Perfusion Part 1
Page 1: Introduction to Perfusion
Title: Perfusion
Contact for questions: Carolahicks@abtech.edu
Page 2: Objectives of the Session
Discuss nursing interventions to promote or improve perfusion.
Define and discuss common disorders of the cardiovascular system.
Discuss diagnostic tests to evaluate perfusion.
Discuss common alterations in perfusion across the lifespan.
Review anatomy & physiology of the cardiovascular system.
Page 3: Essential Functions of the Cardiovascular System
Perfusion is the process of oxygenated capillary blood passing through tissues.
Supplies oxygenated blood to the body.
Affects all body functions and systems, especially oxygenation.
Page 4: Cardiovascular & Respiratory Physiology
Blood flow process:
Deoxygenated blood enters the right atrium from veins.
Blood moves to the right ventricle, then to the lungs via the pulmonary artery.
Oxygenated blood returns to the left atrium and pumps to the body via the aorta.
Page 5: Heart Anatomy
Layers of the Heart:
Pericardium, Epicardium, Myocardium, Endocardium.
Chambers of the Heart and Valves:
Includes AV valves and Semilunar valves.
Page 6: Conduction System of the Heart
Key Components:
Sinoatrial node (pacemaker).
Atrioventricular node.
Atrioventricular bundle (bundle of His).
Right & Left bundle branch.
Purkinje fibers.
Page 7: Heart Valves
Overview of heart valves: Tricuspid valve, Pulmonary valve, Aortic valve, Mitral valve with descriptions of their open and closed states.
Page 8: Cardiac Cycle
Definition: Contraction (Systole) and Relaxation (Diastole) of the heart comprise one heartbeat.
Normal heart rate: 70-80 beats per minute.
Page 9: Heart as a Pump
Pulmonary Circulation: Low-pressure system to lungs.
Systemic Circulation: High-pressure system to the body.
Coronary Circulation: Blood supply specifically to the heart.
Page 10: Stroke Volume (SV)
Calculation: SV = End-diastolic volume - End-systolic volume.
Average SV per heartbeat: 60-100 ml.
Influenced by preload, afterload, and contractility.
Page 11: Heart Rate Regulation
Autonomic Nervous System's effects:
Sympathetic: Increases heart rate.
Parasympathetic: Slows heart rate.
Impact of heart rate changes on cardiac output (CO).
Page 12: Cardiac Output (CO)
Calculation: CO = Stroke Volume (SV) x Heart Rate (HR).
Example calculation: SV = 80ml, HR = 80 bpm -> CO = 6400 ml/min.
Page 13: Average Adult CO
Normal range: 4-8 L/min.
Poor CO impacts tissue perfusion, leading to ischemia and necrosis.
Page 14: Preload and Afterload
Preload: Volume of blood in ventricles at end-diastole.
Increased preload causes:
Hypervolemia.
Regurgitation of cardiac valves.
Heart Failure.
Afterload: Resistance faced by the left ventricle.
Increased afterload causes higher cardiac workload.
Page 15: Preload Details
Starling’s Law: Greater volume leads to greater stretch and contraction force.
Effects of volume variations on cardiac contraction.
Page 16: Afterload Details
Definitions of pulmonary vascular resistance (low pressure) and systemic vascular resistance (high pressure).
Page 17: Contractility
Definition: Strength of heart muscle contraction.
Poor contractility leads to decreased CO and increased ventricular pressures.
Page 18: Cardiac Output in Hypovolemic Shock
Understanding IV fluid impact on cardiac output.
Page 19: Quiz on Stroke Volume Influence
Factors influencing stroke volume include:
Heart Rate
Preload
Contractility
Afterload
Blood pressure.
Page 20: Clinical Indicators of Cardiac Output
Changes in organ function as indicators:
Brain: mental status changes.
Kidneys: decreased urine output.
Skin: temperature, color, integrity issues.
Cardiac Index: CO adjusted for body size (normal: 2.5-4.2L/min/m²).
Page 21: Ejection Fraction (EF)
Calculation: EF = Stroke Volume / End-Diastolic Volume.
Normal EF range: 50-70%.
Page 22: Percent of Blood Pumped Out
Normal Flow: 55%-70%.
Restricted Flow: 40%-50% risk for heart failure if <40%.
Page 23: Categories of Perfusion
Central Perfusion defined by cardiac output, requiring adequate heart function, blood pressure, and volume.
Tissue (Local) Perfusion defined by blood flow to specific tissues, requiring patent vessels and adequate pressure.
Page 24: Normal vs. Impaired Perfusion
Differences between central and tissue perfusion measurements.
Page 25: Symptoms of Impaired Perfusion
Central Symptoms:
Hypotension, Tachycardia, extra heart sounds, shock indicators.
Local Symptoms:
Mentation changes, skin temperature and color changes, absent pulses.
Page 26: Definitions Related to Ischemia and Hypoxia
Ischemia: Insufficient blood flow.
Hypoxia: Reduced oxygen leading to cellular injury and potential infarction.
Anoxia: Total lack of oxygen resulting in cell death.
Page 27: Congenital Heart Disease Development
Focus on infants, children, and pregnancy considerations.
Page 28: Impaired Perfusion Risk Factors
Demographics: Middle to older adults, male prevalence pre-64, women greater post-64.
Conditions: Atherosclerosis, diabetes, obesity, etc.
Page 29: Fetal Circulation Overview
Description of blood flow in fetal circulation and reliance on the placenta.
Page 30: Transition from Fetal to Pulmonary Circulation
Changes after the first breath that re-direct blood flow to the lungs.
Page 31: Vital Signs Across Lifespan
Variations in ranges for neonates, infants, adolescents, adults, and older adults.
Page 32: Infants and Perfusion Factors
Characteristics of infant heart rates and factors affecting their perfusion.
Page 33: Children’s Cardiovascular Response
Changes in heart rate and blood pressure with age, need for urgent interventions during hypoxemia.
Page 34: Nursing Intervention in Children
Effective interventions to reduce cardiac demands.
Page 35: Alterations in Cardiac Function in Children
Congenital defects, infections, murmurs, heart failure.
Page 36: Changes During Pregnancy
Increases in cardiac output, heart rate, and blood volume; complications such as supine hypotensive syndrome.
Page 37: Cardiovascular Aging Changes
Implications of myocardial hypertrophy, arrhythmias, and other age-related changes.
Page 38: Aging Effects on the Heart
Summary of decreased efficiency and increased blood pressure and flow issues.
Page 39: Effects of Aging on the Heart
Age-related changes that affect functional capacity during exercise.
Page 40: Vascular System Aging Effects
Lipid deposits, calcification, and conditions such as PVD and PAD.
Page 41: Vascular Risks
Underdiagnosed vascular problems, with major risk factors identified.
Page 42: Renal System Changes
Decreased renal perfusion implications for medication clearance and sodium regulation.
Page 43: General Assessment Findings of Heart Failure
Common symptoms include chest pain, SOB, fatigue, syncope.
Page 44: Nonmodifiable Risk Factors for CAD
Includes age, gender, ethnicity, and family history, as well as genetic predisposition.
Page 45: Modifiable Risk Factors for CAD
Includes hypertension, tobacco use, physical inactivity, and obesity.
Page 46: Cardiac Function Diagnostic Tests
Methods to assess cardiac function and perfusion status.
Page 47: Common Perfusion Labs
Key lab evaluations to assess cardiac enzymes, blood coagulability, and metabolic markers.
Page 48: Basic Metabolic Panel (BMP)
Vital electrolyte and kidney function ranges presented.
Page 49: Cardiac Monitoring Techniques
Examples of diagnostic tests such as ECG and heart catheterization explained.
Page 50: Echocardiography Techniques
Types of echocardiography and their indications.
Page 51: Indications for 2D Echocardiograms
Specific circumstances for conducting echocardiograms.
Page 52: Pharmacotherapy for Heart Conditions
Overview of various medication classes used for treatment including vasodilators, diuretics, and anticoagulants.
Page 53: Conclusion
Open for Questions: Carolahicks@abtech.edu.