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Nursing 3910 > Week 7: Circulation and Tissue Perfusion > Flashcards

Week 7: Circulation and Tissue Perfusion Flashcards

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1
Q

Interconnected Systems of the Heart

A
  • Structures
  • Electrophysiology – electrical conduction to create heartbeat
  • Vasculature – blood supply to heart muscle itself
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2
Q

Perfusion

A

flow of blood through circulatory system to oxygenate cells and remove rate

Poor perfusion results in cell death over time

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3
Q

Perfusion depends on:

A

Sufficient cardiac output

Sufficient blood pressure

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4
Q

Cardiac Output

A

amount of blood the heart is pumping
- Heart rate x stroke volume

  • Normal = 75 x 70 = 5250ml/min
  • Heart rate – electrical activity that pumps the heart
  • Stroke volume – volume of blood in the heart when it pumps

Influenced by:
o Nervous systems
o Fluid volume
o Heart muscle contraction
o Resistance in vessels (peripheral resistance) – resistance of the arteries to blood
flow

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5
Q

Blood Pressure

A

Cardiac output x peripheral resistance

Influenced by:
o Heart rate (contractility)
o Stoke volume (fluid, contraction, return, constriction)
o Blood viscosity
o Radius of vessel (constriction, atherosclerosis, blood volume)

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6
Q

P wave

A

activation of atria

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7
Q

QRS complex

A

activation of ventricles

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8
Q

T wave

A

recovery wave

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9
Q

Primary Causes of Problems with Perfusion

A
  • Vascular volume disorders – FVO, FVD
  • Electrical disorders – dysrhythmias
  • Mechanical disorders – cardiac myopathy, CHF
  • Coagulation disorders – blood clots (can lead to MI)
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10
Q

Modifiable risk factors for CV disease (co-morbidities)

A

HTN - damage to vessels over time

Obesity – increased demand on all body systems

Dyslipidemia – buildup blocks vessels and impacts flow

Diabetes – damage to vessels over time

Lifestyle – diet, exercise, smoking, alcohol

Sleep apnea – hypoxia (comp. causes damage)

Smoking – increase plaque formation

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11
Q

Non-modifiable risk factors: Cardiac /CV disease

A

Family history – increased risk for diagnosis in immediate family

Genetics – may modify cholesterol, heart structure, etc.

Gender – men more predisposed to CVD, women more predisposed to
stroke

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12
Q

Cardiac Physical exam RED flags

A

Changes in VS – compensation

Altered breath sounds – impaired movement through pulmonary vessels (CHF)

Restlessness, changing LOC – brain hypoxia

Changes in cardiac assessment – structures, electrophysiology,
vasculature

Fatigue – body systems not functioning

SOB – compensation for decreased oxygenation to body

Pain – tissue hypoxia (squeezing/racing palpations, SOB, nausea,
shoulder/jaw pain, anxiety, impending doom, fatigue, dizziness)

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13
Q

ACE Inhibitors

A

blocks the release of ACE, stopping the RAAS system, decreasing blood
pressure

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14
Q

ARBs

A

blocks the binding of Angiotensin II (RAAS system), stopping the vasoconstriction
of vessels, decreasing blood pressure

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15
Q

Beta blockers

A

blocks beta receptors (epinephrine + norepinephrine) binding,
decreasing contraction and heart rate

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16
Q

Calcium channel blockers

A

blocks calcium channels, stopping calcium from entering the
heart, decreasing contraction and heart rate

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17
Q

Hypertension

A

chronic condition where BP remains consistently elevated above set range

Causes stress to body systems, which causes damage

Compensation may occur in an attempt to lower blood pressure - chronic compensation
when body is unsuccessful in reducing BP, causes damage

Major risk factor for heart attack and stroke

18
Q

Categories of Hypertension

A

Patients without diabetes = +140/90

Patients with diabetes = +130/80 (comorbidity, body can handle less

19
Q

Primary Hypertension

A

No cause, 95%

20
Q

Secondary Hypertension

A

Identifiable cause, 5%
Causes: CKD, sleep apnea, pregnancy, NSAID use, alcoholism

21
Q

Non-modifiable risk factors: Hypertension

A

Family history
55+ men, 65+ women

Men are at higher risk

Genetics

SDOHs

22
Q

Modifiable risk factors: hypertension

A

Lifestyle – activity & diet (sedentary, sodium)

Alcohol
Smoking
Weight

23
Q

Physical exam: hypertension

A

Vitals – BP
Cardiac exam

Systems assessment for symptoms of HTN – Silent Killer (often asymptomatic!)
- Headache
- SOB
- Visual disturbances
- Chest pain
- Irregular rhythm
- Bounding pulse
- Nausea/vomiting

24
Q

Nursing Priorities for Hypertension

A

Monitor patterns

Diagnosis requires elevation over time

Response to treatment/lifestyle changes

  • Intake/Output

Interaction between BP and fluid balance

25
Q

Lifestyle: hypertension

A

Reduce risk
Eat – lots of fruits, vegetables, low-fat dairy products, low saturated fats
(DASH DIET)

Quit – smoking

Moderate – alcohol

Reduce - sodium intake, stress

Maintain – health body weight

Increase – exercise (at least 30min/day)

26
Q

Pharmacological Interventions for Hypertension

A

ACE inhibitors
ARBs
Beta-blockers
Calcium channel blockers Diuretics
Hydralazine (vasodilator)

27
Q

targets of therapy: hypertension

A

Lower peripheral resistance
Lower cardiac output
Reduce RAAS system & fluid volume

28
Q

Why Treatment is not Working to Improve BP:

A
  • Adherence
  • Unidentified/untreated associated condition (sleep apnea, alcoholism, pain, etc.)
  • Drug interactions (OTC supplements, NSAIDs, oral contraceptives)
  • White Coat HTN
  • Inappropriate treatment regimen
29
Q

Hypertensive crisis

A

BP = +180/120
- Acute marked increase in BP
- Emergency or urgent

Signs & symptoms:
Chest pain
SOB
Back pain
Visual disturbances
Cerebral edema
Headache

Urgent:
Headache
Nosebleeds
Anxiety

30
Q

hypertensive crisis: pharmacological treatment

A

Emergency – IV vasodilator

Urgent – fast acting oral antihypertensive

31
Q

Treating a Hypertensive Crisis

A

Notify provider
- Assessment:
VS monitoring (q 5mins)
Systems assessment (organ damage)

Blood work:
 Urinalysis
 Electrolytes (K, Mg, Cl, Na)
 Kidney markers
 Lipids
 Blood sugars

12 lead ECG

Intake/Output tracking

Patient education:
Bedrest
Notify of change in symptoms
Reduce stimuli

32
Q

Nurse Management of Hypertensive Crisis

A
  • Administer O2 (allows for perfusion)
  • Monitor BP frequently
  • Monitor cardiac, respiratory, and neuro frequently
  • Initiate IV access
  • Administer meds – IV antihypertensive
  • Assess cardiac monitor
  • Encourage bedrest and reduce stimuli
33
Q

Atrial Fibrillation (AFIB)

A

irregular & often rapid heart rhythm caused by uncoordinated contraction of atrial muscles

Arrhythmia/dysrhythmia
- Significant increase in mortality

Normal – atria fire synchronously to pump blood into ventricles

A Fib – rapid, chaotic, and irregular contraction pattern of atria; caused by
electrophysiological or structural changes of the atria tissues

34
Q

ECG of A Fib

A

Rate – usually over 100

Rhythm – irregular

P wave – non-existent

PR interval – impossible to compute

QRS complex – normal (ventricles, not atria, remains normal)

35
Q

Causes of A Fib

A

HTN – chronic activation of compensation mechanisms causes structural and
electrophysiological changes

Diabetes – vascular changes

Smoking – nicotine causes inflammation & oxidative stress

Obesity – weight-related changes to structure

Alcohol – triggers arrhythmias

36
Q

Outcomes of A Fib

A

Rapid firing of atria – blood pooling, clot formation
o TIAs
o Ischemic stroke
o MI
o Pulmonaryembolism o Heartfailure
- Also causes poor pumping, lower CO, poor perfusion

37
Q

Health History: A Fib

A

Non-modifiable risks:
o Family history
o Age
o Gender
o Genetics
o SDOH

  • Modifiable risks:
    o Lifestyle: activity (sedentary) diet, (sodium)
    o Alcohol consumption
    o Smoking
    o Weight
  • Other relevant data:
    o Comorbidities – HTN, hyperthyroidism, hypokalemia, hypomagnesia
    o Signs & symptoms
38
Q

Physical Assessment: A Fib

A
  • SOB
  • Exertion fatigue
  • Irregular, increased HR
  • Weak pulse
  • Palpations
  • Hypotension
  • Abnormal heart sounds
  • Chest pain
39
Q

Nursing Priorities: A Fib

A
  • Decrease risk of emboli – anticoagulation therapy
  • Rhythm control – manage arrythmia through medication
  • Health teaching – treatment/lifestyle modifications, health literacy, readiness for
    change, support system
40
Q

Pharmacological Intervention: A Fib

A

Target – decrease HR, regulate rhythm, promote clot prevention

Types:
Calcium channel blockers
Beta-blockers
Cardiac glycoside (Digoxin)
Oral anticoagulants

41
Q

Acute Intervention: A Fib

A
  • Transesophageal Echocardiogram (TEE)
  • Synchronized Cardioversion
  • Catheter ablation – tissue with irregular pulse is damaged

Nursing 3910 (12 decks)

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