
PT & INR
A Pt is being discharged with a scrip for warfarin. Which test does the nurse instuct the pt to routinely have done for follow up monitoring
PT & INR
Calculate Map for pt with bp 140/65
90
Map Formula
S+ ( Dx2)= x then divide x 3
How to calculate stroke volume?
What is the stroke volume for a pt that currently has a bp of 118/61, hr 80bpm, 97.7 F, and cardiac output of 5000 mL?
63 ML
A toddler-age client is rushed to the emergency room due to cyanosis precipitated by crying. The parent reports that the client tires easily after playing. The client is diagnosed with tetralogy of fallot. What is the immediate nursing intervention for this client’s cyanosis?
Place the client in Knee-chest position.
You’re assessing your patient’s morning labs. The metabolic panel shows the following results below. Which results are abnormal? (Select all that apply.)
Sodium 110 mEq/L
Magnesium 2.1 mg/dL
Chloride 100 mEq/L
Creatinine 5 mg/Dl
Potassium 2 mEq/L
Potassium
Creatinine
Sodium
Key patient education regarding anticoagulation therapy includes which instructions?
Monitor for any signs of bleeding and report to hcp.
The beta antagonists’ carvedilol and propranolol are contraindicated for which condition?
Asthma
Central Perfusion
- Force of blood movement generated by cardiac output
- Requires adequate cardiac function, bp, and blood volume
- Cardiac Output (CO) = Stoke Volume x hr
Tissue or Local Perfusion
- Volume of blood that flows to target tissue.
- Requires patent vessels, adequate hydrostatic pressure, and capillary permeability
Fluid moves from higher to lower
Atrial pressure is higher that venous pressure
Adequate blood flow depends of 3 things
- Efficiency of the heart as a pump
- the patency and responsiveness of the blood vessels
- Adequacy of circulation blood volume
Impairment of central perfusion occurs when
cardiac output is inadequate.
Reduced cardiac output results in
Reduction of oxygenated blood reaching the body tissues
- if severe associated with shock
- if untreated leads to ischemia cell injury and cell death
Cardiac Output Equation
CO= HR x Sv ( stroke volume)
Cardiac Focused Assessment
- Review Anatomy
- Cardiac hemodynamics
- Heart Sound S1/S2
- Cardiac lab work - diagnostic eval
Hyperlipidemia
When there is high concentrations of low-density lipoprotein (LDL) and low concentrations of high-density lipoproteins (HDL) within the blood.
Treatment is aimed at controlling manageable factors and the use of statins and niacin for hereditary factors.
ATHEROSCLEROSIS/ARTERIOSCLEROSIS
- Not to be used interchangably
- Both are vascular diesases
- Arteriosclerosis HARDENED ARTERIES
- Atherosclerosis PLAQUE
- Pt with athero does not have arterio
- pt often have both
Atherosclerosis
-
Epidemiology
- Emerging epidemic of athero disease in developing countries may start in childhood
- tobacco smoke greatly worsens athero
-
Pathophysiology
- LDL Particles build up in the arterial wall
Athero Clinical Manifestations
- may be no sympotms until critical narrowing of the artery resulting in an emergency
- may result in sudden cardiac death
- athero disease in carotids may result in stroke
- Sudden weaknedd, dizziness, and loss of coordination
- Difficulty talking, facial droop, sudden droop, sudden vision problems, and sudden severe headache
Athero Management
- IDentifying and controlling risk factors
- meds used to lower lipid levels
- Surgical intervention is reserved for irreversible manifestations such as chest pain or gangrene
- intractable chest pain and coronary artery disease require coronary bypass surgery
- gangrene may require amputation
BP
- CO x total peripheral vascular resistance (PVR)
- Pathogenic mechanisms must involve increased CO increased PVR or both
- AHA Recommends yr BP screenings for children 3 yr and older
BP
- BP= CO x SVR
- Non-invasive measurement
- Invasive measurement
- MAP (SBP + 2DBP) / 3
- Renal RENIN- Angiotensinogen aldosterone system ( RAAS)
Vasoconstriction
Higher SVR and BP
Vasodialtaion
Lower SVR and BP
HTN drug therapy has two actions
- Deceases circulating blood volume
- Decrease SVR
Preload and after load
HTN
• As BP increases, so does the risk of – MI – Heart Failure – Stroke – Renal Disease • Affects 1 in 3 adults in the United States • High Priority health concern identified in Healthy People 2020
Factors Influencing BP • Sympathetic Nervous System (SNS) – Activation increases HR and cardiac contractility – Vasoconstriction and renin release – Increases CO and SVR
• Management – Diagnosis, treatment, modifications, and medications – Lifestyle • Weight • Diet • Alcohol • Exercise • Complications – Stroke, aneurysm, and hypertensive crisis
HTN
• Primary (Essential) Hypertension • Secondary Hypertension • Isolated Systolic Hypertension • Psuedohypertension • Osler’s Sign
HTN Affects:
CAKE
Cardiovascular: CHF
BrAin: Stroke
Kidneys: renal failure
Eyes: Retina changes
Life style Modifications
• Weight reduction • DASH eating plan • Dietary sodium reduction • Moderation of alcohol intake • Physical activity • Avoidance of tobacco products • Management of psychosocial risk factors Brunner (15th ed.) pg 871
Laboratory Markers Predictors of Heart Disease
• Lipid Panel- HDL,LDL, Cholesterol **(fasting 8-12hours before this test)** • Cholesterol – Less than 200 mg/dL • Triglycerides – Less than 150 mg/dL • Low-density lipoproteins (LDL) - BAD – Less than 100 mg/dL • High-density lipoproteins (HDL) – Good – Male > 40 mg/dL Female > 50 mg/dL – Medication –statin • C-reactive Protein (not specific for cardiac dx-used in conjunction with other tests, shows inflammation (thinking atherosclerosis)) • Coagulation Studies- platelets,PT,PTT,INR • CMP- BUN/CREATININE • CBC • Thyroid panel: TSH, Free T4 • UA: Proteinuria(?
Lab/Diagnostic Pearls (Dyslipidemia)
• Elevated LDL: DIET/DRUGS/DISEASES • Elevated Triglycerides-DIET/ETOH/DRUGS/DISEASES • HTN pts need a ECG with baseline labs • Statins: Low-Intensity, Moderate-Intensity, HighIntensity -Each lowers LSL at difference percentage rat
Antihypertension Drug therapy recommendations
• Children: aim for reduction of BP to less than 95% BP percentile (Rudd page 244) • 60 years or older • Systolic BP > 150 mm Hg • Diastolic BP > 90 mm Hg • Less than 60 years old • Treatment initiation and goal: 140/90 mm Hg
HTN in Children: Usually begin med therapy with an ACE for chronic HTN Children with Emergency treatment of Acute HTN: Labetalol 0.1mg/k
Beta
ARB
olol
sartan
BP Meds
Angioendema
cough
elevated K
-PRIL
Calcium Channel blockers pine don’t give with vine
Congenital defect symptoms
in pulse
in resp
retarded growth
fatigue
uri
cyanotic congential defects r l shunt
Squatting
cyanosis
clubbing
syncope
Inadequate Central perfusion peds
IN: poor feeding
poor weight gain
failure to thrive
dusky color
Children: squatting
fatigue
developmental delay
PAD
• Progressive narrowing of the arteries of the upper and lower extremities • Epidemiology – Majority are 65 years or older – African Americans are affected more often than any other group • Atherosclerosis is the leading cause of majority of cases
Pathophysiology : PAD – Progressive and chronic condition – Obstruction of blood flow through the large peripheral arteries causes arterial occlusion – Intermittent Claudication – Classic symptom of PAD – For patients with PAD, blood flow to the lower extremities needs to be improved, therefore the nurse encourages keeping the lower extremities in a neutral of dependent position
NOW: 6 Ps 1. Pain 2. Pallor 3. Pulselessness 4. Paresthesia 5. Paralysis 6. Poikilothermia (cool
Thin, shiny, and taut skin • Loss of hair on the lower legs
PAD Management •Smoking cessation •DM management –Glycosylated hemoglobin (A1C) <7.0% for diabetics –Optimal near 6.0% •Aggressive treatment of hyperlipidemia •Hypertension management •Exercise •DASH diet •No heating pads •Trim nails straight across •Float heels (place pillow under calves)
PAD Drug Therapy • ACE Inhibitors (-pril) • Antiplatelet agents •Intermittent claudication treatment –Pentoxifylline (Trental) –Cilostazol (Pletal) • Contradicted in patients with heart failure
PAD Management • Nonsurgical management – Percutaneous transluminal angioplasty – Laser-assisted angioplasty – Rotational atherectomy • Surgical management
Acute Arterial Ischemic Disorders
• Embolus: the most common cause of occlusions, although local thrombus may be the cause • Assessment: 6 Ps • Drug therapy – What are they? How do they work? Antidote? Education? Labwork? Brunner pgs. 848-850 • Surgical therapy
Raynaud’s Phenomenon
• Caused by vasospasm of the arterioles and arteries of the upper and lower extremities • Characterized by discoloration of fingers, toes, ears, & nose (white, blue, red) • Primarily in young women • Drug therapy: calcium channel blockers • Avoid temperature extremes, tobacco, caffeine • Reinforcement of client education • Work-up for autoimmune disease
Chronic Venous Insufficiency (CVI)
- A condition that develops when leg veins and valves fail to keep blood moving forward • Causes • S/S – Edema – Bulging veins – Venous ulcers – Chronic venous stasis – Improved when legs are elevated • Think gravity
- Treatment: focus on management of edema & promoting venous return • Elevate legs, wear elastic or compression stockings, avoid prolonged sitting • TEDs apply in am & remove before hs • Apply compression over wound dressing – Unna boot – Profore
Venous vs. Arterial Ulcers
• Venous – Location • Between knee and ankle – Cause • Venous stasis – Characteristics • Large with irregular borders • Beefy red • Granular tissue • Moderate to heavy exudate • Hyperpigmented surrounding skin • Pain is decreased by elevating legs • Arterial – Location • On feet/ankles – Cause • Arterial insufficiency – Characteristics • Wound margins even and sharply demarcated • Pale, gray, or yellow • No evidence of new tissue • Necrosis • Dry, necrotic eschar • Painful while exercising, while resting with feet elevated, and at night
RBC
4-6
WBC
4-11
PT
11-12.5 sec
INR
2 - 3
PTT
60 - 70 sec
ph
PCO2
HCO3
7.35-7.45
35-45
22-26
