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Nursing 3910 > Week 7: Circulation and Tissue Perfusion > Flashcards

Week 7: Circulation and Tissue Perfusion Flashcards

1
Q

Interconnected Systems of the Heart

A
  • Structures
  • Electrophysiology – electrical conduction to create heartbeat
  • Vasculature – blood supply to heart muscle itself
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2
Q

Perfusion

A

flow of blood through circulatory system to oxygenate cells and remove rate

Poor perfusion results in cell death over time

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3
Q

Perfusion depends on:

A

Sufficient cardiac output

Sufficient blood pressure

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4
Q

Cardiac Output

A

amount of blood the heart is pumping
- Heart rate x stroke volume

  • Normal = 75 x 70 = 5250ml/min
  • Heart rate – electrical activity that pumps the heart
  • Stroke volume – volume of blood in the heart when it pumps

Influenced by:
o Nervous systems
o Fluid volume
o Heart muscle contraction
o Resistance in vessels (peripheral resistance) – resistance of the arteries to blood
flow

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5
Q

Blood Pressure

A

Cardiac output x peripheral resistance

Influenced by:
o Heart rate (contractility)
o Stoke volume (fluid, contraction, return, constriction)
o Blood viscosity
o Radius of vessel (constriction, atherosclerosis, blood volume)

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6
Q

P wave

A

activation of atria

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7
Q

QRS complex

A

activation of ventricles

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8
Q

T wave

A

recovery wave

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9
Q

Primary Causes of Problems with Perfusion

A
  • Vascular volume disorders – FVO, FVD
  • Electrical disorders – dysrhythmias
  • Mechanical disorders – cardiac myopathy, CHF
  • Coagulation disorders – blood clots (can lead to MI)
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10
Q

Modifiable risk factors for CV disease (co-morbidities)

A

HTN - damage to vessels over time

Obesity – increased demand on all body systems

Dyslipidemia – buildup blocks vessels and impacts flow

Diabetes – damage to vessels over time

Lifestyle – diet, exercise, smoking, alcohol

Sleep apnea – hypoxia (comp. causes damage)

Smoking – increase plaque formation

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11
Q

Non-modifiable risk factors: Cardiac /CV disease

A

Family history – increased risk for diagnosis in immediate family

Genetics – may modify cholesterol, heart structure, etc.

Gender – men more predisposed to CVD, women more predisposed to
stroke

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12
Q

Cardiac Physical exam RED flags

A

Changes in VS – compensation

Altered breath sounds – impaired movement through pulmonary vessels (CHF)

Restlessness, changing LOC – brain hypoxia

Changes in cardiac assessment – structures, electrophysiology,
vasculature

Fatigue – body systems not functioning

SOB – compensation for decreased oxygenation to body

Pain – tissue hypoxia (squeezing/racing palpations, SOB, nausea,
shoulder/jaw pain, anxiety, impending doom, fatigue, dizziness)

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13
Q

ACE Inhibitors

A

blocks the release of ACE, stopping the RAAS system, decreasing blood
pressure

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14
Q

ARBs

A

blocks the binding of Angiotensin II (RAAS system), stopping the vasoconstriction
of vessels, decreasing blood pressure

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15
Q

Beta blockers

A

blocks beta receptors (epinephrine + norepinephrine) binding,
decreasing contraction and heart rate

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16
Q

Calcium channel blockers

A

blocks calcium channels, stopping calcium from entering the
heart, decreasing contraction and heart rate

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17
Q

Hypertension

A

chronic condition where BP remains consistently elevated above set range

Causes stress to body systems, which causes damage

Compensation may occur in an attempt to lower blood pressure - chronic compensation
when body is unsuccessful in reducing BP, causes damage

Major risk factor for heart attack and stroke

18
Q

Categories of Hypertension

A

Patients without diabetes = +140/90

Patients with diabetes = +130/80 (comorbidity, body can handle less

19
Q

Primary Hypertension

A

No cause, 95%

20
Q

Secondary Hypertension

A

Identifiable cause, 5%
Causes: CKD, sleep apnea, pregnancy, NSAID use, alcoholism

21
Q

Non-modifiable risk factors: Hypertension

A

Family history
55+ men, 65+ women

Men are at higher risk

Genetics

SDOHs

22
Q

Modifiable risk factors: hypertension

A

Lifestyle – activity & diet (sedentary, sodium)

Alcohol
Smoking
Weight

23
Q

Physical exam: hypertension

A

Vitals – BP
Cardiac exam

Systems assessment for symptoms of HTN – Silent Killer (often asymptomatic!)
- Headache
- SOB
- Visual disturbances
- Chest pain
- Irregular rhythm
- Bounding pulse
- Nausea/vomiting

24
Q

Nursing Priorities for Hypertension

A

Monitor patterns

Diagnosis requires elevation over time

Response to treatment/lifestyle changes

  • Intake/Output

Interaction between BP and fluid balance

25
Lifestyle: hypertension
Reduce risk Eat – lots of fruits, vegetables, low-fat dairy products, low saturated fats (DASH DIET) Quit – smoking Moderate – alcohol Reduce - sodium intake, stress Maintain – health body weight Increase – exercise (at least 30min/day)
26
Pharmacological Interventions for Hypertension
ACE inhibitors ARBs Beta-blockers Calcium channel blockers Diuretics Hydralazine (vasodilator)
27
targets of therapy: hypertension
Lower peripheral resistance Lower cardiac output Reduce RAAS system & fluid volume
28
Why Treatment is not Working to Improve BP:
- Adherence - Unidentified/untreated associated condition (sleep apnea, alcoholism, pain, etc.) - Drug interactions (OTC supplements, NSAIDs, oral contraceptives) - White Coat HTN - Inappropriate treatment regimen
29
Hypertensive crisis
BP = +180/120 - Acute marked increase in BP - Emergency or urgent Signs & symptoms: Chest pain SOB Back pain Visual disturbances Cerebral edema Headache Urgent: Headache Nosebleeds Anxiety
30
hypertensive crisis: pharmacological treatment
Emergency – IV vasodilator Urgent – fast acting oral antihypertensive
31
Treating a Hypertensive Crisis
Notify provider - Assessment: VS monitoring (q 5mins) Systems assessment (organ damage) Blood work:  Urinalysis  Electrolytes (K, Mg, Cl, Na)  Kidney markers  Lipids  Blood sugars 12 lead ECG Intake/Output tracking Patient education: Bedrest Notify of change in symptoms Reduce stimuli
32
Nurse Management of Hypertensive Crisis
- Administer O2 (allows for perfusion) - Monitor BP frequently - Monitor cardiac, respiratory, and neuro frequently - Initiate IV access - Administer meds – IV antihypertensive - Assess cardiac monitor - Encourage bedrest and reduce stimuli
33
Atrial Fibrillation (AFIB)
irregular & often rapid heart rhythm caused by uncoordinated contraction of atrial muscles Arrhythmia/dysrhythmia - Significant increase in mortality Normal – atria fire synchronously to pump blood into ventricles A Fib – rapid, chaotic, and irregular contraction pattern of atria; caused by electrophysiological or structural changes of the atria tissues
34
ECG of A Fib
Rate – usually over 100 Rhythm – irregular P wave – non-existent PR interval – impossible to compute QRS complex – normal (ventricles, not atria, remains normal)
35
Causes of A Fib
HTN – chronic activation of compensation mechanisms causes structural and electrophysiological changes Diabetes – vascular changes Smoking – nicotine causes inflammation & oxidative stress Obesity – weight-related changes to structure Alcohol – triggers arrhythmias
36
Outcomes of A Fib
Rapid firing of atria – blood pooling, clot formation o TIAs o Ischemic stroke o MI o Pulmonaryembolism o Heartfailure - Also causes poor pumping, lower CO, poor perfusion
37
Health History: A Fib
Non-modifiable risks: o Family history o Age o Gender o Genetics o SDOH - Modifiable risks: o Lifestyle: activity (sedentary) diet, (sodium) o Alcohol consumption o Smoking o Weight - Other relevant data: o Comorbidities – HTN, hyperthyroidism, hypokalemia, hypomagnesia o Signs & symptoms
38
Physical Assessment: A Fib
- SOB - Exertion fatigue - Irregular, increased HR - Weak pulse - Palpations - Hypotension - Abnormal heart sounds - Chest pain
39
Nursing Priorities: A Fib
- Decrease risk of emboli – anticoagulation therapy - Rhythm control – manage arrythmia through medication - Health teaching – treatment/lifestyle modifications, health literacy, readiness for change, support system
40
Pharmacological Intervention: A Fib
Target – decrease HR, regulate rhythm, promote clot prevention Types: Calcium channel blockers Beta-blockers Cardiac glycoside (Digoxin) Oral anticoagulants
41
Acute Intervention: A Fib
- Transesophageal Echocardiogram (TEE) - Synchronized Cardioversion - Catheter ablation – tissue with irregular pulse is damaged

Nursing 3910 (12 decks)

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