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Sem 1 Theory > Perfusion > Flashcards

Perfusion Flashcards

1
Q

What is perfusion?

A

the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells

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2
Q

What does perfusion require?

A

Perfusion requires the heart to generate sufficient cardiac output to transport blood through patent blood vessels for distribution in tissues throughout the body

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3
Q

What is the scope of perfusion?

A

Perfusion ranges from optimal perfusion to no perfusion

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4
Q

Changes in perfusion can be…

A

temporary, long-term, or permanent

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5
Q

Type of disorder that leads to changes in perfusion include:

A

acute conditions (MI, stroke, or shock) and chronic disorders (hypertension, heart failure, sickle cell, or hemophilia)

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6
Q

Conditions that specifically involve perfusion include:

A

neurologic (affecting vessels in the brain)

pulmonary (impaired blood flow to and from the lungs)

cardiovascular (interfering blood flow in the heart, arteries, and veins)

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7
Q

What are the causes of disorders related to perfusion?

A

congenital defects, genetic disorders, injury, inflammation, and infections

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8
Q

What does central perfusion require?

A

adequate cardiac function, blood pressure, and blood volume

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9
Q

What is cardiac output?

A

the amount of blood pumped by the heart each minute

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10
Q

What is systole?

A

phase of the cardiac where the ventricles contract

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11
Q

Central perfusion propels blood to all organs & tissues from patent _____ through ____ and returns the blood to the heart through patents ____

A

Central perfusion propels blood to all organs & tissues from patent arteries through capillaries and returns the blood to the heart through patent veins

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12
Q

When does central perfusion begin?

A

heart is stimulated by an electrical impulse that originates in the sinoatrial (SA) node and travels to the atrioventricular (AV) node

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13
Q

What is diastole?

A

the phase of the cardiac cycle when ventricles fill with blood

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14
Q

What is the normal cardiac output range?

A

4 to 6 L/min in the adult

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15
Q

What are two variables that influence cardiac output?

A

stroke volume and heart rate influence cardiac output

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16
Q

What is stroke volume?

A

the amount of blood ejected from each ventricle during contraction

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17
Q

What affects stroke volume?

A

preload and contractility affect stroke volume

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18
Q

What is preload?

A

amount of blood in the ventricles at the end of diastole aka diastolic pressure

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19
Q

What is contractility?

A

strength of myocardial contraction; greater the volume of blood in the ventricles (preload), greater the stretch of the myocardium & stronger the myocardial contraction

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20
Q

Cardiac output (CO) formula =

A

stroke volume x heart rate; normal range is 4-6L/ per minute in the adult

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21
Q

What is after load?

A

force the ventricles must exert to open the semilunar valves (aortic and pulmonic); influenced by systemic vascular resistance (SVR)

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22
Q

What is systemic vascular resistance?

A

resistance to the ejected blood created by the diameter of blood vessels receiving the blood

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23
Q

The smaller or more constricted the blood vessels, the …..

A

greater the pressure required to open the semilunar valves to eject the blood, increasing the heart’s workload (e.g. hypertension)

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24
Q

The larger or more dilated blood vessels, the…

A

less pressure required to eject the blood; reducing the workload on the heart

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25
Q

sympathetic nervous system ____ the heart rate, while the parasympathetic ____ the heart rate

A

sympathetic nervous system INCREASES the heart rate

the parasympathetic DECREASES the heart rate

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26
Q

What is tissue perfusion?

A

blood flow through arteries and capillaries to target tissues

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27
Q

What does tissue perfusion require?

A

patent vessels, adequate hydrostatic pressure, and capillary permeability

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28
Q

Lifespan considerations for infants

A

in infancy, the size of the heart in relation to the total body size is LARGER

systolic blood pressure after birth is low due to the weaker left ventricle of the neonate; develops strength and pressure rises during the first six weeks

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29
Q

Lifespan considerations for older adults

A

stiffening & thickening of the myocardial. tissue and decreased elasticity of arterial walls (age related)

these can lead to reduced cardiac efficiency (stroke volume & cardiac output); thus increasing oxygen demand

arterial stiffening causes increase in blood pressure

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30
Q

Older adults (population) risk factors

A

blood flow, stroke volume, cardiac output, and elasticity of arteries DECREASE

risk for heart failure, stiffening/thickening of heart tissues INCREASE

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31
Q

Social and environmental risk (population) factors

A

low family income, low educational level, access to health care, medical compliance, eating habits, depression, and stress

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32
Q

What populations have the highest risk for heart disease?

A

older adults, low income/educational level

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33
Q

Genetic risk (individual) factors

A

familial hypercholesterolemia, CAD, HF, diabetes, certain arrhythmias, hemophilia A&B, hemoglobinopathies (sickle cell)

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34
Q

Lifestyle (individual) risk factors

A

smoking, inactivity, unhealthy diet, obesity

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35
Q

Baseline history for perfusion

A

present health status, past health history, family history, person & psychosocial history (diet, exercise, smoking), medications or recreational drugs

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36
Q

Problem based history for perfusion

A

pain, fainting (syncope), dizziness, SOB (dyspnea), swelling (edema), bleeding or fatigue

37
Q

What to include in assessment of symptoms?

A

location, duration, severity, description of symptoms, factors that alleviate or aggravate symptoms, and actions taken by patient

38
Q

Examination findings include..

A

vital signs, inspection, palpation, auscultation

39
Q

Primary prevention for perfusion:

A

promote health & prevent disease of heart & peripheral vascular health, including abnormal clotting and bleeding

healthy diet, physical activity, refrain from smoking, maintained blood pressure & weight

40
Q

Secondary prevention

A

blood pressure and lipid screenings

41
Q

Periods of confusion may be related to…

A

mini-strokes or transient ischemic attacks

42
Q

in women, fatigue is…

A

an atypical symptom of MI

43
Q

Perfusion removes ____ ; does not prevent _____, increase _____, or increase _____

A

Perfusion helps to remove waste products

Perfusion does NOT prevent clots, increase cardiac output, or increase mental alertness

44
Q

Exercise in a cardiac rehab program is important because….

A

exercise increases flexibility, cardiac output, muscle mass, and blood flow through the arteries

45
Q

Infarction is the actual ____ of the tissue with an _____ to regenerate

therefore, an MI is ____ of myocardial tissue

A

Infarction is the actual DEATH of the tissue with an INABILITY to regenerate

therefore, an MI is DEATH of myocardial (heart) tissue

46
Q

Impaired central perfusion occurs when…

A

cardiac output is inadequate because it decreases the oxygenated blood reaching the bodily tissues (systemic effect)

47
Q

Impaired central perfusion leads to…

A

ischemia, cell injury, and cell death

48
Q

Most common subjective reported symptoms associated with impaired perfusion includes…

A

fatigue, SOB, pain

49
Q

Most common clinical reported symptoms associated with impaired CENTRAL perfusion includes…

A

reduced cognition, anxiety, diaphoresis, increased respiratory rate

50
Q

Most common clinical reported symptoms associated with impaired LOCAL perfusion includes…

A

reduced or absent pulse, cool or cold extremity, discoloration

51
Q

Impaired tissue perfusion

A

reduced amount of blood or no blood reaching tissues; can lead to ischemia and cell death

52
Q

Signs of impaired tissue in children and infants…

A

poor feeding, poor weight gain, failure to thrive, dusky skin color

53
Q

Signs of impaired tissue in children and toddlers…

A

squatting (increases blood flow to the lungs) and fatigue

can also cause developmental delay (failure to meet milestones)

54
Q

ECG waves are labelled as PQRST which stand for:

A

P wave: depolarization of atria

P-R internal: from beginning of P wave to beginning of QRS complex (aka time needed for atrial depolarization + time for impulses to travel through AV node to ventricles)

QRS complex: depolarization of ventricles

T wave: repolarization of ventricles electrical events slight preced mechanical events in heart

55
Q

What is ischemia?

A

reversible cellular injury that occurs when the demand for oxygen exceeds supply due to a reduction or cessation in blood flow

56
Q

What is infarction?

A

actual death of tissues with an inability to regenerate

e.g., myocardial infarction is the death of heart tissue

57
Q

The amount of blood pumped by the heart each minute generates…

A

cardiac output

58
Q

The flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells is called….

A

Perfusion

59
Q

Tissue/Local Perfusion is supplied by…

A

blood flowing from arteries to capillaries

60
Q

What requires adequate cardiac function, blood pressure, and blood volume?

A

Central perfusion

61
Q

What requires patent vessels, adequate hydrostatic pressure, and capillary permeability?

A

Tissue/Local Perfusion

62
Q

First step of blood flow through the heart

A

right atrium receives venous blood from inferior/superior vena cave & coronary sinus

travels through the tricuspid valve into the right ventricle

63
Q

Second step of blood flow through the heart

A

each contraction causes the right ventricle to pump blood through the pulmonic valve into the pulmonary artery and to the lungs

64
Q

Third step of blood flow through the heart

A

oxygenated blood flows from lungs the left atrium via the pulmonary veins

65
Q

Fourth step of blood flow through the heart

A

oxygenated blood passes through the mitral valve and into the left ventricle

66
Q

Fifth step of blood flow through the heart

A

As the heart contracts, blood is ejected through the aortic valve into the aorta and thus enters the systemic circulation

67
Q

The mitral valve is the tissue between ____ atrium & ____ ventricle

A

mitral valve is the gate between left atrium and left ventricle

68
Q

The aortic valve…

A

pushes blood from the left ventricle into the aorta to be transported to the rest of the body (systemic circulation)

69
Q

Chordae tendinae is the…

A

fibrous connective tissue commonly called the “heart strings”

70
Q

Pulmonic valve is located…

A

between right ventricle & pulmonary artery

71
Q

Aortic valve is located…

A

between left ventricle & the aorta

72
Q

If you don’t have good conduction…

A

the ventricles won’t contract

73
Q

Relative refractory period

A

heart muscle recovers excitability

74
Q

Absolute refractory period

A

heart muscle does not respond to any stimuli

75
Q

Re-polarization

A

contractile and conduction pathway cells regain resting polarized condition

76
Q

How does the conduction system travel?

A

begins in SA node –> interatrial pathways –> AV node –> intermodal pathways –> bundle of His –> left & right bundle branches –> Purkinje fibers to ventricular contraction

77
Q

Systole vs Diastole

A

systole = contraction of heart muscle (eject blood from ventricles)

diastole = relaxation of heart muscle (ventricles fill with blood)

78
Q

Hypovolemia

A

very low volume of blood that leads to decreased blood pressure

79
Q

Blood pressure is the…

A

Cardiac output x Systemic Vascular Resistance (SVR)

80
Q

Systemic vascular resistance is the…

A

force opposing movement of blood

81
Q

If a blood pressure cuff size is too large…

A

blood pressure shows a lower blood pressure, making the reading inaccurate

82
Q

If a blood pressure cuff size is too small…

A

blood pressure shows a high blood pressure, making the reading inaccurate

83
Q

Pulse pressure is the…

A

difference between systolic BP & diastolic BP

84
Q

Mean arterial pressure is the…

A

average pressure within the arterial system

MAP = (SBP + 2 DBP) divided by 3

needs to be greater than 60 mm HG to perfuse vital organs

85
Q

At what age should blood pressure screening begin?

A

beginning in infancy, BP screening is recommended at every-well child visit and at least annually

adult screening is recommended for every 2 years when BP is below 120/80 mm Hg

adult screening is recommended for every year if BP is between 120/80 mmHg or 139/90 mm Hg

86
Q

How often should blood pressure screening occur?

A
87
Q

Who should have lipid screening? How often?

A

for at risk men and women, lipid screening should be started at 20 years of age

men without risk are recommended lipid screening beginning at 35 years of age

women without risk are recommended lipid screening beginning at 45 years of age

no optimal frequency has been established

88
Q

George Jones is a 59-year-old male who went to the emergency department with chest pain. He had experienced this chest pain for 30 minutes and it was not relieved after taking three nitroglycerin tablets 5 minutes apart. He reports the pain feels like “an elephant sitting on my chest. “He is diaphoretic and appears anxious. His vital signs are temperature 99° F, blood pressure 100/68 mm Hg, heart rate 110 beats/min, and respiratory rate 24 breaths/min. Mr. Jones is overweight and has type 2 diabetes mellitus, hyperlipidemia, and hypertension. He quit smoking last year after a 40- year history of one pack of cigarettes a day.. The nurse administers oxygen and draws blood for arterial blood gas analysis. A cardiac catheterization revealed a 90% blockage in one coronary artery. The cardiologist performed a balloon angioplasty and placed a stent in Mr. Jones’ blocked coronary artery to reestablish perfusion. Mr. Jones was admitted to the cardiovascular surgery unit and was ambulating within 24 hours after stent placement.

Develop a nursing care plan for perfusion

A

The nurse’s goals for Mr. Jones’ plan of care are to maintain effective cardiac output, control pain, relieve anxiety, and balance physical activity with energy-conserving activities. The nurse also played a significant role in Mr. Jones’ therapy by teaching him and his family about lifestyle changes, including diet and exercise, and the purpose of his prescribed medications, including adverse effects and the importance of following the medication regimen. Mr. Jones is referred for cardiac rehabilitation after discharge.

89
Q

George Jones is a 59-year-old male who went to the emergency department with chest pain. He had experienced this chest pain for 30 minutes and it was not relieved after taking three nitroglycerin tablets 5 minutes apart. He reports the pain feels like “an elephant sitting on my chest. “He is diaphoretic and appears anxious. His vital signs are temperature 99° F, blood pressure 100/68 mm Hg, heart rate 110 beats/min, and respiratory rate 24 breaths/min. Mr. Jones is overweight and has type 2 diabetes mellitus, hyperlipidemia, and hypertension. He quit smoking last year after a 40- year history of one pack of cigarettes a day.. The nurse administers oxygen and draws blood for arterial blood gas analysis. A cardiac catheterization revealed a 90% blockage in one coronary artery. The cardiologist performed a balloon angioplasty and placed a stent in Mr. Jones’ blocked coronary artery to reestablish perfusion. Mr. Jones was admitted to the cardiovascular surgery unit and was ambulating within 24 hours after stent placement.

What individual risk factors & heath conditions put him at risk?

A

type 2 diabetes, hyperlipidemia, hypertension, being overweight, and smoking

Sem 1 Theory (12 decks)

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