Perfusion, Cardiovascular, and Peripheral Vascular Flashcards
perfusion
passage of fluid through the circulatory system or lymphatic system to an organ tissue
- bring o2 to tissues
Cardiac output
Volume of blood pumped by the heart in one min
- measured w invasive procedures, less accurate measures are VS
Stroke volume
Amount of blood ejected from the LV every time it pumps
Heart rate
Number of times heart beats/min
What can alter cardiac output
Any changes in HR, stroke volume or myocardial contractility
- can occur bc meds, disease processes, activity
Myocardial contractility
How hard heart contracts regardless of stretch factor
Ejection fraction
The percent of blood pumped out of the LV w each contraction
- normal is above 50%
- heart failure is less than 40%
Blood pressure
Force exerted by the blood against the bv walls
- needs to be adequate to maintain tissue perfusion during activity and rest
- 120/80
Pulse pressure
Difference between sbp and dbp
- normal: should be 1/3 of sbp
High pulse pressure caused by
Atherosclerosis
Excerise
Low pulse pressure
Severe heart failure
Hypovolemia
Pulsus alternans
Regular rhythm but strength varies w each beat
- possible explanation is heart failure
Cardiopulmonary resuscitation
CPR: performed when no pulse respirations
- CAB: circulate o2 blood to brain
* need to add more*
HTN
Pressure in ur arteries is high causing increased peripheral vascular resistance
Why is HTN bad
Causes adverse affects on arterial walls
- if left untreated it can cause dec blood flow and perfusion
Factors influencing bp
Age, stress, ethnicity, genetics, gender, daily variation, medications, activity, weight, smoking
Types of risk factors for bp
Modifiable:
- DM, elevated serum levels, excess Na, obesity, sedentary lifestyle, stress, tobacco, alcohol
Non modifiable:
- family history, race, ethnicity, increasing age, gender, chronic kidney disease, obstructive sleep apnea
Diagnosis is HTN
Avg or 2 or more readings in on at least subsequent visits that are above 120/80
HTN symptoms
Dizziness, headache, heart palpations, nose bleeds, SOB, anger, red face, visual problems, fatigue, insomnia, sore knee
Complications of HTN
- cardiovascular disease
- myocardial infarction
- heart attack / failure
- stroke
- peripheral vascular disease
- renal disease
- retinal disease
Nursing actions for HTN
- measure BP
- lifestyle modifications
- determine risk factors
- educate
Goal: prevent heart disease, stroke, renal disease
Education to teach pt for HTN
- how to check BP
- potential dangers
- management options
- lifestyle modifications
- nutrition
- exercise
- stress management
- drug therapy
- when to seek care
Hypertensive crisis: when to seek immediate care
- severe headaches, dyspnea, chest pain, dizziness, numbness, weakness, loss of vision, difficulty speaking, nosebleeds, severe anxiety, unresponsive
Diet often prescribed to HTN pt
DASH: dietary approach to stop HTN
- sometimes restrict Na intake
Hypotension
Low bp, usually sbp falls below 90
Causes of hypotension
- dilation of arteries
- loss of blood volume
- failure of heart muscles to pump
Do we treat just number of bp
Yes and no, we address number but also pts baseline, if they have any symptoms
why do we care about hypotension
Need to make sure organs are getting the proper amount of o2 to function properly
Symptoms of hypotension
- skin: pallor, skin mottling, clamminess
- dec perfusion to brain: lightheadedness, dizziness (syncope)
- blurred vision
- chest pain
- inc HR
- decreased urine output
- nausea/ vomiting
Treating hypotension
Treat cause
- Vasodilation
- loss of blood volume
- failure of heart muscle to pump
Nursing considerations for hypotension
- monitor VS
- assess for symptoms
- consider more Na in diet
- inc fluids
- compression fluids
- medications
Orthostatic hypotension
Decreased blood pressure if you stand up too fast
- creates fall risk
- blood can pool in areas like brain
- typically elderly ppl, immobile/ bed rest
Diagnosing orthostatic hypotension
Sbp dec 20
Dbp decrease by 10
- measure bp supine, sitting, standing etc, w/in 3 mins of each other
Nursing considerations for orthostatic hypotension
- change positions slowly
- don’t cross legs
- early ambulation
- isometric exercises
- compression hose
- avoid standing
- risk for falls
Hyperlipidemia
Too many lipids ( cholesterol and triglycerides) in the blood
Cholesterol
Waxy fat like substances found in all cells of the body
- made in the liver
Triglycerides
Most common fat in the body’
- made in body and ingest it
Why do we care about hyperlipidemia
Can form hard deposits inside arteries
- can build up on artery walls causing it to narrow and became less elastic
Hyperlipidemia diagnostic tests
- test at age 20, then a 4-5 yr
- age 40, assess risk for cardiovascular disease/stroke
- must fast 9-12 hr before
Hyperlipidemia nursing care
- assess what they can change
- be active
- maintain healthy weight
- limit smoking
- dietary modifications
- lipid lowering drug therapy
Dietary modifications for Hyperlipidemia
- reduce trans/sat fats
- inc complex carbs and fibers
- limit major sources of cholesterol, alcohol, simple sugars
- eat fatty fish (salmon, herring, mackerel, sardines)
- other foods high in omega 3 fas
VTE
Venous thromboembolism
- obstruction of a bv by a blood clot that has become dislodged from another site and is moving in the circulation
- commonly starts in legs and travels to lungs
Who is at risk for VTE
Ppl who have
- venous stasis
- hypercoagulability
- endothelial damage
Venous stasis
Blood pools caused by
- obesity, pregnancy, post surgery, thickened blood
Endothelial damage
Lining of vessel has injury from
- IV fluids
- drug abuse
- fracture, dislocation
- diabetes
VTE s/s
- localized redness, tenderness, swelling over vein sites
- warmth, firmness in muscle
- complaints of pain in calf w ambulation
- unilateral
Assessing for VTE
Palpation and visual
- often they are deep so must palpate in order for pt to feel tenderness
VTE diagnosis
obtain history, physical assessment, vascular ultrasounds
- ultrasounds only reliable tool to detect (non invasive and will look dismally from area of concern)
Why do we care about VTE
Pulmonary embolism: a dislodged clot that travels to lungs and blocks blood flow
Nursing care for VTE
- assess for symptoms
- measure calf circumference
- tenderness, phlebitis
- early ambulation
- TED hose, SCDs, calf pumping
VTE treatment
- prevention
- anticoagulation
- thromoblytic (lysis of thrombus)
- IVC filter (vena cava device that strains blood to catch clots before getting to lungs
diagnostics related to cardiovascular systems for fundamentals
- complete blood count
- fasting lipid panel
- chest x ray
- electrocardiography
Hemoglobin and hematocrit counts
Hgb: Fe containing pigment of RBC that o2 adheres to
- f: 12-16, m: 14-18
Hct: % of total volume of blood that is made of RBC
- f: 37-47%, m: 42-52%
ECG
Electrocardiogram: measures sinus rhythms
Normal sinus rhythm
Originate in the SA node, follows normal sequence through conduction system
- P, PR, QRS, QT
Telemetry
Monitors heart activity for an ongoing basis
- shows heart rhythm, continuous monitors but not as through as EKG
electrode placement of telemetry
-snow over grass
- smoke over fire
- chocolate by my heart (5th intercostal space)
- snow and smoke (2nd intercostal space)
- grass and fire below rib cage
Potential cardiac problems
- unstable bp
- activity intolerance
- dec cardiac output
- ineffective tissue perfusion
- risk for dec tissue perfusion
- fatigue
- impaired gas exchange
- ineffective airway clearance
- fluid volume excess/deficit
Nursing assessments for cardiac system
- inspect/palpate
- auscultation
- obtain history
- assess/monitor VS and O2
- skin
- LOC changes
- peripheral pulses
- calf tenderness
- edema
- JVD: jugular venous dissension
Abnormal heart sounds
- S3/4
- murmurs: swishing, problem with valve
- clicks : mechanical valve?
- rubs: scratchy
5 p’s for cardiac assessment
Pain
Pulse
Pallor
Paresthesia: numbness
Paralysis: movement
Nursing implementations for cardiac
- strict i and o
- oxygen prn
- telemetry
- med admin
- monitor labs
- implement heart healthy diet
- limit stress
- prevent thrombus formation
Nursing collab cardio
- cardio pulm rehab
- hcp
- cardiologist
- rt
- code team
- dietician
- cardiac nurse navigators
- support groups
- social services/ case manager
Pt teaching cardio
- pt centered
- set goals
- no smoking
- limit stress
- control HTN, HLP, DM
- nutrition
- exercise
Afterload
Amount of pressure the heart needs to exert to eject blood during ventricular contraction
Infarction/necrosis
Obstruction of bloody supply to an organ/region and can cause tissue death
- typically cause by thrombus/embolus
Ischemia
Blood flow is restricted restricting o2 to reach that area risking hypoxia
Preload
Force that stretches the cardiac muscle prior to contraction
stroke
Blood supply to the brain is cut off, preventing o2 from reaching the brain
