Perfusion Flashcards
Central Perfusion
Force of blood movement generated by cardiac output
Cardiac output: CO = stroke volume x heart rate
Tissue/ Local Perfusion
Volume of blood that flows to target tissues
Requires patent vessels, hydroastic pressure and capillary permabillity
Impairment of central perfusion
Occurs when cardiac output is inadequate
Reduced cardiac output results in reduction of oxygenated blood reaching the body tissues ( systemic effect )
- Shock
-Ishemia, cell injury, cell death
- Systemic effect
Heart Failure
Pump Failure: inability of heart to work effictively as a pump
Usually leads to drop in CO
Classifications:
- Left side vs right side HF
- Systolic ( HFrEF ) verus
- Diastolic ( HFpEF )
- Low output vs high output
-Acute vs chronic
Left Sided Heart Failure
Most failure starts on the left side and progresses to both sides
Causes: Hypertension, CAD, Valvular Disease, MI
Manifestations: Dizziness, Fatigue, Tachy, Dysnpnea, s3, CRACKLES, FROTHY SPUTUM, AMS
Right Sided Heart Failure
Causes: Left ventricular failure, Right ventricular MI, Pulm HTN, Right ventricle can’t empty completely, increased volume and pressure
Manifestations: Peripheram EDEMA, JVD, anorexia, nausea, enlarged liver ( RUQ pain ) , Nocturia, hepatomegaly
- Elevated CVP
Cardiomypathy
Causes:
CAD
Infection or inflammation of the heart muscle
Various cancer treatments
ETOH
Heredity
Four Types:
Dilated* most common
Hypertrophic ( stiff )
Arrhythmogenic right ventricular ( rare )
Restrictive
Manifestations:
Fatigue, HF, Dysrhymias, s3 gallop, angina
Labs and Diagnostics
BMP: 100-300 = heart failure
Hemodynamic monitoring
ECHO ***
EKG
ABG
Urinalysis
Interventions ( MAWDS )
Med: Take as prescribed
Activity: Know your limits- rest as needed
Goal 30 minutes of exercise of moderate
Daily weights 2-3 lbs in one day, 5 lbs in week
Diet: Sodium restriction-2.3 gm/day
Goal 1.5 gm/day
Fluid restriction 1500-1800 ml/day
Med Considerations
DONT give calcium channel blockers ( diltiazem, valsartan )
ACE ( dry cough, angioedema )
Nitrates ( 8-10 hr nitrate free period )
ARB ( renal patients, avoid salt substitutes )
Alodosterone Agonist: Aldactone
Beta blockers ( brady )
Loop diuretic
Nonsurgical options
CPAP: Improving oxygenation need others med w it
CRT
CardioMEMS
Gene therapy
Impaired tissue ( local ) perfusion
Impairment of tissue perfusion is associated with loss of vessel patency or permeability or inadequate central perfusion
Results in impaired blood flow
Leads to ischemia
PVD
Are conditions affecting peripheral arteries and veins
- Arteriosclerosis
- Athersclerosis
- CVI ( Chronic Venous Insufficiency )
Arteriosclerosis
Thickening or hardening of arterial wall
- Associated w aging
Athersclerosis
Type of arteriosclerosis of plaque wall within arterial wall
PAD
Result of systemic arteriosclerosis usually athersclerosis typically in lower extremities
- Risk factors:
- HTN
- Hyperlipidemia
- DM
- Smoking
- Obesity
- Lifestyle
- Genetics
- Stress
- Female
- Older than 65
Assessment PAD
: Intermittent claudication- Burning, cramping and pain in the legs during EXERCISE
- pain that occurs while at rest
- Bruit
- Decreased CRT
- Nonpalpable pulses
- Pallor
- Gangrene of toes
- Dependent rubor
- Cold and cynanotic
- Hair loss
- Thick toenails
PAD Diagnostic Assessments
Ankle brachial Index
Doppler and Ultrasound
MRA
Exercise tolerance
Arteriography: contrast agent
PAD Interventions
Exercise: Start gradually and increase slowly
Positioning: Avoid crossing legs, elevations should NOT be above heart, dangle if needed
Warm enviroment
Smoking cessation
Avoid stress
Drug therapy ( antiplatlets and statins )
Percutaneous transluminal angiplasty ( stent )
Atherectomy ( scrape out )
IV Heparin
Venous Insufficiency
Result of prologned venous hypertension stretching veins and damaging valves
Risk: Heart failure, immobility, pregnancy, oral contraceptives
Manifestations: Aching, feeling fullness or heaviness in the legs, brown, edema, stasis ulcers
Venous Insufficiency Complications
Stasis Dermatitis, Stasis Ulcers, DVT
Treatment: Elevate legs above the heart for 20 mins, 4-5 times a day
Venous Stasis Ulcer
Would shallow, weird shape, pink, warm, hard hyperpigmented.
Varicose Veins
Distended protruding veins that appear darkened and tortuous
- Elastic stockings
- Elevation
- Sclerotherapy
- Surgical removal
- Radiofrequency
Pulm Embolism ( PE )
Obstruction of blood flow in pulmonary vascualr system
- Embolus
- Tumors
- IV injection of air
- Fat
- Fluid release
Risk factors for PE
- Altered blood coagulation
- Prolonged immobility
- Obesity
- MI, heart failure
- Smoking
- Hip fracture
- Preg
- Advanced age
- Surgery
PE assessment
Hypoxemia
- Anxiety
Resp: Dyspnea, air hunger, tachypnea, chest pain, decreased O2, sudden SOB, crackles
Cardio: DNV, tachy, cyanosis, hypotension
Lab assessment
D-Dimer: assess clotting
ABGS: assess oxygenation
Pulm angiography: assess lungs
ECHO: assess for RV involvement
Nursing Interventions PE
Resp: High fowlers, monitor ABG, maintain O2 above 94
Cardio: Ausculate heart, assess skin, assess signs of bleeding
Meds: Anticoagulants
Embolectomy: removing embolism
Vena Cava filter: Stops future pe’s
Hemmorrhagic Stroke
Intracranial hemmorrhage
Ruptured cerebral blood vessel
Most fatal
Types:
Intracerebral
Subarachnoid
- Blood leaks into brain tissue
Ischemic Stroke
Blood clot, stenosis
TIA: mini stroke
Thrombotic Stroke: 1/2 of all strokes
- Occlusion of large vessel by thrombus
Embolic Stroke: Blood clot or matter through cerebral vessels
- Clot stops blood supply to an area of the brain
Risk factors for Stroke
Clotting disorders
History of Strokes, TIAS
AV malformation: Thinned vessels
Oral contraceptions
Hypertension
Smoking
DM ( High glucose, lipid = plaque )
Assessment CVA
Left Cerebral Hem
Langauge, mathematic skills, analytic thinking
- Expressive and receptive aphasia
- Agnosia ( can’t recognize familiar things )
- Alexia ( difficult reading )
- Agraphia ( writing difficulty )
Right Cerebral Hem
Visual and spatial awareness and proprioception
- Altered perception
- Loss of depth
- Poor impulse
- Emotinal
Diagnositc for Stroke
Non-contrast CT
MRI
MRA
Lumbar puncture
Interventions Stoke
Improve cerebral perfusion
- Fibrinolytic Therapy
- Endovascular Interventions
Monitor Saftey
Monitor for increased ICP
Promote mobility: Early
Rehab
Speech Therapy
Effective communication
Assist w feeds
Encourage independence
Monitor bowels and bladder
Surgical and Pham Interventions
- TpA : Tissue plasminogen activator (tPA) is classified as a serine protease (enzymes that cleave peptide bonds in proteins). It is thus one of the essential components of the dissolution of blood clots.
- Intra- arterial thrombolysis
- Cartoid endarterectomy
- Extracranial intracrnial bypass
- Cartoid angioplasty w stent
