Perfusion_

Perfusion

Learning Outcomes

• Identify the key components of the cardiovascular system in maintaining an adequate supply of nutrients and oxygen to the cells.

• Identify risk factors that potentially affect the cardiovascular system.

• Demonstrate skill competencies that evaluate tissue perfusion.

• Describe common physical assessment techniques used to evaluate cardiovascular health for the adult and the aging population.

• Identify normal parameters for cardiovascular assessment.

• Apply the nursing process in providing care to patients with alterations in perfusion.

• List common nursing diagnoses related to alterations in perfusion.

• Discuss basic nursing interventions to support and maintain effective perfusion in the adult patient.

Definition

• Perfusion: Refers to the cardiovascular system's ability to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.

• Indicates the passage of fluid through specific organs or areas of the body.

Cardiovascular Physiology

Heart Structure

• The heart is composed of:

  • Four chambers

  • Valves

• Functions include:

  • Pumps blood out to the body and receives blood back.

Blood Vessels & Cardiac Cycle

Types of Blood Vessels

• Arteries: Carry blood away from the heart to the body, delivering oxygen and nutrients.

• Veins: Carry blood back to the heart, aided by valves, gravity, and muscle contractions.

• Blood is typically not oxygenated except for the pulmonary vein.

Cardiac Cycle

• The cardiac cycle consists of:

  • Systole: Ventricle contracts, causing AV valves to close – "LUB"

  • Diastole: Ventricle relaxes, causing SL valves to close – "DUB"

Cardiac Output

• Cardiac Output: Normal is 4-8 L/min.

  • Defined as the amount of blood pumped from the left ventricle per minute.

• Stroke Volume (SV): Volume of blood ejected from the ventricle with each contraction (normal range: 50-75 mL).

• Cardiac Output formula: CO = SV x HR

• Preload: End diastolic volume.

• Afterload: Resistance to left ventricular ejection.

• Myocardial contractility: Force of cardiac contraction; ability of muscles to shorten.

Conduction System

• The heart's rhythmic contraction and relaxation depend on:

  • The organized transmission of electrical impulses generated by the SA node (60-100 beats per minute).

• Electrocardiogram (ECG): Measures the electrical activity of the conduction system, assessing for Normal Sinus Rhythm (NSR).

Pulse & Characteristics

• The pulse is created when the heart contracts, generating a wave of blood.

Assessment Techniques

• Rate

• Rhythm

• Strength/Volume/Amplitude

• Symmetry

• Pulse deficit (difference between heart rate and pulse rate).

Alterations in Cardiac Function

• Conditions that may affect:

  • Cardiac rhythm and strength of contractions.

  • Blood flow through the heart and peripheral circulation.

• Compliance: The ability of arteries to expand and contract.

• Vascular Resistance: Combination of arteriole restriction and blood viscosity.

• Older Adults:

  • Valve stiffening.

  • Increased left ventricular wall thickness.

  • Chronic heart disease.

Blood Pressure

Definition and Terms

• Blood Pressure (BP): Force exerted by blood on arterial walls, indicating cardiac health.

• Systolic BP: Maximum pressure during ventricular ejection.

• Diastolic BP: Minimum pressure during ventricular relaxation.

• Pulse Pressure (PP): Difference between systolic and diastolic BP (SBP - DBP).

Normal Blood Pressure

• Normal BP is around 120/80 mmHg.

• Patterns indicating health issues:

  • Wide PP (>50-60 mmHg): potential heart or kidney problems.

  • Narrow PP (<30 mmHg): early signs of sepsis, bleeding, or heart failure.

Hypertension

• Defined as:

  • Two or more readings above baseline on different days.

  • May be asymptomatic.

• Classification:

  • Prehypertension: 121/81 - 139/89 mmHg.

  • Stage 1: 140/90 - 159/99 mmHg.

  • Stage 2: 160/100 mmHg and greater.

Hypotension

• Defined as BP less than 90/60 mmHg; can be normal for some individuals or result from health problems.

Signs and Symptoms

• Dizziness

• Syncope

• Diaphoresis

• Nausea and vomiting

• Confusion

• Decreased urine output

Orthostatic Hypotension

• Occurs within 3 minutes of rising from a sitting or lying position.

  • Assessment includes taking BP and pulse while lying down, sitting, and standing at intervals.

BP Assessment

Process and Considerations

• BP assessment should be individualized and track trends.

• Significant changes of 20-30 mmHg should be noted regardless of the initial BP reading.

• Utilize a two-step method to estimate systolic BP.

Factors Affecting Blood Pressure

• Influences include:

  • Age

  • Ethnicity/Genetics

  • Family history

  • Gender

  • Circadian rhythms

  • Stress and emotions

  • Weight/obesity

  • Medications

  • Smoking

Changes Related to Aging

• Valve calcification

• Decrease in pacemaker cells

• Increased vascular resistance and risk for orthostatic hypotension.

Nursing Process

Assessment

• Gather health history, risk factors, lifestyle, diet, activity level, and perform holistic physical assessments.

Diagnosis

• Common nursing diagnoses related to perfusion:

  • Ineffective tissue perfusion

  • Decreased cardiac output

  • Fatigue

  • Activity intolerance

  • Risk for falls/Injury

  • Risk for impaired skin integrity

  • Self-care deficit

  • Disturbed sensory perception.

Planning

Goal Setting

• SMART goals for patient outcomes regarding perfusion-related issues:

  • Improved perfusion and stable vital signs within defined time frames.

Interventions

Prevention Strategies

• Primary: Education and lifestyle changes.

• Secondary: Annual physicals, BP screening, and lab tests.

• Tertiary: Rehabilitation and maintaining current function.

Specific Nursing Interventions

• Promote ambulation.

• Use compression stockings.

• Maintain hydration.

• Monitor vital signs and peripheral vascular assessment (PVA).

• Apply skin care and prophylactic anticoagulants as necessary.

Evaluation

• Assess patient progress towards goals and modify care plans as needed, prioritizing patient-centered care and health promotion.

Perfusion Case Study

• Example scenario of a patient with lightheadedness and atrial fibrillation; includes guidelines on nursing actions indicating appropriate responses to patient needs.

Summary

• Recap of key learning outcomes, evaluation techniques, nursing diagnoses, and interventions related to cardiovascular and perfusion health.