Tissue Perfusion Flashcards
What is perfusion
The movement of blood
What is inadequate blood supply & perfusion
Ischemia, heart doesn’t get good blood supply
What is blood flow
Cardiac output, the volume of blood that circulates through the system
Cardic output equation
Heart RatexStroke Rate OR
Mean Arterial Pressure/Resistance
Mean Arterial Pressure
COxR
What are the indicators of adequate perfusion
Strong peripheral pulses
Blood pressure is within acceptable range
NO mental status deficits, cyanosis, pallor, dyspnea or edema
no JVD
Skin is warm and dry not cool and clammy
Urine output is 30 mm/hour
What is cyanosis
Blue coloration of the skin
What is pallor
No color of skin
What is JVD look like
Popping out of the veins when laying down
Sign of heart failure
What does clubbing look like
Nails are angled and have blue coloration
What is stroke volume
The preload, how much blood is in the cavity of the heart
What is afterload
Force the ventricles must overcome to eject blood volume
What is the pulse
Represents a heart beat
peripheral pulse and apical pulse
strong=good perfusion
weak=bad perfusion
What factors can affect heart rate
Age, older you are the higher it is
Gender, women have a higher one
Exercise
fever
medication
stress
position, lower heart rate laying down
hypovolemia
pathology
What is arterial pressure
Measure of pressure of blood flow through arteries
Give an overall summary of blood pressure
Recorded as a fraction:systolic, blood comes out, over diastolic, ventricles at rest,
typical in healthy adults: 120/80
but can vary considerably among individuals
What is elevated blood pressure and hypertension
Elevated is 120 to 129/80
hypertension is anything from 130 to 140/80 to 90
How do you find the mean arterial pressure
Systolic blood pressure + diastolic blood pressure x 2/3
What is resistance
The opposition to blood flow due to friction between blood in the walls of blood vessels the higher
the resistance to lower the blood flow
What does resistance depend on
Size of the blood vessel lumen, how vasodilator or vessel restricted it is
Blood viscosity
Total blood vessel length
What are the medications for hypertension
HCTZ, losartan, captopril, metoprolol, nefedipine
HCTZ
Diuretic decreases blood volume, orthostatic hypotension
Increased blood sugar
s.e= Dizziness, weakness, hypokelemia and ED
Losartan
Vasodilator, decreases R
s.e= dizziness, headaches, nausea, vomitting, diarrea
Captopril
ACE inhibitor vasodilator, decreases R
s.e= dizziness, salty taste, cough, fast heartbeat, tiredness
Metoprolol
Beta-blocker, decreases CO. Bradycardia
s.e= dizziness, vertigo, fatigue, ED
Nifedipine
Calcium channel blocker vasodilator, decreases R
Cannot eat grapefruit
What are some non-modifiable factors to hypertension and stroke
Age, gender, race, personal health history, family history( high cholesterol, early onset CAD)
What are modifiable risk factors
Quit smoking, eat healthy diet for normal BMI, start daily regiment of physical exercise, YOGA
What are secondary risk factors
Control high BP, decrease high blood cholesterol, decrease stress, abstain from or consume only small amounts of alcohol
What are some health screenings you can do
Blood pressure screenings, ECG, stress tes
What are some lifestyle modifications
Proper nutrition, exercise, keeping BP under 25, quit smoking, exercise (yoga or meditate)
Where can you assess the pulses
Temporal
carotid
apical
bronchial
radial
femoral
popliteal
posterior tibial
pedal
Where do you NOT measure blood pressure
Shoulder, arm or hand injury
Cast or bulky bandage on any part of the limb
Where axila lymph nodes on that side have been removed
IV infusions in that limb
What are the common errors and taking blood pressure
Haste (doing it quickly and letting go of the needle quickly not being able to see the real measurement and making up a number)
Sub conscience bias(may hear value consistent with the expectation)
What factors will increase blood pressure measurements
Caffeine, cigarette smoking, bladder distention, cold exposure, white lab coa
What factors will not make a difference in blood pressure measurements
taking blood pressure over clothing, on dominant arm or stethoscope under the cuff
Perfusion in older adults
Valves become stiff, myocardial hypertrophy, slight decline in CO, decrease elasticity, elevated BP, lower arterial 02 Tonchin decreased ability to concentrate urine a.k.a. dehydration
Shock
In adequate perfusion results in failure of the CV system to meet the metabolic demands of body cells
type of shocks are: hypovolemic, cardiogenic, vascular, obstructive
Who has a higher risk of developing Hypersention & what works better for them
40% greater risk are African Americans
Least effective: Beta-blockers like metoprolol and ACE inhibitor like Captopril
Best: HCTZ and channel calcium blockers like diltiazem or nifedipine or Losartan
