Perfusion Exemplars

What factors influence blood pressure?

cardiac output and peripheral resistance

When is the RAAS activated?

when baroreceptors note the blood pressure is low

Hypertension

high blood pressure (140/90+); often called the silent killer

What are some S+S of HTN?

asymptomatic, headache, dizziness, epistaxis, blurred vision

Primary HTN

no known cause

Secondary HTN

due to another disease process (kidney disease, COA, endocrine disorders, neuro disorders, drug use, pregnancy, sleep apnea

How does HTN affect the body?

strain on the heart, permanent damage and remodeling of the vessels and heart, heart failure, MI, CVA, kidney injury

What are some prevention or management options for HTN?

healthy weight, DASH diet, exercise, stress management, smoking and alcohol cessation, regular monitoring, adherence to treatment plan

Which drug classes are used to treat HTN?

ace inhibitors, arbs, CCB, BB, vasodilators, diuretics

Hypotension

low blood pressure (90/60 or less)

Orthostatic Hypotension

decrease in blood pressure upon changing position (laying to sitting, sitting to standing)

What are some consequences of severe and prolonged hypotension?

shock, death

What are some causes of hypotension?

hypovolemia, medications, heart conditions, hormonal imbalances, sepsis

Cerebral Vascular Accident

stroke; sudden decrease in perfusion to a localized area of the brain

Thrombotic Stroke

ischemic stroke which occurs due to occlusion of large vessels by a thrombus

When are thrombotic strokes likely to occur?

at night due to lower blood pressure

Embolic Stroke

ischemic stroke which occurs due to a clot traveling to the cerebral vessels

When does an embolic stroke typically occur?

during more strenuous activity

Hemorrhagic Stroke

occur when blood vessels break due to the rupture of a plaque or aneurysm, or due to trauma erosion of a vessel, leading to bleeding in the brain

Transient Ischemic Attack

mini stroke; damage is usually not permanent and resolves within 24 hours

What is significant about a TIA?

more likely to have a CVA thereafter

Penumbra

functionally impaired, but still viable tissue which surrounds the core of ischemia

What is the leading cause of stroke?

hypertension

FAST

face, arms, speech, time

Time equals _______.

tissue

What are the S+S of stroke dependent on?

dependent on the area of the brain that is affected

Manifestations of Stroke (Brainstem)

breathing, temperature, swallowing concerns

Manifestations of Stroke (Frontal Lobe)

reasoning, judgement, speech, voluntary movement concerns

Expressive Aphasia

unable to form words (broca-en speech)

Receptive Aphasia

unable to comprehend words (werincke, what)

Dysarthria

defect in the muscular control of speech

Manifestations of Stroke (Cerebellum)

weakness, spasticity, paralysis concerns

Hemiparesis

weakness on one side

Hemiplegia

paralysis on one side

What is the significance of one-sided effects in stroke?

will often occur on the opposite side of the stroke

Pronator Drift

involuntary pronation and lowering of forearm when outstretched and supine

Homonymous Hemianopsia

loss of half the visual field (which will often lead to one-sided neglect)

Diplopia

double vision

What are some emergent treatment options for stroke?

CT scan, alteplase, thrombectomy

What is a CT scan looking for in stroke?

hemorrhage

What is important to remember about the timing of stroke treatment?

after about 4 hours, patients are no longer eligible for clot busters

What are some longer term treatment options following a stroke?

anticoagulants, antihypertensives, statins

What are two common anticoagulants?

warfarin, heparin

What lab value is significant with warfarin?

PT/INR

What lab value is significant with heparin?

aPTT

Normal PT/INR

10-13 seconds; 1 second

Therapeutic INR

2-3 seconds

Normal aPTT

20-35 seconds

Therapeutic aPTT

60-80 seconds

PT/INR

prothrombin time/international normalized ratio

aPTT

activated partial thromboplastin time

Ventral Septal Defect (VSD)

defect in the membranes or muscular portion of the ventricular septum

Heart Failure

the heart fails to pump as well as it should which causes blood and fluid to accumulate

Systolic Heart Failure

heart cannot pump with enough force (muscles are too small)

Diastolic Heart Failure

heart cannot fill with enough blood (muscles are too big)

How does VSD affect weight?

weight loss

How does HF affect weight?

weight gain

LS Heart Failure causes _______ edema.

pulmonary

RS Heart Failure causes _______ edema.

peripheral

How does the heart compensate during HF?

squeezes harder, or squeezes faster

What is the significance of compensation in HF?

eventually leads to a worsened condition

Coarctation of the Aorta (COA)

obstructive issue in the aorta near the ductus arteriosis

How do pulses and BP differ in COA?

upper extremities will have a higher HR and a higher BP

How does digoxin help to treat HF?

improves cardiac efficiency by slowing the HR and increasing contractility

What medication is often used to treat edema related to HF?

diuretics (lasix)