Week 3 Perfusion and Dementia Flashcards
What is perfusion?
How blood gets from tissues to organs and how they respond to that blood arriving there.
—– needs to be adequate to maintain health
perfusion
What is a sign of good healthy kidneys?
Good urine output
What is a sign of health going down hill?
Low urinary output (not enough blood flow to the kidneys)
—– —– is the amount of blood that leaves the left ventricle and is pumped through the body
stroke volume
What is related to heart rate and stroke volume?
Cardiac output
Formula for cardiac output?
heart rate x stroke volume
What condition is a sign of a weak heart pump>
Heart failure
What is a common medication used to make the heart pump more effectively (stronger)?
Digoxin
Action of digoxin?
strengthens heart’s “force of contraction”, and slows down the heart beat, allowing for more time for the heart to fill before pumping.
What does slowing the heart rate do for stroke volume?
It can increase it, because more blood will be in the heart before pumping.
What does running do to stroke volume?
Decreases stroke volume while heart rate is increased
What does the left ventricle act like for an athlete?
Stronger: injection fraction remains high because pump is so strong. It can keep stroke volume up
What might an active HR for athletes be?
110, because it still meets their physiological needs
Where may an athletes resting heart rate lie?
50- lower than a normal HR = healthy, athletic, conditioned, strong
What are the symptoms of HF with a heart rate around 40 bpm?
-fatigue and confusion= not good oxygenation/perfusion
Which autonomic system doesn’t work very well in someone with HF?
SNS
What three factors influence vascular resistance?
-blood vessel diameter
-elasticity
-blood viscosity
What does it mean when blood is spun and the hematocrit is high?
Ct. is dehydrated: less plasma and more of the fixed components (hematocrit)
If a ct. is dehydrated, there will be less volume, blood is thicker, and the heart has to work harder to push blood through.
What is the process of blood vessels when a pt. is dehydrated?
Vessels would dilate, then vasoconstrict.
-increase HR
-BP would bottom out (hypo)
-stroke volume would decrease
When it comes to stroke volume and HR, what is the correlation?
High stroke volume = slower heart rate
Fast heart rate = lower stroke volume
How is blood viscosity in our control?
Drink 1/2 body weight (lbs) in oz.
Ages effects on blood vessels:
-scarring
-less elasticity
-less resilient
When is cholesterol synthesized?
At night
Which type of medication prevents cholesterol formation?
statins
How does vascular sclerosis occur?
Cholesterol burrows into the vessel
Which vascular disorder is inevitable due to vessels losing flexibility as we age?
Arteriole sclerosis
Which system(s) control perfusion?
SNS & PNS
Which system are we supposed to spend most of our time?
PNS
What are symptoms of SNS activation?
High HR, low stroke volume, feeling hot/ sweaty, agitated, anxious
What is the best tactic for preventing endothelial injury?
Recognize when in SNS and calm down
Which nerve is effected when baring down to eliminate or void?
“vagal nerve”
What is the goal for our patient when they are ill?
Listen to their body and take it slow
Symptoms of hypotension?
dizzy, fainting, confusion, nauseous (decreased perfusion to organs), tachycardia, tachypnea (rapid breathing)
What are 4 causes of hypotension?
- medications
- standing up too quickly (orthostatic hypo)
- blood loss
- dehydration
What can excessive hypotension cause?
Shock
How many oxygen molecules can be picked up by a red blood cell?
4
Why might hypotension cause tachypnea (rapid breathing)?
heart rate increases, therefore, if blood cells are moving too quickly through the blood stream, not enough oxygen is being gathered by red blood cells = not enough perfusion to the body
When someone feels a palpitation (heart flutters) what should I do?
Compare radial pulse to apical pulse
where is the apical pulse found?
below the nipple, 5th intercostal space
What other condition can cause tachypnea due to lack of perfusion?
Anemia, not enough red blood cells
—– is an abnormal rhythm
Arrhythmia
What does PVC stand for?
premature ventricular contraction
What is a normal premature ventricular contraction range?
6 PVC per minute
What does a premature ventricular contraction (PVC) of 7 or more cause?
-effects levels of consciousness
-“” ability to communicate
—– interferes with ADL (activities of daily living) due to unmet needs by the heart.
Dysrhythmia
Two classifications of palpitations:
Significant or insignificant
Symptoms of significant heart palpitaiton?
Short of breath, dizzy, light-headed
Symptom of non-significant heart palpitation?
Annoying
What are significant palpitations a sign of?
Atrial fibrillation
The atria conduction is supposed to be smooth, but with A-fib, it is turbulent. What do I worry about with A-fib ct?
Clots, stroke, MI
What can cause turbulence and/or palpitations/discomfort.
Bad valves anywhere in the heart
What heart sound can be heard with increased volumes of blood when one is pregnant?
S3 (fluid overload)
What other condition may cause an S3 sound?
HF due to fluid retention
two types of murmurs:
functional or problematic
What causes a heart murmur?
Foramen ovale does not permanently close
What does a murmur sound like?
Whoosh sound: “whoosh, lub dub”.
When a murmur begins giving someone problems (which for many people it doesn’t), what procedure may be needed?
Open heart surgery.
What is a functional murmur?
We know the problem is there and are monitoring.
Prevention of a functional murmur becoming a problematic murmur involves what intervention?
Drugs that slow heart rate (beta blockers and digoxin)
What is a symptom of taking medications that slows do HR?
HR doesn’t increase during exercise- struggle to establish exercise tolerance; prevents adequate perfusion for intense exercise needs
What modifiable action can develop new arteries?
Exercising
What is a concern when it comes to A-fib and it’s affect on the ventricles?
A-fib agitation may cause ventricular agitation (ventricular fibrillation), which could lead to cardiac arrest and death.
What is documented when a heart has arrhythmia?
“Atypical heart sounds” Refer to PCP.
—– —— is a condition that is presented by fingertips/hand that is blue.
Peripheral cyanosis
What causes peripheral cyanosis?
vasoconstriction/ shock/ Raynaud’s disease
A person with Raynaud’s disease needs to do what with their extremities?
Keep them warm
What is Raynaud’s disease?
A condition that causes reduced blood flow to the fingers, toes, ears, lips, or nipples.
What type of cyanosis is characterized by blue face or lips?
Central cyanosis (tissue hypoxia)
What should be prevented with central cyanosis?
From the chest turning blue- poor pump = not enough o2 = HF; asthma; COPD; pneumonia
Symptoms of CO2 poisoning:
pink/red skin
What is the only test that can detect CO2 poisoning?
ABG (oximeter won’t pick it up)
*Urgent to treat
What are our 4 roles in perfusion assessment?
-BP monitoring
-Pulse checks
-Skin color and temp
-Fluid management
What are the three things we check for with pulse and document?
Rate, rhythm, strength
What is the indication when assessing skin and finding pale, cool skin?
Poor perfusion.
What is assessed when checking skin and temperature that relates to perfusion?
-capillary refill time
-color (cyanosis, pallor)
-temperature of skin
-dry or damp
What are the 2 Ts that will require a blood infusion?
Tachycardia, Tachypneic (rapid shallow breathing)
What needs to happen besides a blood infusion if ct. is tachypneic and has tachycardia?
Increase isotonic IV fluids. If we increase volume, the heart won’t have to pump so fast and perfusion will be restored!
If vascular space is dehydrated, what type of fluids would help water go into the cells?
Hypotonic. Water flows to higher concentrations, so if it is hypotonic, it will flow into the cell.
If there are too many fluids, and the ct. has a weak heart, what will occur?
Congestive HF.
What is an intervention to be done when a ct. has too many fluids with a weak heart?
Give hypertonic fluids (will pull water from the cells and be excreted from the kidneys) OR diuretics (but can be hard on kidneys)
—– —— is an indication for fluid resuscitation in pt. in a hypovolemic state?
fluid management
What is assessed to manage fluids in a ct?
-fluid balance
-electrolyte levels
A ct. is bleeding out and losing a lot of fluid. What can we give them to lower viscosity without having blood products?
IV fluids. “isotonic” = goes where I put them (the vascular space)
When giving the heart enough fluids, what does this help?
Gives heart enough fluid to pump effectively so helps with B/P and perfusion.
What happens to cells when a hypertonic solution is injected?
The cells lose water to the highly saturated water (from lower concentration [sat] to higher)
Nursing intervention for someone who has hypertension with low volume?
Raise legs
Why would I raise the legs of a client with hypertension with low volume?
increases the blood flow to the heart.
What to veins have that actively pushes blood back towards the heart?
valves
If there is edema in the extremities and legs are elevated, what does this do for vascular resistance?
It decreases it, and improves venous return.
What positions compress blood vessels?
Crossing limbs
What are the 3 most common conditions we face in the U.S (HINT: cardiac conditions)
- HT
- HF
- PVD (peripheral vascular disease)
what is peripheral vascular disease?
When blood vessels narrow or become blocked. = reduced blood flow to all areas outside of the heart
Elevated blood pressure- prehypertension = what range?
120-129 bp/ even if diastole is less than 80
Hypertension stage 1 range:
130-139/ 80-89
What are the very important educational goals when it comes to a ct. newly diagnosed with HT?
-medication adherence
-lifestyle changes (exercise, decreased sodium, stress, etc.)
Symptoms of HF?
shortness of breath at rest; fluid restriction/change diet (PRN)
two types of ulcers to prevent with foot care
venous and arterial
Important Pt. Ed for peripheral vascular disease?
-smoking cessation
-exercise
-foot care (prevents ulcers)
symptoms of peripheral vascular disease?
-skin red, swollen, and may dif. to find pulse due to edema.
Interventions for peripheral vascular disease?
-raise legs
-compression stocking (first thing in the am) [as soon as legs go down, blood begins to accumulate].
