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Health And Illness 2 > Perfusion > Flashcards

Perfusion Flashcards

1
Q

Central Perfusion

A

Force of blood movement generated by cardiac output
Cardiac output: CO = stroke volume x heart rate

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1
Q

Tissue/ Local Perfusion

A

Volume of blood that flows to target tissues
Requires patent vessels, hydroastic pressure and capillary permabillity

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2
Q

Impairment of central perfusion

A

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

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3
Q

Heart Failure

A

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

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4
Q

Left Sided Heart Failure

A

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

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5
Q

Right Sided Heart Failure

A

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

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6
Q

Cardiomypathy

A

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

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7
Q

Labs and Diagnostics

A

BMP: 100-300 = heart failure
Hemodynamic monitoring
ECHO ***
EKG
ABG
Urinalysis

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8
Q

Interventions ( MAWDS )

A

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

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9
Q

Med Considerations

A

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

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10
Q

Nonsurgical options

A

CPAP: Improving oxygenation need others med w it
CRT
CardioMEMS
Gene therapy

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11
Q

Impaired tissue ( local ) perfusion

A

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

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12
Q

PVD

A

Are conditions affecting peripheral arteries and veins
- Arteriosclerosis
- Athersclerosis
- CVI ( Chronic Venous Insufficiency )

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13
Q

Arteriosclerosis

A

Thickening or hardening of arterial wall
- Associated w aging

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14
Q

Athersclerosis

A

Type of arteriosclerosis of plaque wall within arterial wall

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15
Q

PAD

A

Result of systemic arteriosclerosis usually athersclerosis typically in lower extremities
- Risk factors:
- HTN
- Hyperlipidemia
- DM
- Smoking
- Obesity
- Lifestyle
- Genetics
- Stress
- Female
- Older than 65

16
Q

Assessment PAD

A

: 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

17
Q

PAD Diagnostic Assessments

A

Ankle brachial Index
Doppler and Ultrasound
MRA
Exercise tolerance
Arteriography: contrast agent

18
Q

PAD Interventions

A

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

19
Q

Venous Insufficiency

A

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

20
Q

Venous Insufficiency Complications

A

Stasis Dermatitis, Stasis Ulcers, DVT
Treatment: Elevate legs above the heart for 20 mins, 4-5 times a day

21
Q

Venous Stasis Ulcer

A

Would shallow, weird shape, pink, warm, hard hyperpigmented.

22
Q

Varicose Veins

A

Distended protruding veins that appear darkened and tortuous
- Elastic stockings
- Elevation
- Sclerotherapy
- Surgical removal
- Radiofrequency

23
Q

Pulm Embolism ( PE )

A

Obstruction of blood flow in pulmonary vascualr system
- Embolus
- Tumors
- IV injection of air
- Fat
- Fluid release

24
Q

Risk factors for PE

A
  • Altered blood coagulation
  • Prolonged immobility
  • Obesity
  • MI, heart failure
  • Smoking
  • Hip fracture
  • Preg
  • Advanced age
  • Surgery
25
Q

PE assessment

A

Hypoxemia
- Anxiety
Resp: Dyspnea, air hunger, tachypnea, chest pain, decreased O2, sudden SOB, crackles
Cardio: DNV, tachy, cyanosis, hypotension

26
Q

Lab assessment

A

D-Dimer: assess clotting
ABGS: assess oxygenation
Pulm angiography: assess lungs
ECHO: assess for RV involvement

27
Q

Nursing Interventions PE

A

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

28
Q

Hemmorrhagic Stroke

A

Intracranial hemmorrhage
Ruptured cerebral blood vessel
Most fatal
Types:
Intracerebral
Subarachnoid
- Blood leaks into brain tissue

29
Q

Ischemic Stroke

A

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

30
Q

Risk factors for Stroke

A

Clotting disorders
History of Strokes, TIAS
AV malformation: Thinned vessels
Oral contraceptions
Hypertension
Smoking
DM ( High glucose, lipid = plaque )

31
Q

Assessment CVA
Left Cerebral Hem

A

Langauge, mathematic skills, analytic thinking
- Expressive and receptive aphasia
- Agnosia ( can’t recognize familiar things )
- Alexia ( difficult reading )
- Agraphia ( writing difficulty )

32
Q

Right Cerebral Hem

A

Visual and spatial awareness and proprioception
- Altered perception
- Loss of depth
- Poor impulse
- Emotinal

33
Q

Diagnositc for Stroke

A

Non-contrast CT
MRI
MRA
Lumbar puncture

34
Q

Interventions Stoke

A

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

35
Q

Surgical and Pham Interventions

A
  • 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

Health And Illness 2 (4 decks)

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