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Amy Gualtieri

on 9 April 2014

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Transcript of Perfusion


What is Perfusion?
Perfusion is the process by which the cardiovascular and pulmonary systems work together to provide a continuous supply of oxygenated blood to every cell in the body.
The Nursing Process
in Perfusion

Heart Sounds
-First heart sound
-Produced by closure of the AV valves
-Characterized by "lub"
-AV valves close when ventricles have been filled
-Second heart sounds
-Produced by closure of the semilunar valves
-Characterized by "dub"
-Semilunar valves close when the ventricles have emptied their blood into the aorta and pulmonary arteries
-Third heart sound
-May be heard in children, young adults, or in pregnant females during the third trimester
-Termed a "ventricular gallop"
-Occurs when the AV valves open and blood flow into the ventricles causes vibrations
-Vibrations occur during diastole
-May also be heard in children, well-conditioned athletes, and even healthy older adults without cardiac disease
-Caused by atrial contraction and ejection of blood into the ventricles in late diastole
-S4 is heard before S1 and is termed an atrial gallop
*S3 and S4 may be associated with pathologic conditions such as myocardial infarction or heart failure

Congenital Heart Defects
Coronary Artery Disease
Deep Venous Thrombosis
Disseminated Intravascular Coagulation
Heart Failure
Life-Threatening Dysrhythmias
Peripheral Vascular Disease
Pregnancy-Induced Hypertension
Cardiomyopathy describes a diverse group of disorders that affect both systolic and diastolic functions.

Primary Cardiomyopathies- idiopathic

Secondary Cardiomyopathies- occur as a result of other processes, such as ischemia, infectious disease, exposure to toxins, connective tissue disorders, metabolic disorders, or nutritional deficiencies.
Defects in the heart or great vessels that result from an alteration in mormal fetal development or persistence of a fetal structure that does not convert to extrauterine anatomy after birth.
Defects are categorized by pathophysiology and hemodynamics:
-Defects increasing pulmonary blood flow
-Defects decreasing pulmonary blood flow
-Mixed defects
-Defects obstructing system blood flow
CAD is caused by impaired blood flow to the myocardium. Accumulation of atherosclerotic plaque in the coronary arteries is the usual cause. CAD may be asymptomatic, or it may lead to angina pectoris, acute coronary syndrome, MI, dysrhythmias, heart failure, and even sudden death.
A condition in which a blood clot forms on the wall of a vein, accompanied by inflammation of the vein wall and some degree of obstructed venous blood flow.
*An important nursing action is prevention of a DVT for the immobilized, postoperative, or postpartum patient.
A disruption of hemostasis chracterized by widespread intravascular clotting and bleeding. It can range from acute and life-threatening, or can be relatively mild.
A complex syndrome resulting from cardiac disorders that impair the ability of the ventricles to fill with and effectively pump blood. In heart failure, the heart is unable to pump enough blood to meet the metabolic demands of the body
Defined as a systolic blood pressure above 140 mmHg, or a diastolic blood pressure above 90 mmHg.
*A major risk factor for coronary artery disease, heart failure, stroke and renal failure despite the rarely noticed symptoms.
Dysrhythmias are abnormal heart rates or rythms; more specifically, a disturbance or irrularity in the electrical system of the heart.
-Decreased cardiac output
-Alterations in oxygenation
-Stasis of blood in the heart
-Sudden cardiac death
Pathological changes such as arteriosclerosis and atherosclerosis which impair the blood supply to peripheral tissues, particularly the lower extremities.
Hypertensive disorders affect 5-10% of pregnant women and are the most common medical complications in pregnancies.
Preeclampsia- an increase in blood pressure after 20 weeks of gestation accompanied by proteinuria
Eclampsia- generalized seizures and/ or coma can develop
Pulmonary Embolism
Debris (an embolus) can block a blood vessel, obstructing blood flow in part of the pulmonary vascular system.
* Medical Emergency
Sources of debris can include: blood, fat, clump of pathogens, tumors, bone marrow entering circulation as a result of trauma, amniotic fluid released into circulation during childbirth, intravenous injection of air
A clinical syndrome characterized by a systemic imbalance betwen oxygen supply and demand, which results in a state of inadequate blood flow to body organs and tissues, causing life-threatening cellular dysfunction.
A condition in which neurologic deficits result from a sudden decrease in blood flow to a localized area of the brain. Strokes may be ischemic (caused by emboli) or hemorrhagic (pooling of blood from bursted blood vessel in spaces surrounding neurons).
-Past medical history
-Current/Past medications
-Vital signs
-Apical/Radial/Peripheral Pulses
-Cardiac rate and rhythm
-Presence of chest pain (i.e. location,
quality, timing, setting, intensity,
aggravating and relieving factors,
associated symptoms)
-Sleep and rest
-Alcohol/drug use
-Smoking, include history
-Cultural beliefs

-Genetic considerations
-Family history
-Activity level/ Exercise
-Serum cholesterol, triglycerides, and lipids
-Stress/exercise tests
-X-ray, MRI, CT
-Transesophageal echocardiogram
-Cardiac catheterization with either coronary angiography or coronary arteriography
-Troponin, MB isoenzyme of creatine kinase
Possible Nursing Diagnoses for Patients with alterations in Perfusion:
-Ineffective tissue perfusion
-Impaired oxygenation
-Ineffective breathing pattern
-Fluid volume deficit (or excess)
-Risk for impaired skin integrity
Care should be directed toward promoting, maintaining or regaining the best possible cardiopulmonary function. The design for nursing action is to assess the situation and client for stressors. The nurse develops a plan of care and prioritizes interventions. Interventions usually fall into three categories:

-Inputs (arterial lines, venous lines, fluids, drugs, transfusions, and blood components.
-Outputs (suctioning with specialized equipment such as hemovacs and chest tubes and procedures such as thoracentesis.
-Pressure supports include dressings, direct compression, tourniquets, and cardiopulmonary resuscitation
The nurse should always assist in the evaluation of planned actions, report client responses, and assist in modifying the interventions as indicated.
-Assessing pulses
-Recording and interpreting ECG
-Administering CPR
-Achieving defibrillation
-Measure for and apply elastic compression stockings
-Fetal monitoring
-Applying sequential compression devices
-Applying continuous cardiorespiratory monitoring
-Obtaining capillary wedge pressures
-Measuring cardiac output
-Reading central and peripheral blood pressures
-Caring for the client with arterial pressure monitor
-Administer medications
Classes of Medications Used for
Alterations in Perfusion
Ace Inhibitors
Adrenergic Antagonists
Calcium-Channel Blockers
Phosphodiesterase Inhibitors
Interrelated Concepts
-Acid-Base Balance
-Cellular Regulation
-Fluids and Electrolytes
-Tissue Integrity
-Stress and Coping
-Addiction Behaviors
-Caring Interventions
-Teaching and Learning
North Carolina Board of Educators (eds) (2011). Nursing: A Concept Based Approach to Learning (MassBay Community College Custom Edition), Vol 2. Upper Saddle River: Pearson.
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