Upgrade to remove ads
2900 TEST #1
Terms in this set (41)
Consistent supply of blood to deliver oxygen and nutrients, then remove wastes
Inconsistent supply or reduced supply so delivery and removal is suboptimal
Tissue death / infarction / hypoxemia
No perfusion (necrosis)
What is central perfusion generated by?
What is cardiac output?
SVxHR=CO, amount of blood pumped each minute
Are clinical manifestations systemic or localized if central perfusion is impaired?
Systemic (whole body is affected) END RESULT = SHOCK
Where does central perfusion reach in the body?
Propels to all organs via vessels
What is local / tissue perfusion?
Blood volume that flows through target tissues, supplied by flow from arteries to capillaries (smooth muscle contraction)
Force from heart creates ________ pressure in capillaries, pushing oxygen, fluid, and nutrients into the interstitial space and into tissues
What could be the cause of inadequate perfusion to tissues?
Poor central perfusion, a blockage to or from or excessive edema blocking cellular oxygen excess
What are some consequences of decreased perfusion?
- body is forced to use anaerobic metabolism = lactic acid = cellular acidosis -> cells digestive lysosomes swells and releases enzymes to self-destruct = release of CK
- lack of ATP = Na+/K+ poops out = K+ deficit in the cell -> triggers a lot of electrolyte shifting and chemical changes
- increased membrane permeability = swelling, free radical production, inflammation
- end result = necrosis
What is the assessment for perfusion?
- patient history
- good central perfusion = WNL VS (HR & BP)
- neuro: should be oriented, bilateral movement/sensation, clear speech
- good tissue perfusion = extremities warm, CMS intact, dorsalis pedis pulses palpable 60-100 BPM, cap refill <2 seconds, and ABI of 1-1.4, normal sinus rhythm
What are assessment signs that are problem based for perfusion?
- pain - sensation issues
- dyspnea / lung sounds - confusion
- edema - dysrhythmias
- dizziness / syncope - abnormal BP & P
- clubbing of nail beds - cyanosis
- LE's with deep red rubor, ulceration
- weight gain - JVD
- murmurs / S3/4 - carotid bruits
What is JVD an indication of?
Right sided heart congestion
What is the importance of orthostatic BP's for perfusion?
- SBP drops 10-30 from any change of position
- DBP drops 5 mmHg after a change from supine to upright
What is the importance of pulse pressure for perfusion?
- SBP - DBP , NML = 40
- critically ill have narrow pulse pressure, to try to maintain adequate organ perfusion
- hypotenuse septic patients have a wide pulse pressure which provides inadequate perfusion
What are pertinent labs for perfusion?
- CK- MB
- anemia? Infection?
What is the calculation for MAP?
MAP = SBP + (2) DBP / 3
What are possible diagnostic tests for perfusion?
- 12 lead EKG, also telemetry
- cardiac stress test
- ultrasound (echocardiogram or venous Doppler for peripheral circulation)
What is the normal value for MAP?
What is the normal value for central venous pressure (pressure created by volume in the right heart)?
What is the normal value for pulmonary artery occlusion pressure (wedge) (pressure from volume in left heart)?
What is stroke volume?
the amount of blood ejected by the heart in any one contraction
What is the normal value for stroke volume?
What is cardiac output?
Volume of blood ejected by the heart in one minute:
cardiac output = heart rate x stroke volumne
What is the normal value for cardiac output?
4-6 L/min at rest
What is ejection fraction?
How much blood is being pumped out by left ventricle each contraction (beat)
What is the normal value for ejection fraction ?
What are key labs for oxygenation?
- CBC -> Hgb/Hct (relative to hydration status)
- ABGs -> respiratory acidosis / alkalosis
- sputum sample -> before antibiotics and not after a meal - sterile collection
- TB screen
- chest x-ray, CT scan, VQ scan, pet scan, pulmonary function tests
Signs / symptoms of respiratory acidosis
- hypoventilation --> hypoxia
- rapid, shallow respirations
- decrease BP with vasodilation
- muscle weakness
- drowsiness, dizziness, disorientation
Signs / symptoms of respiratory alkalosis
-deep, rapid breathing
-decreased or normal BP
-numbness and tingling of extremities
-lethargy and confusion
What is atelectasis?
collapse of the alveoli in the lung
prevents normal exchange of O2 and co2
What is pulmonary effusion?
buildup of fluid between the tissues that line the lungs and the chest
What is a throacentesis?
Used to withdraw fluid from the pleural space
What are pulmonary infiltrates?
substance denser than air, such as pus, blood, or protein, which lingers within the parenchyma of the lungs
What is a hemothorax?
blood in the pleural space
What is a pneumothorax?
air in the pleural space
What are some nursing implications for oxygenation?
- O2 therapy
- nutrition: high protein, high calorie for kcals burned with work of breathing
- airway management; vest, IS use, chest tube, thoracentesis assist, CPAP, BIPAP, suctioning, ventilation via bagging or mechanical
How do you prevent VAP?
- elevate head of bed 30-45
- daily attempts to wean from vent
- oral care with chlorhexidine solution
- peptic ulcer prophylaxis
- DVT prophylaxis
- sterile technique
Nursing care teaching for oxygenation?
- smoking cessation
- incentive spirometer
- cough, deep breathe, positioning
- medication management
- avoiding respiratory triggers / allergens
- nutritional support
- asthma management
What happens with ARDS?
- leading cause: sepsis
- high mortality rate!
- NEEDS PEEP
YOU MIGHT ALSO LIKE...
Critical Care - Hemodynamic Monitoring a…
Cardiac A&P- Cardiac Output & Hemodynamics
OTHER SETS BY THIS CREATOR
2900 medications test #2
Pharm test #2
OTHER QUIZLET SETS
RCP 210 pathophysiology Exam 1
Marketing Test Chapters 1-7
Biology Final Exam