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Circulation BADNAP NPI

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Jennifer Brumley

on 30 May 2018

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Transcript of Circulation BADNAP NPI

NP1 2018

Inherent rate: 20-40
Cardiac Output (CO)
HR is the number of contractions/minute
SV is the amount of blood ejected with each contraction
Normal SV is approximately 70 mls
Normal CO is 4-8 liters/minute
HR 100 x SV 70 mls = 7 liters/min
Atherosclerosis
What Determines Stroke Volume?
Stroke Volume
Preload
Afterload
Contractility
Volume at end of diastole
blood volume
blood distribution
cardiac rhythm
medications (furosemide)
Pressure against systole
vascular resistance
temperature
shock states
medications (pressors)
Strength of contraction
electrolytes
myocardial damage
SNS stimulation
medications (inotropes)
Remember CO = heart rate x stroke volume
A patient is taking a newly prescribed antihypertensive and is experiencing orthostatic hypotension. A change in which component of cardiac output is most likely causing this side effect?

a. heart rate
b. preload
c. afterload
d. contractility
"hardening of the arteries"


1. Lipids or "fatty streaks" are deposited in arteries
2. Collagen covers the streaks and forms a fibrous plaque
3. Plaque grows and becomes unstable

Risk Factors

Nonmodifiable
age
gender
ethnicity
family history
genetics
Modifiable
HTN
tobacco use
physical inactivity
obesity
diabetes
elevated serum lipids
CO = heart rate (HR) x stroke volume (SV)
Circulation Objectives
Blood Pressure
Systolic blood pressure (SBP) <120 mmHg
Diastolic blood pressure(DBP) <80mmHg
Regulation of Blood Pressure
Age-related Circulatory Changes
Loss of elasticity in large arteries
Increased collagen in the myocardium
Increased peripheral vascular resistance
Decreased adrenergic receptor sensitivity
Blunted baroreceptor reflex
Decreased renal function
Decreased renin response to sodium and water depletion
Increase in SBP - DBP rises up to 55 then declines
Hypertension Etiology
Blood Pressure Measurement
Beta 1
and
Beta 2
Alpha 1
Blood pressure devices
automated
manual
arterial line
doppler
Pulse pressure
Mean arterial pressure (MAP)
Hypertension is defined as persistent
elevation of SBP 140 mmHg or above
and DBP 90 mmHg or above.
90-95% of all cases the cause is unknown

Age
Alcohol
Tobacco use
Diabetes mellitus
Hyperlipidemia
Excess sodium
Gender
Family history
Obesity
Ethnicity
Sedentary lifestyle
Socioeconomic status
Stress
Secondary to another disease or disorder
MAP = SBP + 2(DBP)
3
Hypertension Lifestyle Modifications
Weight reduction
weight loss of 22 lb may lower SBP 5-20 mmHg
DASH eating plan
Physical activity
moderate intensity activity 30 mins 5 days per week or
vigorous intensity 20 mins (or combination)
muscle-strengthening 2 times per week
Tobacco cessation
Sodium restriction
Stress management
What are some complications of atherosclerosis?
Venous Thromboembolism (VTE)
PAD Assessment
Intermittent claudication (classic) but only 10% experience
ischemic muscle pain during exercise, resolves with rest
lactic acid due to anaerobic metabolism
occurs in buttocks and thighs for iliac arteries
occurs in calf for femoral or popliteal arteries
Thin, shiny, taut skin with hair loss
Dependent rubor and elevation pallor
Raynaud's and Buerger's Disease
Ankle-brachial index (ABI)
Segmental blood pressures
PAD Etiology
"6 Ps"
Pain
Pallor
Pulselessness
Parathesia
Paralysis
Poikilothermia
VTE Prevention
Hyperlipidemia: Interventions
Diet and exercise
Statins
inhibit synthesis of cholesterol in liver
decrease LDL and increase HDL
take at night for increased effectiveness
side effects: GI upset, HA
must report muscle aches/weekness d/t risk of rhabdomyolysis
atorvastatin pravastatin simevastatin
Goal!
Sequential compression devices (SCDs)
Compression hose (TEDs)
Early mobilization
Anticoagulants
heparin
warfarin
Antiplatelets
aspirin
clopidogrel


Atherosclerosis
Family history
Hyperlipidemia
Elevated C-reactive protein
Uncontrolled HTN
Tobacco use
Age
Obesity
Sedentary lifestyle
Stress
Hypertriglyceridemia
*Table 38-3 page 836 lists interpretation
Varicose Veins Interventions
Prevention
avoid sitting or standing for long periods
avoid restrictive clothing
control weight
walk daily
Post-procedure
elastic compression hose
deep breathing
leg elevation to reduce swelling
Renal system
Endocrine system
Vascular endothelium
Autonomic nervous system
baroreceptors
Prehypertension is defined as
a SBP of 120-139 mmHg or
DBP of 80-89 mmHg.
Questions?
A & P review
Factors that affect circulation
Assessment
Diagnostic testing
Client-centered plan
Effects of age and/or diversity
Health promotion and teaching
Legal and ethical nursing responsibilities



Venous Stasis
Venous Stasis
Pulse Pressure = SBP - DBP
Electrical System of the Heart
Electrical Tracing of the Heart
Electrocardiogram (ECG)
Cardiac Monitor
Circualtory Assessment
Patient History
Diagnosis
Measurements of function
Past impairments
Family history
Lifestyle factors
Medications and supplements
Circulatory Assessment
Vital Signs
BP SBP <120 DBP <80 mmHg
MAP >60 mmHg
HR 60-100 beats/min
RR 12-20 breaths/min*
SaO2 95 - 100%
Temp 96.8 - 100.4 F
Circulatory Assessment
Inspection
General appearance
Skin color, temperature, turgor, texture
Hair distribution
Ulcers
Edema
Mucous membranes
Capillary refill
Venous distention

Circulatory Assessment

Palpation
Pulses
0 = absent
1+ = weak
2+ = normal
3+ = full, bounding
Circulatory Assessment

Palpation
Pitting edema
0 = absent
1+ = mild
2+ = moderate
3+ = moderately severe
4+ = severe
Occurs when valves are dysfunctional or the muscles of the extremities are inactive.
Venous Stasis

Risk factors
Obesity
Advanced age
Pregnancy
Chronic heart failure
Atrial fibrillation
Travel
Surgical procedures
Immobility
Varicose veins
Risk for Venous Thromboembolism
(VTE)
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Chronic venous insufficiency (CVI)
edema, eczema
lower leg becomes leathery, "brawny"
venous leg ulcers
Interventions
compression
balanced diet
woundcare
avoid prolonged dependent positions

Ischemia
Inadequate blood blow (and thereby oxygen) to an area of the body due to vessel blockage or stenosis
Circulatory Assessment
*Poikilothermia - the 6th P
Auscultation
S1 S2
Valves
Murmurs
Extra heart sounds

Circulation
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