Perfusion powerpoint Flashcards
peripheral vascular disease deifinition and types?
to any conditions that result in altered blood flow outside the brain and heart.
chronic venous disease(CVD) and peripheral artery disease (PAD)
chronic venous disease
Progressive disease within the wall of the vein or valves.
▪ Damaged, occluded, or congenitally altered veins
Blood flow is altered- reducing the
amount of blood returned to the heart
Chronic venous disease consequences /
Blood pooling in the legs.
✓Increased venous pressure.
✓Vein distention and varicose veins.
✓ Leads to problems- venous stasis,
increased venous pressure, thrombus,
incompetent valves, and damage to
tissue (ulcer formation).
CVD risk factors
▪ Smoking/ Tobacco
▪ Obesity
▪ Pregnancies
▪ Injury
▪ Leg Pain (Description, when it
started, improves or worsens?
CVD manifestations
Dilated veins
* Edema that worsens when the legs
are dependent
* Brownish pigmentation
* Stasis dermatitis
* Lipodermatosclerosis
* Venous ulceration or
manifestations of healed venous
ulcerations.
CVD implementation
Decrease venous pressure.
▪ Reduce pain and edema.
▪ Heal ulcerated skin areas.
CVD conservative treatment
Compression therapy
▪ Meticulous foot care
▪ Leg exercises
▪ Elevation of lower extremities
▪ Weight reduction (if needed)
CVD surgical treatment
▪ Vein Stripping (removal of diseased
vein)
▪ Sclerotherapy (rerouting blood to
healthier veins)
▪ Laser Ablation (sealing off of vein)
CVD pharmacological treatment
Flavonoids(anti-inflammatory, diosmin[Daflon]),
Pentoxifylline(Trental)-hemorhedogic agent,
Acetylsalicylic acid (aspirin)-nonsteroidal anti-inflammatory,
Saponins-anti-inflammatory
CVD client safety
Unsteady Gait- Assess the client for
the need of a mobility aid, such as a
cane or walker.
▪ Hemorrhage, phlebitis, and deep
vein thrombosis can also develop as
the disease progresses- Educate
client of signs and symptoms
CVD nursing intervention
Leg Elevation- above their heart for 30 min 3 to 4 times a day.
▪ Injury Prevention.
▪ Prevention and management lower extremity ulcers.
▪ Smoking Cessation.
▪ Exercise- walking for 30 minutes a day.
▪ Avoid standing for long periods of time and crossing their legs when sitting.
▪ Healthy diet and weight maintenance.
▪ Compression Stocking Use- should apply them prior to getting out of bed.
Peripheral artery disease (PAD)
Progressive disorder that affects blood
flow to the arteries in the lower
extremities
Damaged, inflamed, or occluded arteries
PAD common cause
Common Cause: Atherosclerosis
▪ Plaque builds up in the artery walls
and causes decreased flow, blockage, or
spasms.
▪ Tissue hypoxia or anoxia results.
▪ Collateral circulation develops but not
usually enough.
Factors that affect cardiac output
Vasoconstriction
Compliance of the arteries → stretch
Volume of blood entering the heart from the veins
PAD risk factors
Smoking, diabetes, hypercholesteroLemia, hypertension, family history of cardiovascular disease
Manifestation of PAD
↓ or absent pulses
Atrophy of lower extremity muscles
Cool skin
Elevated pallor and ↑ pain
Dependent redness and ↓ in pain
Pain upon palpation
Abnormal results: ankle brachial index, duplexultrasound.
Treatment of PAD
Lifestyle modifications
Smoking cessation
Control hypertension
Weight / cholesterol maintenance
Blood glucose control
Exercise
Invasive treatment of PAD
Ballon angioplasty →
Arterial stent
Bypass graft
Endarterectomy
Pharm treatment of PAD
(antiipemic)→ (antilipemic) → aggressive lipid management combined with dietary interventions
Antiplatelet → caspirin/ clopidrogreL → inhibits platelet aggregation, treats intermittent claudication
Pentoxifylline → trental → ↓ blood viscosity
Vasodilators → lisosorbidle mono/dinitrate → increases vessel size, ↑ oxygenation
The P wave
Electricity passing through the atrium
→ atrial contraction
The electrical pathway
SA node ( impulse begins)
Av node (captures the impulse and slows it)
Bundle of his
Bundle of branches → left bright
Purkinje fiber network
PR interval
Time it take to travel through the atrial, bundle of his, bundle branches, and purkunje fibers
Before ventricular contraction
QRS complex
Ventricular contraction
QRS interval
Contraction of both ventricles (systole)
ST segment
Time between systole (depolarization) and diastole (repolarization).
Should be flat the same as the isoelectric line
T-wave
Time for ventricular repolArization
Q T interval
Entire electrical depolarization and depolarization of the ventricles
Described a normal sinus rhythm →NSR
P wave present
PR intervals less than 0.20 and regular
QRS complexes present and regular
Other ECG elements present and regular
HR between 60-100 bpm
Describe sinus bradycardia
P wave present
PR intervals less than 0.20 and regular
QRS complexes present and regular
Other ECG elements present and regular
HR ↓ 60 bpm
Bradycardia risk factors
High-endurance physical activity
Myocardial infarction
Sleep apnea
↑intercranial pressure
Eating disorder↓ metabolic need
Vagus nerve stimulation ( coughing and gagging, bowel movement straining)
Infections
Certain meds
Meds that cause bradycardia
- parasympathommetics (acetylcholine)
Beta blockers (metoprolol)
Digitalis glycosides (digoxin)
Calcium channel blockers (diltiazem)
Antiarrhythmics (amiodarone)
Chemotherapy agents (thalidomide)
Lithium
Symptoms of bradycardia
Dizziness Chest pain
Syncope
Mental status changes
SOB
↓ hr
Nursing intervention of bradycardia
Stable: monitor clients ECG and vital signs
Insert saline lock
Anticipate administration of IV admin
Unstable: gather supplies in preparation for urgent transcutaneous pacemakerplacement.
Client education bradycardia
Lifestyle changes
Change body positions slowly
How to check bp and pulse, normal or abnormal rates and when to notify provider.
Describe Sinus tachycardia
P waves present
PR intervals less than 0.20 and regular
QRS complexes present and regular
Other ECG elements present and regular
Hr ↑ 100 bpm
Symptoms of tachycardia
↑ rr
Sob
Chest pain
Hypotension
Mental status changes
↓ urine output
Dehydration
Tachycardia risk factors
Fluid volume loss
Fluid volume excess
Pain, fever, mi, shock, or hyperthyroidism
prescribed meds ( atropine, catecholamines, theophylline)
Illicit drugs
Caffeine/nicotine
Implementation Tachycardia
Stable: monitor patients ECG and vital signs - hemodynamic stability
Vasovagal maneuvers
Insert-a saline lock
Unstable: monitor hr and bp
Insert saline lock
Anticipate admin of iv fluids or meds to lower hR
Such as beta blockers
Describe arrhythmia
P Waves present
Pr intervals less than 0.20 and irregular
QRS complexes present but irregular
Other ECG elements present and regular
Hr varies
Hypertension types
PrimarY→ no specific cause, 90-95% of HTN adults
Secondary→ specific, correctable cause- 5-10%, appears rapidly.
Hypertension risk factors
Modifiable: ↑ sodium intake
Smoking use , obesity, alcohol use
Microalbuminuria GFR < 60
Dyslipidemia
Physical inactivity
Non-modifiable: age, race (AA) diabetes, family hx
Organs affected with hypertension
Heart: ChF MI
Brain: confusion, headache, stroke, memory loss
Kidneys
Eyes: retinopathy
Reproductive: erectile dysfunction
Manifestations hypertension
Usually no symptoms other than ↑ bp
Symptoms seen relatedto organ damage are seen late and are serious.
