Perfusion Flashcards
perfusion
circulation of blood through the vascular bed of tissue
pericardium
- double layer of fibroserous membrane covering the heart
- anchors heart to surrounding structures, forming pericardial sac
- snug fit prevents heart from over filling with blood
layers of the pericardium
- inner: partiel pericardium
- outer: visceral pericardium or epicardium
layers of the heart
- 3 layers
- endocardium
- myocardium
- epicardium
epicardium
- covers entire heart and great vessels
- than folds over to form the parietal layer, lining the pericardium and adheres to the surface of the heart
myocardium
- middle layer
- consists of specialized cardiac muscle cells (myofibrils)
myofibrils
specialized cardiac muscle cells
endocardium
- innermost layer
- thin membrane composed of 3 layers
Chambers of the heart
- 4 hollow chambers
- 2 Atria (R/L)
- 2 Ventricles (R/L)
Ventricles are separated by…
Interventricular Septum
Blood flow through the heart (include all valves/oxygenated blood/arteries/veins)
- Right Atrium recieves deoxygenated blood from inf/sup vena cava
- Right Atrium pumps deoxygenated blood through (AV) tricuspid valve into the Right ventricle
- Right Ventricle pumps deoxygenated blood to the lungs through the pulmonary artery (semilunar)
- Oxygenated blood empties into Left atrium from lungs and pulmonary veins
- Left atrium pumps oxygenated blood into the left ventricle through the bicuspid(mitral) valve
- Left ventricle pumps oxygenated blood into the aorta through the aortic valve
- Blood flows to the rest of the body
vein
blood from body to heart
artery
heart to body
Heart sounds are..
the sound made when the heart valves close
“lub dub”
S1 and S2
S1
AV valves closing
S2
- “dub”
- semilunar (Aortic and Pulmonic) valves closing
AV valves close when…
ventricles fill
Semilunar valves close when…
ventricles empty
Systole
- Phase of ventricle contraction
- ventricles filled and contract, expelling blood into aorta and pulmonary artery
- begins with closure of the AV valves (S1) and ends with the closure of the semilunar valves (S2)
Diastole
- Phase of ventricular relaxation
- Ventricles relax and fill during atrial contraction
- begins with the closure of semilunar valves (S2) and ends with the closure of the AV valves (S1)
Murmurs
harsh, blowing sounds cause by disruption of blood flow into the heart, between the chambers, or into the vascular system
systolic murmur
S1 unclear and S2 amplified
panstolic murmur
one beat, no “lub dub”
Who grades murmurs?
MD or ARNP - NOT nurses
Documentation of Heart sounds
- do not say “present”
- “S1 and S2 ausculated clearly, no murmur or extra heart sounds ausculated”
Pulse
- wave of blood created by contraction of the left ventricle
- Generally represents SV output or the amount of blood that enters the arteries with each ventricular contraction
Compliance of the artery
ability to contract and expel
peripheral pulse
away from the heart; foot or wrist
central pulse
carotid
PMI
point of maximal impulse; heart, apex
Pulse locations
Pulse: Increased age
decreased pulse
Pulse: after puberty, men..
lower pulse than females
Pulse: increased exercise
increased pulse (during), decreased pulse (resting)
Pulse: high stress
high pulse
Pulse: high fever
high pulse
Pulse: hypovolemia
(low blood volume) high pulse
Pulse: Meds
depends
Pulse: Position change
Usually, low BP, high pulse
Pulse: Pathology
depends
Assessment for Pulse
- fingertip pads
- radial -most common for adults
- brachial for infants
- assess rhythm
- pulse volume
- elasticity
- compare peripheral pulses
- check apical pulse
- count pulse for full min w/ infants/children
- count 30 sec x2 for adults
- apical-radial pulse - check for deficit
Pulse volume
- bounding (strong/hydrated)
OR
- threading (weak/dehydrated)
Elasticity of artery
- Smooth/soft
- hardened (hardens with age)
tachycardia
above 100 (anxiety, pain, exercise)
bradycardia
below 60 (usually athletes)
Tip for finding pulse
If you can’t find it, take some pressure off
Apical-Radial Pulse Deficit
- Apical will never be lower than radial
- If a difference, there is a pulse deficit
Systolic BP
pressure in systemic arteries when left ventricle contracts
Diastolic BP
pressure between contractions - heart at rest
AHA Guidelines Recommended BP
(Sys) Lower than 120/Lower than 80 (Dia)
BP: Baby
low BP; increases slowly to puberty
BP: males
higher BP than women until menopause
BP: Blacks
higher BP than whites; sensitive to salt
BP: Obesity
high BP
BP: Exercise
high BP during exercise
BP: Stress
high BP
BP: diurnal variations
BPs lower in AM
Types of BP Assessment
- electronic
- manual
- doppler - noninvasive
- arterial line - invasive
locations: usually arm; can use thigh or wrist
Where to not take BP
limb if injured/diseased, cast or dressing, lymph nodes removed, IV in arm, AV fistula for dialysis
BP Measurement
- There is 1 step & 2 step
- cuff in correct position and correct size cuff
- Pump up cuff
- Slowly release pressure
- Watch manometer and listen for Korotkoff phases
Korotkoff Phases
- 1st tapping sound heard- systolic
- swishing/whooshing sound
- thump; softer than phase 1
- softer blowing muffled sound that fades (some use this as diastolic)
- silence/last sound - diastolic
Orthostatic Hypotension
- peripheral vasodilation occurs when standing up
- dizzy, lightheaded, may faint due to decreased blood to brain
- causes: dehydration, bleeding, BP meds or narcotics
How to access for Orthostatic Hypotension
- check BP/Pulse while in supine position
- Sit up and recheck BP/Pulse
- Repeat in 3 min and document
low ejection fraction
high BP due to not a lot of blood being pumped out
low CO (cardiac output)
low BP, high pulse
Perfusion Assessment Documentation
- color and warmth of extremities
- pulses
- heart sounds
- capillary refill
- presence of edema
Diagnostic tests of cardiac function
- Serum cholesterol
- Stress/Exercise test - chest pain
- Xray, CT, MRI
- Echocardiogram - heart activity
- cardiac catheterization
- EKG
- Serum cardiac enzymes
RN’s role in diagnostic testing
Regardless of which test is being done, the nurse is responsible for the education of the procedure, montioring for appropriate meds, any prep needed.
Infant/children considerations for assessing CV health
- pediatric stethoscope in infants
- thigh & arm BP equal in infants
- thigh BP 10mmHg higher than arm in children
Older Adult considerations for assessing CV health
- skin fragile
- consider antihypertensive meds
Modifiable risks factors for cardiac health
- smoking
- HTN
- Hypercholesterolemia
- Obesity
- Physical activity
- Diabetes
Non-modifiable risk factors for cardiac health
- age
- gender
- race
- family hx
- personal health hx
Genetic/Ethnic Considerations for Cardiac health
- heart dx runs in families
- cardiomyopathies
- CAD:coronary artery dx
- Atherosclerosis
- Arrhythmias
- Blacks at higher risk for heart failure, HTN, low HDL
- High risk for MI in woman after menopause
- Men more likely to have MI earier in life
Cognition
LOC: level of conscientiousness
- low blood supply to brain; confusion/dizzy
Comfort
low perfusion may manifest as pain
Oxygenation
low perfusion can cause respiratory distress
Statins
inhibits cholesterol biosynthesis
Vasodilators
cause dilation of blood vessels, lowers BP
Beta Blockers
block beta-adrenergic sites in heart, lowers BP
ACE Inhibitors
inhibits vasoconstriction; lowers BP
