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NUR 1110 > Perfusion Notes > Flashcards

Perfusion Notes Flashcards

1
Q

What are antiplatelets?

A

Keep the platelets from clumping together & forming a clot. Disrupts the blood flow & can cause a problem with the heart leading to a MI.

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2
Q

What is a thrombolytic?

A

A drug used to bust open a blood clot.

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3
Q

What are cardiac glycosides?

A

Drugs used for the heart to strengthen the contraction of the heart (Digoxin, Lanoxin).

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4
Q

What is telemetry?

A

A pt. with a heart monitor & monitoring that pt’s heart.

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5
Q

What is perfusion?

A

Flow of the blood through arteries & capillaries delivering nutrients and oxygen to cells. If interrupted for long period of time you could die!
* Veins carry the blood to the heart & arteries carry the blood away from the heart.

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6
Q

What things go with perfusion?

A

Cap refill, pulses, heart sounds, & etc.

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7
Q

Where are CBC labs drawn from? Where are ABGs drawn?

A

The veins. ABGs are drawn from the artery.

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8
Q

What happens with variations from baby to death with perfusion?

A

*When baby is birthed (cord cut off) -doesn’t have the same circulatory system. Things shut off (ductus arteriosus) and seal off so we can experience the same as the parents outside of the body.
*As we age things happens physiological & psychological.
*Arteries and veins lose their elasticity- (physiological example). B/P goes up in elderly & can’t do what it needs to.

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9
Q

Changes in perfusion can be temporary or permanent. Name some different types of conditions with altered perfusion.

A

*MI (coronary artery blocked off & causes permanent damage-Will need to put a stent in coronary artery to get blood flow going again in Cath lab
*Stroke (something blocked off going to head)
*Heart-Coronary arteries
*Shock (body decompensated)
*When a MI is not treated & you become very sick, muscle is stunned & not getting enough o2 can lead to CHF

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10
Q

Chronic disorders that affect perfusion?

A

*Silent killer-HTN
*Heart failure (heart muscle affected & not pumping properly leading to fluid overload. (test question)
*Sickle cell anemia (affects blood-Hemoglobin & Hematocrit (carry O2) labs need to be looked at.
*Hemophilia-free bleeders-active bleeding & don’t have proper clotting mechanisms

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11
Q

What is central perfusion?

A

*Central perfusion is generated by cardiac output—the amount of blood pumped by the heart each minute. Heart beat/stroke volume are affected. Two systems to function-Electrical System(EKG STRIP-Atrial Fibrillation)/mechanical-Closing/opening of valves-Ventricle, Atrial, & valves(leaflets of valves cause back flow in heart), Aortic stenosis-closing of lumen.
*Pulse is an indicator of perfusion. *Pacemakers help with rate & stimulation of the heart.

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12
Q

What is Cardiac Output?

A

-Cardiac Output-Heart beat in a minute
-Beats/minute x volume/beat)=volume/minute
-Stroke volume=volume/beat (Amount of blood ejected from each ventricle during contraction. It’s affected by the preload, contractility, & afterload.)
-Cardiac output=HR X SV; normal is 4-6L/min
-Volume of blood pumped by ventricle/minute
*Each heart beat pumps about 60 mL of blood in a minute(5 L/minute).

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13
Q

What are the two systems cardiac output requires to function?

A

Two systems to function-Electrical System: P wave, QRS Complex, (EKG STRIP-Atrial Fibrillation-Something is not firing right from SA node to AV node to Bundle of His to Purkinje fibers)
*Mechanical (Structures)-Closing/opening of valves-Ventricle, Atrial, & valves stay open (leaflets of valves cause back flow in heart), Mitral valve stenosis/Aortic stenosis-closing of lumen(narrowing).
*Any problem with any system will affect the cardiac output.

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14
Q

Firing of the heart

A

*SA Node(pacemaker of heart) helps with producing normal heart beat Impulse is originated from.
*AV Node-Heartbeat goes down if SA Node is not functioning properly (40-60 beats/minute)
*When AV Node is not working properly the Bundle of His takes over (20-40)-Bifurcates in two directions to Purkinje Fibers-Nothing to around 20 heart beat (takes over when Bundle of His is not working properly.

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15
Q

What happens when SA Node fires on a EKG strip?

A

*EKG-P wave when SA Node fires (right atrium) QRST (Heartbeat traveling through ventricles)

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16
Q

What is going on with ventricular fibrillation and ventricular tachycardia?

A

*Ventricles pumping really fast causing decreased Cardiac Output. Deadly situation.
*No blood is being pumped and if not shocked they will die if it’s not in a normal rhythm. Pt. needs to be shocked with ADE. Atrial fibrillation problems alter the perfusion and cardiac output.
*ADE-Shocks deadly rhythms in pt. into normal sinus rhythm.

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17
Q

What happens with the mechanical structures of the cardiac output?

A

Mechanical Structures-Heart has a septum that separates the left from right side. There is a right & left atrium/ventricle. The right atrium gets deoxygenated blood from superior/inferior vena cava. (Vena Cava largest vein) When SA node fires (right atrium contracts) opening tricuspid value-blood goes to right ventricle. Pulmonic valve opens goes to pulmonary artery feeding both lungs. Oxygenated blood and co2 goes off & goes to veins to heart and dumps in left atrium. Mitral valve /bicuspid valve(2 leaflets) opens and down to left ventricle to aortic valve to aorta. Blood goes to coronary artery openings and oxygen goes and perfuses brain & rest of body (renal arteries). Femoral artery & veins get blood & to rest of body. Cycle starts over . You can’t make it if aorta ruptures.
*Aortic dissection-death.

18
Q

Why does the blood pressure depend on the cardiac output of the heart?

A

Pressure from heart through ventricles creates the blood pressure. *Good indicator of cardiovascular system function.
*High blood pressure-pt. is perfusing to much (risk of a stroke). To low of a blood pressure-pt. is perfusing little.
-More blood more volume (higher pressure). Less blood less volume (hemorrhaging).

19
Q

What is the viscosity of blood?

A

-Thickness of blood (if it’s thicker the more time it takes to pump effectively.)
-Hematocrit (percentage of viscosity) *If hematocrit goes up-blood flow slows down(thicker) & heart works harder to pump the blood.
*If blood is thin (Like a cut) -The pt. will bleed excessively.
-Importance of patient teaching when people are on anticoagulants.
*People on blood thinners you want thin blood to prevent clots.

20
Q

What is peripheral vascular resistance?

A

-The resistance of blood flow & is determined by size of blood vessel. *When vessels lose elasticity, the vessel doesn’t contract as it should. Blood pressure gets higher & higher. *As we get older the vessels lose elasticity.

21
Q

What is the systolic blood pressure?

A

Pressure exerted when blood is ejected into arteries. Normal systolic blood pressure is 120 mmHg or below.

22
Q

What is the diastolic blood pressure?

A

Pressure blood exerts within the arteries between heartbeats. Normal diastolic blood pressure 80 mmHg or below.

23
Q

What is preload?
*Cardiac drugs are prescribed based on preload or afterload of heart.

A

-Volume of blood received by the heart.
*Preload is stretch. The amount of volume being returned to the heart (What’s coming into the heart).
*Volume of blood in the ventricles after the end of diastole (end diastolic pressure)
-Increased in Hypervolemia, Regurgitation of cardiac valves, and heart failure

24
Q

What is afterload?

A

-Pressure or resistance the heart has to overcome to eject blood.
*Afterload is the squeeze. The amount of resistance that the heart has to overcome in order to eject blood. (Resistance the left ventricle has to overcome to circulate the blood)
-Increased in hypertension and vasoconstriction (things clamping down)
*Increase in afterload =Increase in cardiac workload

25
Q

What is tissue perfusion?

A

-Tissue perfusion refers to blood that flows through arteries (something big) and goes to capillaries (exchange of oxygen & CO2) to the target tissues.
*Arteries/arterioles maintain blood pressure by constricting or dilating.
*Tissue perfusion is when it is in the tissues, arteries, veins, small vessels, to capillary membranes.

26
Q

Consequences of Impaired Central perfusion

A

-Two coronary arteries(Right & Left) on surface of heart-left bifurcates into two arteries.
*Plaque builds up & can be cholesterol plaque or platelet plaque (Rought plaque snagging things up). Causing disruption of blood flow forming a clot(occlusion) or blood can still be flowing through the narrow artery causing chest pain.
*There is not enough oxygen in the blood flowing. Pt. gets Heart Cath to tell if heart is working properly (narrowing artery with not enough blood flowing through artery).
*Coronary arteries perfuse the heart muscle (when there is a blockage in the coronary arteries-that is why there is probably some chest pain-no oxygen getting to heart)
*Stent or balloon blowed up can be put in two crunch plaque up against the wall so that blood can flow again.

*Atrial fibrillation- Atrium is staggering and there is not enough blood flow to the ventricles. Valves can get diseased or prolapse on self or stenosis ( plaque on leaves of valves.Vegetation on the valves cause them to stretch because blood flow is still trying to go through them.

27
Q

What are consequences of impaired local or tissue perfusion?

A

Ex. DVTs in the leg. Impaired circulation & breaks off( embolus)and travels to brain, heart, or lung. To prevent DVT: Ambulatory, TED Hose/sequential hose as prevention.

*Common strokes (Hemorrhagic, Ischemic, & Arthersclerosis)

28
Q

Risk Factors of Perfusion

A

-Elderly- Loss of elasticity, disease processes, cheeseburgers- to plaque buildup.
- Heredity, cholesterol, Age, Race, Lack of funds (stress, nutrition-Higher foods if organic.) Do something modifiable like getting something cheaper- process foods)
-Socioeconomic can impair health, medicine is high, couch potato-sedentary lifestyle (modifiable lifestyle), smoking(modifiable), family history (non modifiable).
- Graduate-The higher the education level the higher they are exposed to money for medicine.

29
Q

What is included in the assessment of perfusion issues?

A

History-Problem from past (heart attack), family history, baseline, cormobidities (DM- small vessels, HTN, coronary artery disease, arthrosclerosis, what meds are you taking including over the counter & why you are taking it? How much of it? Street drugs (recreational)

*Nitroglycerin is used for chest pain- IV for cocaine users for the vasoconstriction of artery.

-Problem-based history-When providing their history, patients may describe pain, fainting (syncope), dizziness, SOB, swelling (edema), bleeding, or fatigue. Need details.

-Pain-morning, night, or on exertion-Describe it ( chest pain or leg pain-know when it starts if walking & when it stops resting).

-Syncopy-Faint or almost due to cerebral perfusion-What caused it and do they remember what caused it.

-Dizziness-Inadequate circulation (orthostatic hypotension)

-Dsypnea-decreased oxygen transport

-Edema-Fluid accumulated somewhere it should not be (pitting vs. nonpitting)

-Inspect-Lok at skin tone, nail bed, mucous membrane, look for cyanosis-blue, pale blue, grayish. Petchaice-Red pinpoint spots. Anemia. Jugular veins- distention. Edema in extremities. Unilateral (DVT) vs. Lateral. Skin discoloration- lower extremities, pale extremities- no hair.

30
Q

Diagnostic Tests

A

CBC-Hemoglobin, RBC, & hematocrit & cholesterol Test (plaque buildup in artery) fat, Total cholesterol Less than 200)
*LDL- Less than 130( Lower density lipoprotein-The lower the number the better)
*HDL-50 or higher for male & female (High density lipoprotein) A high cholesterol level can be modified by exercise or medication.

-A genetic problem is a hard problem. A serum test is run to see about lipids.
*Altered perfusion there will be an opposite with LDL & HDL.

-Triglycerides-35-160 for male & female (calories your body don’t need- unhealthy eating) really high & bad for body.

31
Q

What can be done for V-Tach?

A

Medication(Amiodarone) can be taken for it. When you check the carotid artery and there is no pulse. The pt. Has to be shocked backed into normal sinus rhythm.

32
Q

What is angina?

A

-Blood down coronary arteries provide oxygen to muscle underneath it. Angina pain caused by hypoxia.
*Radiating down left arm in men like an elephant sitting on chest(pressure/tightness). Say take a deep breath and decrease after you exhale (pleuritic pain). They can’t feel their breath.
*Women are atypical. Women may not feel right like a jaw ache with extreme pain or a toothache.

-Assess for heart attack & prove its not heart first-Assess for pain, 12 Lead EKG (Acute MI), LABS-Cardiac enzymes-elevated for heart attack. *Then assess other things like toothache.

33
Q

What is included in LV Disfunction?

A

-Not pumping out like it should(previous MI)-Largest chamber, Blood doesn’t empty correctly so ventricle expands(bulges) from pressure & it flops causing deceasing Cardiac Output.
-When backed up, blood goes to Mitral valve & into Left atrium into lungs causing Left side Heart Failure. -Assessment findings-Adventitious lung sound(fluid backed up), hypoperfusion.

*Heart Failure-Pump is not pumping adequately & forcefully as it should.
*Thickness of septum wall and muscle there can’t perfuse adequately leading to heart failure.

34
Q

What is Right Heart Failure?

A

-Blood not pumping correctly into right ventricle leads to blood backing up into tricuspid value into superior vena cava.
-Blood goes to lower extremities leading to (Edema)/Liver(ascites).

35
Q

Anticoagulant (Xarelto) Medicine

A

-Prevents clots or PE(DVT, MI & can involve lungs or heart)
*Don’t ever eat leafy greens everyday (spinach, kale, mix spring) Changes blood level as well.
-Frequently test PT time to see how thin or thick blood is.

36
Q

Antiplatelet-Clopidogrel Medicine (Plavix)

A

-Decrease the possiblity of stroke & MI by decreasing platelet aggregation
*Assess for thrombotic/thrombolytic purpura, monitor blood studies, CBC, Hct, Hgb, bleeding time.

37
Q

Beta Blockers-Atenolol (Tenormin)

A

-Decrease B/P, heart rate & prevention of angina pectoris, & MI. You want B/P Lowered.
*HR less than 50 don’t give.
*Teach pt. if medicine is working to continue to give medication to lower B/P.
*Teach pt. if B/P is low in morning when sleep. Retake it to see what B/P is when awake.
*Teach pt. to don’t just up & stop taking it cause it can lead to angina & MI.
*Can mask symptoms of hypoglycemia- & lower B/P.

38
Q

Ace Inhibitor-Lisinopril Medicine (Zestril)

A

-Antihypertensive-Decrease B/P in hypertension, decreased preload, afterload in Heart Failure.
*Given for hypertensive.
*Teach pt. to not take if pregnant without approval.
Monitor B/P, HTN, Acute MI, HR
*Teach pt. to not just up & discontinue.
*Check with health care provider before using over counter & herbal meds.

39
Q

Thrombolytic (Alteplase) Medicine

A

-Destroys clots(lysis of thrombin in MI, pulmonary embolic(life threatening) & perfusion starts back in the blood.
Don’t give if pt. just had a Craniotomy 8 days ago would cause you to bleed in the head.
*This is a big bad clot buster.

40
Q

Digoxin (Digitalis, Lanoxin) Medicine

A

Cardiac Glycoside-Increased contractility of the heart by decreasing the workload. Helps the heart to pump more forcefully & effectively. Decreased edema, pulse.
*Slows down heart rate & should check heart rate before giving. Take apical pulse for 1 minute.
*Don’t give if pulse is less than 60. It has blood level-labs drawn for digoxin level(dig toxic)Serious signs & symptoms.

NUR 1110 (14 decks)

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