Perfusion

Question 1

Central Perfusion

Answer 1

Force of blood movement generated by cardiac output
Cardiac output: CO = stroke volume x heart rate

Question 1

Tissue/ Local Perfusion

Answer 1

Volume of blood that flows to target tissues
Requires patent vessels, hydroastic pressure and capillary permabillity

Question 2

Impairment of central perfusion

Answer 2

Occurs when cardiac output is inadequate
Reduced cardiac output results in reduction of oxygenated blood reaching the body tissues ( systemic effect )
- Shock
-Ishemia, cell injury, cell death
- Systemic effect

Question 3

Heart Failure

Answer 3

Pump Failure: inability of heart to work effictively as a pump
Usually leads to drop in CO
Classifications:
- Left side vs right side HF
- Systolic ( HFrEF ) verus
- Diastolic ( HFpEF )
- Low output vs high output
-Acute vs chronic

Question 4

Left Sided Heart Failure

Answer 4

Most failure starts on the left side and progresses to both sides
Causes: Hypertension, CAD, Valvular Disease, MI
Manifestations: Dizziness, Fatigue, Tachy, Dysnpnea, s3, CRACKLES, FROTHY SPUTUM, AMS

Question 5

Right Sided Heart Failure

Answer 5

Causes: Left ventricular failure, Right ventricular MI, Pulm HTN, Right ventricle can’t empty completely, increased volume and pressure
Manifestations: Peripheram EDEMA, JVD, anorexia, nausea, enlarged liver ( RUQ pain ) , Nocturia, hepatomegaly
- Elevated CVP

Question 6

Cardiomypathy

Answer 6

Causes:
CAD
Infection or inflammation of the heart muscle
Various cancer treatments
ETOH
Heredity

Four Types:
Dilated* most common
Hypertrophic ( stiff )
Arrhythmogenic right ventricular ( rare )
Restrictive

Manifestations:
Fatigue, HF, Dysrhymias, s3 gallop, angina

Question 7

Labs and Diagnostics

Answer 7

BMP: 100-300 = heart failure
Hemodynamic monitoring
ECHO ***
EKG
ABG
Urinalysis

Question 8

Interventions ( MAWDS )

Answer 8

Med: Take as prescribed
Activity: Know your limits- rest as needed
Goal 30 minutes of exercise of moderate
Daily weights 2-3 lbs in one day, 5 lbs in week
Diet: Sodium restriction-2.3 gm/day
Goal 1.5 gm/day
Fluid restriction 1500-1800 ml/day

Question 9

Med Considerations

Answer 9

DONT give calcium channel blockers ( diltiazem, valsartan )
ACE ( dry cough, angioedema )
Nitrates ( 8-10 hr nitrate free period )
ARB ( renal patients, avoid salt substitutes )
Alodosterone Agonist: Aldactone
Beta blockers ( brady )
Loop diuretic

Question 10

Nonsurgical options

Answer 10

CPAP: Improving oxygenation need others med w it
CRT
CardioMEMS
Gene therapy

Question 11

Impaired tissue ( local ) perfusion

Answer 11

Impairment of tissue perfusion is associated with loss of vessel patency or permeability or inadequate central perfusion
Results in impaired blood flow
Leads to ischemia

Question 12

PVD

Answer 12

Are conditions affecting peripheral arteries and veins
- Arteriosclerosis
- Athersclerosis
- CVI ( Chronic Venous Insufficiency )

Question 13

Arteriosclerosis

Answer 13

Thickening or hardening of arterial wall
- Associated w aging

Question 14

Athersclerosis

Answer 14

Type of arteriosclerosis of plaque wall within arterial wall

Question 15

PAD

Answer 15

Result of systemic arteriosclerosis usually athersclerosis typically in lower extremities
- Risk factors:
- HTN
- Hyperlipidemia
- DM
- Smoking
- Obesity
- Lifestyle
- Genetics
- Stress
- Female
- Older than 65

Question 16

Assessment PAD

Answer 16

: Intermittent claudication- Burning, cramping and pain in the legs during EXERCISE
- pain that occurs while at rest
- Bruit
- Decreased CRT
- Nonpalpable pulses
- Pallor
- Gangrene of toes
- Dependent rubor
- Cold and cynanotic
- Hair loss
- Thick toenails

Question 17

PAD Diagnostic Assessments

Answer 17

Ankle brachial Index
Doppler and Ultrasound
MRA
Exercise tolerance
Arteriography: contrast agent

Question 18

PAD Interventions

Answer 18

Exercise: Start gradually and increase slowly
Positioning: Avoid crossing legs, elevations should NOT be above heart, dangle if needed
Warm enviroment
Smoking cessation
Avoid stress
Drug therapy ( antiplatlets and statins )
Percutaneous transluminal angiplasty ( stent )
Atherectomy ( scrape out )
IV Heparin

Question 19

Venous Insufficiency

Answer 19

Result of prologned venous hypertension stretching veins and damaging valves
Risk: Heart failure, immobility, pregnancy, oral contraceptives
Manifestations: Aching, feeling fullness or heaviness in the legs, brown, edema, stasis ulcers

Question 20

Venous Insufficiency Complications

Answer 20

Stasis Dermatitis, Stasis Ulcers, DVT
Treatment: Elevate legs above the heart for 20 mins, 4-5 times a day

Question 21

Venous Stasis Ulcer

Answer 21

Would shallow, weird shape, pink, warm, hard hyperpigmented.

Question 22

Varicose Veins

Answer 22

Distended protruding veins that appear darkened and tortuous
- Elastic stockings
- Elevation
- Sclerotherapy
- Surgical removal
- Radiofrequency

Question 23

Pulm Embolism ( PE )

Answer 23

Obstruction of blood flow in pulmonary vascualr system
- Embolus
- Tumors
- IV injection of air
- Fat
- Fluid release

Question 24

Risk factors for PE

Answer 24

- Altered blood coagulation - Prolonged immobility - Obesity - MI, heart failure - Smoking - Hip fracture - Preg - Advanced age - Surgery

Question 25

PE assessment

Answer 25

Hypoxemia - Anxiety Resp: Dyspnea, air hunger, tachypnea, chest pain, decreased O2, sudden SOB, crackles Cardio: DNV, tachy, cyanosis, hypotension

Question 26

Lab assessment

Answer 26

D-Dimer: assess clotting ABGS: assess oxygenation Pulm angiography: assess lungs ECHO: assess for RV involvement

Question 27

Nursing Interventions PE

Answer 27

Resp: High fowlers, monitor ABG, maintain O2 above 94 Cardio: Ausculate heart, assess skin, assess signs of bleeding Meds: Anticoagulants Embolectomy: removing embolism Vena Cava filter: Stops future pe's

Question 28

Hemmorrhagic Stroke

Answer 28

Intracranial hemmorrhage Ruptured cerebral blood vessel Most fatal Types: Intracerebral Subarachnoid - Blood leaks into brain tissue

Question 29

Ischemic Stroke

Answer 29

Blood clot, stenosis TIA: mini stroke Thrombotic Stroke: 1/2 of all strokes - Occlusion of large vessel by thrombus Embolic Stroke: Blood clot or matter through cerebral vessels - Clot stops blood supply to an area of the brain

Question 30

Risk factors for Stroke

Answer 30

Clotting disorders History of Strokes, TIAS AV malformation: Thinned vessels Oral contraceptions Hypertension Smoking DM ( High glucose, lipid = plaque )

Question 31

Assessment CVA Left Cerebral Hem

Answer 31

Langauge, mathematic skills, analytic thinking - Expressive and receptive aphasia - Agnosia ( can't recognize familiar things ) - Alexia ( difficult reading ) - Agraphia ( writing difficulty )

Question 32

Right Cerebral Hem

Answer 32

Visual and spatial awareness and proprioception - Altered perception - Loss of depth - Poor impulse - Emotinal

Question 33

Diagnositc for Stroke

Answer 33

Non-contrast CT MRI MRA Lumbar puncture

Question 34

Interventions Stoke

Answer 34

Improve cerebral perfusion - Fibrinolytic Therapy - Endovascular Interventions Monitor Saftey Monitor for increased ICP Promote mobility: Early Rehab Speech Therapy Effective communication Assist w feeds Encourage independence Monitor bowels and bladder

Question 35

Surgical and Pham Interventions

Answer 35

- TpA : Tissue plasminogen activator (tPA) is classified as a serine protease (enzymes that cleave peptide bonds in proteins). It is thus one of the essential components of the dissolution of blood clots. - Intra- arterial thrombolysis - Cartoid endarterectomy - Extracranial intracrnial bypass - Cartoid angioplasty w stent