Chapter 16: Altered Perfusion

Hypertension

-Progressive cardiovascular syndrome detected by an evaluation in BP and/or presence of organ damage due to persistent BP elevation
-Primary: genetic or environmental
-Secondary: caused by systemic disease process

Hypertension Clinical Manifestations

Often asymptomatic (detect by screening)

Prehypertension

120-129/

Stage 1 Hypertension

130-139/80-89mmHg

Stage 2 Hypertension

>140/>90mmHg

Hypertensive crisis

>180 and/or >120mmHg

Shock

Circulatory failure and impaired perfusion of vital organs

Shock Ineffective Pumping

Cardiogenic

Shock Low Blood Volume

Hypovolemic

Shock Systemic Vasodilation

-Severe infection: septic
-Brain/spinal cord injury: neurogenic
-IgE ran: anaphylactic

Shock Treatment

Medical Emergency
ABCs

Shock Compensatory Mechanisms (temporary) Goals

1. Shunt blood to vital organs
2. Increase cardiac output

Myocardial Infarction

Occlusion of coronary arteries
-ischemia, cell death

Myocardial Infarction Treatment

-ABCs
-Quit smoking

Myocardial Infarction Diagnosis

Labs: Troponin

Myocardial Infarction Etiology

Atherosclerosis (Plaque) is most common

Heart Failure

-Inadequate pumping of heart
-Forward movement of blood is restricted
-Results in: Impaired cardiac functioning and excessive workload
-Left or right

Left Heart Failure

Pulmonary edema
-Systolic vs. Diastolic failure (HTN, DM, MI)

Right Heart Failure

Peripheral edema
-Restriction of blood flow to lungs

Heart Failure Treatment

Goal: Correct cause; improve quality of life

Stroke

-ACUTE neurologic injury
-Interruption of cerebral circulation/perfusion
-CVA (complete) vs. TIA (warning)
-Leads to inflammation, ischemia, neuron death

Stroke Diagnosis

Imaging: CT, MRI

Stroke Clinical Manifestations

F: Face drooping
A: Arm weakness
S: Speech difficulties
T: Time to call

Stroke Classification

Ischemia
-Thrombotic (atherosclerosis)
-Embolic (fragmented clot)
Hemorrhagic

Stroke Treatment

-Emergency
-Rehabilitaion

Disseminated Intravascular Coagulation (DIC)

Too much clotting -> no clotting
-Leads to massive hemorrhage

Disseminated Intravascular Coagulation (DIC) Etiology

Caused by any condition that leads to dysfunction of body's normal clotting process
-> tissue ischemia

Disseminated Intravascular Coagulation (DIC) Diagnosis

Labs: Prothrombin time

Disseminated Intravascular Coagulation (DIC) Treatment

Restore normal plasma levels