Upgrade to remove ads
Only $2.99/month

Perfusion

Terms in this set (80)

the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular waste products.
tissue perfusion refers to
When blood supply is available but decreased, the term
___________ is used
ischemia
Myocardial infarction indicates
death of myocardial tissue with an inability to regenerate.
prolonged ischemia of tissue leads to
necrosis, and eventually infarction if blood supply is not restored.
local or tissue perfusion
(actual amount of blood available to target tissues)
central perfusion
(mechanisms for blood delivery)
Central perfusion is generated by
cardiac output—the amount of blood pumped by the heart each minute.
When central perfusion is impaired,
clinical manifestations are systemic; in other words, the entire body is affected.
Tissue perfusion refers to
the volume of blood that flows through target tissues.
Atherosclerosis is characterized by
plaques of cholesterol and other lipids lining the inner layers of arteries, which results in obstructed blood flow
The force of ventricular contractions creates
a pressure, called capillary hydrostatic pressure, which pushes blood through capillaries into the interstitial spaces allowing delivery of oxygen, fluid, and nutrients to cells.
Smoking: risk factor
nicotine vasoconstricts
Elevated serum lipids:risk factor
contribute to atherosclerosis
Sedentary lifestyle:risk factor
contributes to obesity
Obesity: risk factor
increases risk for type 2 diabetes and atherosclerosis
Diabetes mellitus: risk factor
increases risk of atherosclerosis
Hypertension:risk factor
increases work of myocardium
Serum lipids are measured to detect
hyperlipidemia and include cholesterol lipoproteins (low-density lipoproteins [LDLs], high-density lipoproteins [HDLs], very-low-density lipoproteins [VLDLs], and triglycerides).
Venous compression ultrasound is performed to determine if
deep femoral, popliteal, and posterior tibial veins collapse with application of external pressure, which is normal. Veins with a deep vein thrombosis are unable to collapse.
Duplex ultrasound is a combination of
compression ultrasound and Doppler flow studies. Veins are examined for filling defects to help determine the location and extent of thrombus.10
Chest x-rays provide
visualization of the lungs, ribs, clavicles, vertebrae, heart, and major thoracic vessels. For patients with impaired perfusion, x-rays are taken to visualize the size of the heart and lung fields.8
Creatine kinase (CK) is
an enzyme present in myocardium (CK-MB), in muscle (CK-MM), and in brain (CK-BB) tissues.
Lactate dehydrogenase (LDH) is
an enzyme found in large amounts in the heart, liver, muscles, and erythrocytes.
When enzymes are isolated, the level of LDH1 isoenzyme is elevated
after damage to the myocardium and erythrocytes.
When enzymes are isolated, the level of CK-MB is
elevated after a myocardial infarction.
Natriuretic peptides include what two hormones?
Atrial natriuretic peptide (ANP) & Brain-type natriuretic peptide (BNP)
Atrial natriuretic peptide (ANP) is
a hormone secreted from right atrial cells when right atrial pressure increases; it is used to detect heart failure.
Brain-type natriuretic peptide (BNP) is
a hormone secreted from cardiac cells in increased amounts when pressures are high; it is used to detect heart failure.
Troponin is a
myocardial muscle protein released after myocardial injury.
Increased blood levels of this protein are found in patients who have had a myocardial infarction
Troponin
Troponin also can be used to
predict the likelihood of future cardiac events
Homocysteine (Hcy) is
an amino acid produced during protein metabolism
The link to perfusion is that elevated levels of Hcy
have been identified as a predictor of coronary artery disease (CAD), cerebrovascular accident, peripheral arterial disease, and venous thrombosis
Hcy promotes atherosclerosis by
causing endothelial damage, promoting deposits of low-density lipoproteins, and promoting vascular smooth muscle growth
Testing for Hcy has been recommended
in those patients with a familial predisposition for early cardiovascular disease or history of cardiovascular disease in the absence of other common risk factors.
C-reactive protein (CRP) is
a protein produced by the liver during acute inflammation and is emerging as an independent risk factor for CAD(coronary artery disease)
Maintain total cholesterol
•Adults >20 years of age <200 mg/dL
•Children 6-19 years of age <70 mg/dL
Maintain fasting blood glucose
• Adults >20 years of age: less than 100 mg/dL
• Children 12 to 19 years of age: less than 200 mg/dL
The nurse is assessing a patient for sleep patterns. The patient reports that he has trouble sleeping when lying flat. The best response from the nurse is
Use pillows to prop yourself up while sleeping.
A patient is experiencing periods of confusion, and the family is concerned. The patient's son asks the nurse for an explanation and recommendation. The nurse's best response is
"Your father may be having mini strokes; I will notify his physician
A patient is questioning the nurse about circulation and perfusion. The nurse's best response to explain this concept is
Perfusion assists the cell by delivering oxygen and removing waste products.
The nurse is assessing a female patient at the neighborhood clinic. The patient is complaining of "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of
Myocardial infarction
HALLMARK SIGNS AND SYMPTOMS of MI
• Chest pain that is unrelieved by rest or nitroglycerin, unlike angina
• Pain that radiates to arms, jaw, back and/or neck
• Shortness of breath, especially in the elderly or women
• Nausea or vomiting possible
• Maybe asymptomatic, known as a silent MI, which is more common in diabetic
patients
• Heart rate >100 (tachycardia) because of sympathetic stimulation, pain, or
low cardiac output
• Variable blood pressure
• Anxiety
• Restlessness
• Feeling of impending doom
• Pale, cool, clammy skin; sweating (diaphoresis)
• Sudden death due to arrhythmia usually occurs within first hour
INTERPRETING TEST RESULTS for MI
• EKG.
• T-wave inversion—sign of ischemia.
• ST-segment elevated or depressed—sign of injury.
• Significant Q-waves—sign of infarction.
• Decreased pulse pressure because of diminished cardiac output.
• Increased white blood count (WBC) due to inflammatory response to injury.
• Blood chemistry:
• Elevated creatine kinase MB (CK-MB)—usually done serially, the numbers
will rise along a predetermined curve to signify myocardial damage
and resolution.
• Elevated troponin I- and troponin T-proteins elevated within one hour of
myocardial damage.
• Less than 25 ml/hr of urine output due to lack of renal blood flow.
Morphine sulfate reduces
reduces preload and afterload. Frequently used in the treatment of acute coronary syndrome and HF
Vasodilator that reduces circulating blood volume, improves coronary artery circulation by dilating the coronary arteries. Reduces preload, slightly reduces afterload and increases myocardial oxygen supply
Nitroglycerin
An adverse reaction the nurse monitors for as a result from hydralazine therapy..
A Lupus like Syndrome
Unstable Angina Pectoris
The nurse should question the use of nifedipine (Procardia) for a pt. who has a HX of what?
------ is to be avoided when taking amiodarone (Cardarone) because it causes toxicity in potassium channel blockers
Grapefruit juice
There are 4 categories of drugs that support the treatment of heart failure
diuretics-thiazide, loop, potassium sparing
cardiac glycosides-maintenance therapy for heart failure
sympathomimetics- increase cardiac output
phosphodiesterase inhibitors-short term tx of low cardiac output
A serious adverse reaction as a result from taking simvastasin (Zocar) to treat hypercholesterolemia . This needs to be reported by the pt. because it could warrant stopping drug therapy
Muscle pain
Sodium Na
135-145
Potassium K
3.5-5.5
Calcium Ca
8.5-10.9
Magnesium
1.5-2.5
BUN
7-22
Glucose
70-110
Creatinie
0.6-1.35
Anti hypertensive drugs do what?
take pressure off the heart
Ace inhibitors do what? and Goal
inhibit ACE,
Goal- decrease BP, decrease preload and afterload
decrease sodium
take pressure off the heart
Beta Blockers (decrease the rate)--- end in "lol"
block beta receptors
Goal: decrease heart rate, decrease Blood Pressure
take pressure off the heart through vasodilation
decrease the workload of the heart
Calcium Channel Blockers --most end in pine and pen...
Nefedipine, Diltapen (cartazem)
(exception atropine)
Block Calcium from the heart... think about it Calcium is found in bones, bones are hard.. decrease the contract ability of the heart to soften the heart
S&S of a reaction to ACE
A---angio edema
C--cough
E---electrolyte imbalance
Diuretics (decrease workload, bring down the volume)
take fluid out through kidneys
Decrease fluid volume, decrease preload
decrease pulmonary venous pressure
relieve symptoms of heart failure
Loop diuretics-
Furosemide- (lasix) potassium wasting, sodium loss
Pt. needs to eat potassium foods
Thiazide diuretics
Potassium wasting diuretic
HCTZ hydrochlorothiazide
metalazone (zaroxolyn
Potassium sparing diuretics
Examples of potassium-sparing diuretics include
Eplerenone (Inspra)
Spironolactone (Aldactone)
People who take diuretics may also develop
too much potassium in their blood (hyperkalemia) if they take a potassium-sparing diuretic, or too little potassium in their blood (hypokalemia) if they take a thiazide diuretic.
The nurse knows NOT to give _________ to a patient with long term opiod use
Talwin pentazocine
A pain level of 3 or less will
help the patient heal more effectively
Narcan (naloxone) & dosage
Antidote for Morphine, opiod-induced respiratory depression
0.4 ml diluted in 9ml of Normal saline. Slowly push 0.54 ml IV over 2 mins until pt. respiration's improve.
Morphine indicationsi & adverse reactions
indications :Moderate to severe pain
adverse: sedation, decreased resp, nausea, vomiting
Stadol (butorphanol) & Oxycodone
indications: moderate to severe pain
adverse: decreased repiration
Codeine
indications: mild to moderate pain,and or cough
adverse: nausea & vomiting
Fentanyl
indications: severe pain
adverse: decreased respiratory depression
Research has shown the antidepressants reduce the pain of
Fibromyalgia
Reassess oral pain medication given with in
30 to 45 minutes
Reassess intramuscular meds given with in
15 to 30 minutes
Reassess IV pain meds given with in
5 to 15 minutes
Morphine use with Heart Failure
reduces preload and afterload
decreases pulmonary pressure and myocardial oxygen needs, and improvement in gas exchange
Pt. often experiences relieg from dyspnea and anxiety
THIS SET IS OFTEN IN FOLDERS WITH...