Perfusion Notes

Question 1

What are antiplatelets?

Answer 1

Keep the platelets from clumping together & forming a clot. Disrupts the blood flow & can cause a problem with the heart leading to a MI.

Question 2

What is a thrombolytic?

Answer 2

A drug used to bust open a blood clot.

Question 3

What are cardiac glycosides?

Answer 3

Drugs used for the heart to strengthen the contraction of the heart (Digoxin, Lanoxin).

Question 4

What is telemetry?

Answer 4

A pt. with a heart monitor & monitoring that pt’s heart.

Question 5

What is perfusion?

Answer 5

Flow of the blood through arteries & capillaries delivering nutrients and oxygen to cells. If interrupted for long period of time you could die!
* Veins carry the blood to the heart & arteries carry the blood away from the heart.

Question 6

What things go with perfusion?

Answer 6

Cap refill, pulses, heart sounds, & etc.

Question 7

Where are CBC labs drawn from? Where are ABGs drawn?

Answer 7

The veins. ABGs are drawn from the artery.

Question 8

What happens with variations from baby to death with perfusion?

Answer 8

*When baby is birthed (cord cut off) -doesn’t have the same circulatory system. Things shut off (ductus arteriosus) and seal off so we can experience the same as the parents outside of the body.
*As we age things happens physiological & psychological.
*Arteries and veins lose their elasticity- (physiological example). B/P goes up in elderly & can’t do what it needs to.

Question 9

Changes in perfusion can be temporary or permanent. Name some different types of conditions with altered perfusion.

Answer 9

*MI (coronary artery blocked off & causes permanent damage-Will need to put a stent in coronary artery to get blood flow going again in Cath lab
*Stroke (something blocked off going to head)
*Heart-Coronary arteries
*Shock (body decompensated)
*When a MI is not treated & you become very sick, muscle is stunned & not getting enough o2 can lead to CHF

Question 10

Chronic disorders that affect perfusion?

Answer 10

*Silent killer-HTN
*Heart failure (heart muscle affected & not pumping properly leading to fluid overload. (test question)
*Sickle cell anemia (affects blood-Hemoglobin & Hematocrit (carry O2) labs need to be looked at.
*Hemophilia-free bleeders-active bleeding & don’t have proper clotting mechanisms

Question 11

What is central perfusion?

Answer 11

*Central perfusion is generated by cardiac output—the amount of blood pumped by the heart each minute. Heart beat/stroke volume are affected. Two systems to function-Electrical System(EKG STRIP-Atrial Fibrillation)/mechanical-Closing/opening of valves-Ventricle, Atrial, & valves(leaflets of valves cause back flow in heart), Aortic stenosis-closing of lumen.
*Pulse is an indicator of perfusion. *Pacemakers help with rate & stimulation of the heart.

Question 12

What is Cardiac Output?

Answer 12

-Cardiac Output-Heart beat in a minute
-Beats/minute x volume/beat)=volume/minute
-Stroke volume=volume/beat (Amount of blood ejected from each ventricle during contraction. It’s affected by the preload, contractility, & afterload.)
-Cardiac output=HR X SV; normal is 4-6L/min
-Volume of blood pumped by ventricle/minute
*Each heart beat pumps about 60 mL of blood in a minute(5 L/minute).

Question 13

What are the two systems cardiac output requires to function?

Answer 13

Two systems to function-Electrical System: P wave, QRS Complex, (EKG STRIP-Atrial Fibrillation-Something is not firing right from SA node to AV node to Bundle of His to Purkinje fibers)
*Mechanical (Structures)-Closing/opening of valves-Ventricle, Atrial, & valves stay open (leaflets of valves cause back flow in heart), Mitral valve stenosis/Aortic stenosis-closing of lumen(narrowing).
*Any problem with any system will affect the cardiac output.

Question 14

Firing of the heart

Answer 14

*SA Node(pacemaker of heart) helps with producing normal heart beat Impulse is originated from.
*AV Node-Heartbeat goes down if SA Node is not functioning properly (40-60 beats/minute)
*When AV Node is not working properly the Bundle of His takes over (20-40)-Bifurcates in two directions to Purkinje Fibers-Nothing to around 20 heart beat (takes over when Bundle of His is not working properly.

Question 15

What happens when SA Node fires on a EKG strip?

Answer 15

*EKG-P wave when SA Node fires (right atrium) QRST (Heartbeat traveling through ventricles)

Question 16

What is going on with ventricular fibrillation and ventricular tachycardia?

Answer 16

*Ventricles pumping really fast causing decreased Cardiac Output. Deadly situation.
*No blood is being pumped and if not shocked they will die if it’s not in a normal rhythm. Pt. needs to be shocked with ADE. Atrial fibrillation problems alter the perfusion and cardiac output.
*ADE-Shocks deadly rhythms in pt. into normal sinus rhythm.

Question 17

What happens with the mechanical structures of the cardiac output?

Answer 17

Mechanical Structures-Heart has a septum that separates the left from right side. There is a right & left atrium/ventricle. The right atrium gets deoxygenated blood from superior/inferior vena cava. (Vena Cava largest vein) When SA node fires (right atrium contracts) opening tricuspid value-blood goes to right ventricle. Pulmonic valve opens goes to pulmonary artery feeding both lungs. Oxygenated blood and co2 goes off & goes to veins to heart and dumps in left atrium. Mitral valve /bicuspid valve(2 leaflets) opens and down to left ventricle to aortic valve to aorta. Blood goes to coronary artery openings and oxygen goes and perfuses brain & rest of body (renal arteries). Femoral artery & veins get blood & to rest of body. Cycle starts over . You can’t make it if aorta ruptures.
*Aortic dissection-death.

Question 18

Why does the blood pressure depend on the cardiac output of the heart?

Answer 18

Pressure from heart through ventricles creates the blood pressure. *Good indicator of cardiovascular system function.
*High blood pressure-pt. is perfusing to much (risk of a stroke). To low of a blood pressure-pt. is perfusing little.
-More blood more volume (higher pressure). Less blood less volume (hemorrhaging).

Question 19

What is the viscosity of blood?

Answer 19

-Thickness of blood (if it’s thicker the more time it takes to pump effectively.)
-Hematocrit (percentage of viscosity) *If hematocrit goes up-blood flow slows down(thicker) & heart works harder to pump the blood.
*If blood is thin (Like a cut) -The pt. will bleed excessively.
-Importance of patient teaching when people are on anticoagulants.
*People on blood thinners you want thin blood to prevent clots.

Question 20

What is peripheral vascular resistance?

Answer 20

-The resistance of blood flow & is determined by size of blood vessel. *When vessels lose elasticity, the vessel doesn’t contract as it should. Blood pressure gets higher & higher. *As we get older the vessels lose elasticity.

Question 21

What is the systolic blood pressure?

Answer 21

Pressure exerted when blood is ejected into arteries. Normal systolic blood pressure is 120 mmHg or below.

Question 22

What is the diastolic blood pressure?

Answer 22

Pressure blood exerts within the arteries between heartbeats. Normal diastolic blood pressure 80 mmHg or below.

Question 23

What is preload?
*Cardiac drugs are prescribed based on preload or afterload of heart.

Answer 23

-Volume of blood received by the heart.
*Preload is stretch. The amount of volume being returned to the heart (What’s coming into the heart).
*Volume of blood in the ventricles after the end of diastole (end diastolic pressure)
-Increased in Hypervolemia, Regurgitation of cardiac valves, and heart failure

Question 24

What is afterload?

Answer 24

-Pressure or resistance the heart has to overcome to eject blood.
*Afterload is the squeeze. The amount of resistance that the heart has to overcome in order to eject blood. (Resistance the left ventricle has to overcome to circulate the blood)
-Increased in hypertension and vasoconstriction (things clamping down)
*Increase in afterload =Increase in cardiac workload

Question 25

What is tissue perfusion?

Answer 25

-Tissue perfusion refers to blood that flows through arteries (something big) and goes to capillaries (exchange of oxygen & CO2) to the target tissues.
*Arteries/arterioles maintain blood pressure by constricting or dilating.
*Tissue perfusion is when it is in the tissues, arteries, veins, small vessels, to capillary membranes.

Question 26

Consequences of Impaired Central perfusion

Answer 26

-Two coronary arteries(Right & Left) on surface of heart-left bifurcates into two arteries.
*Plaque builds up & can be cholesterol plaque or platelet plaque (Rought plaque snagging things up). Causing disruption of blood flow forming a clot(occlusion) or blood can still be flowing through the narrow artery causing chest pain.
*There is not enough oxygen in the blood flowing. Pt. gets Heart Cath to tell if heart is working properly (narrowing artery with not enough blood flowing through artery).
*Coronary arteries perfuse the heart muscle (when there is a blockage in the coronary arteries-that is why there is probably some chest pain-no oxygen getting to heart)
*Stent or balloon blowed up can be put in two crunch plaque up against the wall so that blood can flow again.

*Atrial fibrillation- Atrium is staggering and there is not enough blood flow to the ventricles. Valves can get diseased or prolapse on self or stenosis ( plaque on leaves of valves.Vegetation on the valves cause them to stretch because blood flow is still trying to go through them.

Question 27

What are consequences of impaired local or tissue perfusion?

Answer 27

Ex. DVTs in the leg. Impaired circulation & breaks off( embolus)and travels to brain, heart, or lung. To prevent DVT: Ambulatory, TED Hose/sequential hose as prevention.

*Common strokes (Hemorrhagic, Ischemic, & Arthersclerosis)

Question 28

Risk Factors of Perfusion

Answer 28

-Elderly- Loss of elasticity, disease processes, cheeseburgers- to plaque buildup.
- Heredity, cholesterol, Age, Race, Lack of funds (stress, nutrition-Higher foods if organic.) Do something modifiable like getting something cheaper- process foods)
-Socioeconomic can impair health, medicine is high, couch potato-sedentary lifestyle (modifiable lifestyle), smoking(modifiable), family history (non modifiable).
- Graduate-The higher the education level the higher they are exposed to money for medicine.

Question 29

What is included in the assessment of perfusion issues?

Answer 29

History-Problem from past (heart attack), family history, baseline, cormobidities (DM- small vessels, HTN, coronary artery disease, arthrosclerosis, what meds are you taking including over the counter & why you are taking it? How much of it? Street drugs (recreational)

*Nitroglycerin is used for chest pain- IV for cocaine users for the vasoconstriction of artery.

-Problem-based history-When providing their history, patients may describe pain, fainting (syncope), dizziness, SOB, swelling (edema), bleeding, or fatigue. Need details.

-Pain-morning, night, or on exertion-Describe it ( chest pain or leg pain-know when it starts if walking & when it stops resting).

-Syncopy-Faint or almost due to cerebral perfusion-What caused it and do they remember what caused it.

-Dizziness-Inadequate circulation (orthostatic hypotension)

-Dsypnea-decreased oxygen transport

-Edema-Fluid accumulated somewhere it should not be (pitting vs. nonpitting)

-Inspect-Lok at skin tone, nail bed, mucous membrane, look for cyanosis-blue, pale blue, grayish. Petchaice-Red pinpoint spots. Anemia. Jugular veins- distention. Edema in extremities. Unilateral (DVT) vs. Lateral. Skin discoloration- lower extremities, pale extremities- no hair.

Question 30

Diagnostic Tests

Answer 30

CBC-Hemoglobin, RBC, & hematocrit & cholesterol Test (plaque buildup in artery) fat, Total cholesterol Less than 200)
*LDL- Less than 130( Lower density lipoprotein-The lower the number the better)
*HDL-50 or higher for male & female (High density lipoprotein) A high cholesterol level can be modified by exercise or medication.

-A genetic problem is a hard problem. A serum test is run to see about lipids.
*Altered perfusion there will be an opposite with LDL & HDL.

-Triglycerides-35-160 for male & female (calories your body don’t need- unhealthy eating) really high & bad for body.

Question 31

What can be done for V-Tach?

Answer 31

Medication(Amiodarone) can be taken for it. When you check the carotid artery and there is no pulse. The pt. Has to be shocked backed into normal sinus rhythm.

Question 32

What is angina?

Answer 32

-Blood down coronary arteries provide oxygen to muscle underneath it. Angina pain caused by hypoxia.
*Radiating down left arm in men like an elephant sitting on chest(pressure/tightness). Say take a deep breath and decrease after you exhale (pleuritic pain). They can’t feel their breath.
*Women are atypical. Women may not feel right like a jaw ache with extreme pain or a toothache.

-Assess for heart attack & prove its not heart first-Assess for pain, 12 Lead EKG (Acute MI), LABS-Cardiac enzymes-elevated for heart attack. *Then assess other things like toothache.

Question 33

What is included in LV Disfunction?

Answer 33

-Not pumping out like it should(previous MI)-Largest chamber, Blood doesn’t empty correctly so ventricle expands(bulges) from pressure & it flops causing deceasing Cardiac Output.
-When backed up, blood goes to Mitral valve & into Left atrium into lungs causing Left side Heart Failure. -Assessment findings-Adventitious lung sound(fluid backed up), hypoperfusion.

*Heart Failure-Pump is not pumping adequately & forcefully as it should.
*Thickness of septum wall and muscle there can’t perfuse adequately leading to heart failure.

Question 34

What is Right Heart Failure?

Answer 34

-Blood not pumping correctly into right ventricle leads to blood backing up into tricuspid value into superior vena cava.
-Blood goes to lower extremities leading to (Edema)/Liver(ascites).

Question 35

Anticoagulant (Xarelto) Medicine

Answer 35

-Prevents clots or PE(DVT, MI & can involve lungs or heart)
*Don’t ever eat leafy greens everyday (spinach, kale, mix spring) Changes blood level as well.
-Frequently test PT time to see how thin or thick blood is.

Question 36

Antiplatelet-Clopidogrel Medicine (Plavix)

Answer 36

-Decrease the possiblity of stroke & MI by decreasing platelet aggregation
*Assess for thrombotic/thrombolytic purpura, monitor blood studies, CBC, Hct, Hgb, bleeding time.

Question 37

Beta Blockers-Atenolol (Tenormin)

Answer 37

-Decrease B/P, heart rate & prevention of angina pectoris, & MI. You want B/P Lowered.
*HR less than 50 don’t give.
*Teach pt. if medicine is working to continue to give medication to lower B/P.
*Teach pt. if B/P is low in morning when sleep. Retake it to see what B/P is when awake.
*Teach pt. to don’t just up & stop taking it cause it can lead to angina & MI.
*Can mask symptoms of hypoglycemia- & lower B/P.

Question 38

Ace Inhibitor-Lisinopril Medicine (Zestril)

Answer 38

-Antihypertensive-Decrease B/P in hypertension, decreased preload, afterload in Heart Failure.
*Given for hypertensive.
*Teach pt. to not take if pregnant without approval.
Monitor B/P, HTN, Acute MI, HR
*Teach pt. to not just up & discontinue.
*Check with health care provider before using over counter & herbal meds.

Question 39

Thrombolytic (Alteplase) Medicine

Answer 39

-Destroys clots(lysis of thrombin in MI, pulmonary embolic(life threatening) & perfusion starts back in the blood.
Don’t give if pt. just had a Craniotomy 8 days ago would cause you to bleed in the head.
*This is a big bad clot buster.

Question 40

Digoxin (Digitalis, Lanoxin) Medicine

Answer 40

Cardiac Glycoside-Increased contractility of the heart by decreasing the workload. Helps the heart to pump more forcefully & effectively. Decreased edema, pulse.
*Slows down heart rate & should check heart rate before giving. Take apical pulse for 1 minute.
*Don’t give if pulse is less than 60. It has blood level-labs drawn for digoxin level(dig toxic)Serious signs & symptoms.