Transcript A Concept-Based Approach to Learning

Nursing:
A Concept-Based Approach to Learning
Volume One
CONCEPT
22
Perfusion
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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About Perfusion
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Normal Presentation
• Heart
• Pericardium
• Layers of the heart wall
– Epicardium
– Myocardium
– Endocardium
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Figure 22-3 The internal anatomy of the heart, frontal section.
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
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Chambers and Valves
of the Heart
• 4 hollow chambers
– Right atrium
– Left atruim
– Right ventricle
– Left ventricle
• Heart chambers separated by valves
– Atria separated by atrioventricular valves
– Pulmonic valve
– Aortic valve
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Normal Heart Sounds
• Closure of valves creates heart sounds
– AV valve produces S1
– Semilunar produces S2
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Contraction and relaxation of the heart
Splitting of S2 normal in some
S3 ventricular gallop
S4 atrial gallop
Characteristics of heart sounds
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Figure 22-5 Heart sounds in systole and diastole.
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
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Normal Heart Sounds, continued
• Additional Heart Sounds
– Damaged tissue
– Mitral stenosis
– Ejection clicks
– Nonejection clicks
– Friction rubs
– Heart murmurs
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
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Systemic, Pulmonary, Coronary
Circulation
• Pulmonary circulation
– Right side of heart
• Systemic circulation
– Left side of heart
• Coronary circulation
– Vessels that supply the heart muscle itself
Nursing: A Concept-Based Approach to Learning, Volume One
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Transition from Fetal to
Pulmonary Circulation
• Flow of blood
• Foramen ovale
• Blood pumped into aorta, systemic
circulation
• System vascular resistance
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North Carolina Concept-Based Learning Editorial Board
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The Cardiac Cycle
and Cardiac Output
• One heartbeat of contraction and
relaxation
• Stroke volume
• Cardiac output
• Ejection fraction
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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The Cardiac Cycle
and Cardiac Output, continued
• Cardiac output determined by
– Autonomic stimulation
– Preload
– Afterload
– Contractility
• Clinical indicators of cardiac output
– Cardiac index
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Conduction System of the Heart
• Sinoatrial node (SA node)
– Creates impulse
– Depolarization causes myocardial contraction
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Action potential is basis for EKG
Depolarization
Repolarization
Anatomic landmarks for cardiovascular
assessment
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
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Pulse
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Wave of blood created by LV contraction
Peripheral pulse
Apical pulse
Factors affecting pulse
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Blood Pressure
• Measure of pressure of blood flow through
arteries
– Systolic
– Diastolic
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Pulse pressure
Measured in millimeters of mercury
Determinant of blood pressure
Factors affecting blood pressure
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Developmental Aspects
• Pediatric differences
– Cardiac functioning
– Oxygenation
• Cardiovascular changes in pregnancy
– Cardiac output increases early in pregnancy
– Enlarging uterus places pressure on veins
 Interferes with returning blood flow
– When supine, pressure on vena cava
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Figure 22-13 Vena caval syndrome. The gravid uterus compresses the vena cava when the woman is supine. This
reduces the blood flow returning to the heart and may cause maternal hypotension.
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Developmental Aspects
• Cardiovascular changes in pregnancy,
continued
– Blood volume increases
– Leukocyte production increases
– Fibrin and plasma fibrinogen increase
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North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Developmental Aspects, continued
• Normal changes of aging
– Determined by genetics
 Physical, social environment
– Cardiovascular system
– Vascular system
– Pulmonary system
– Renal system
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Figure 22-14 Normal changes of aging in the cardiovascular system.
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
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Alterations
• Alterations in pediatric cardiology
– Congenital heart defects
– Congenital anomalies
• Common cardiovascular illnesses of aging
– CAD
– Dysrhythmia
– Shock
– Stroke
– Cardiomyopathy
– Valve disease
– Hypertension
– PIH
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Assessment
• Physical assessment
– Inspection
– Palpation
– Percussion
– Auscultation
• Perfusion assessments
– Apical impulse
– Heart sounds
– Cardiac rate and rhythm – Murmurs
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Assessing the Pulse
• Techniques
• Assess for
– Rate
– Volume
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– Rhythm
– Arterial wall elasticity
Developmental considerations
Pulse sites
Apical pulse assessment
Apical-radial pulse assessment
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Assessing Blood Pressure
• Measured with sphygmomanometer
• Blood pressure sites
• Methods
– Direct
– Indirect
 Auscultate, palpate
 Korotkoff’s sounds
 5 phases of blood pressure
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Assessing Blood Pressure,
continued
– Developmental considerations
– Care settings
– Common errors in assessing blood pressure
 Haste
 Unconscious bias
– Hypotension
 Orthostatic hypotension
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Health Assessment Interview
• Explore chief complaint
• Assessing chest pain
• Genetic considerations
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
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Diagnostic Tests
• Determining cardiac function
– Serum cholesterol, triglycerides, lipids
– Stress/exercise tests
– X-ray, MRI, CT, PET
– Echocardiogram
– Transesophageal echocardiogram
– Cardiac catheterization, angiography
– Pericardiocentesis
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Diagnostic Tests, continued
– Electrocardiography
 Interpreting an ECG
– Troponin, MB isoenzyme of creatine kinase
• Nursing responsibilities
– Explain the procedure and preparation
– Assess for medication use
– Support client during test if necessary
– Document procedure, monitor results
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Caring Interventions
• Support, improve, promote perfusion
• Interventions to
– Reduce stress on the heart
– Decrease cardiac workload
– Increase efficacy of cardiac contractions
– Meet fluid needs
– Primary prevention
 Diet
 Exercise
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Caring Interventions, continued
• Interventions – 3 categories
– Inputs
– Outputs
– Pressure supports
• Specific skills
– Assessing pulses
– Recording and interpreting an ECG
– Administering CPR
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Caring Interventions
• Specific skills, continued
– Achieving defibrillation
– Measuring for, application of elastic
compression stockings
– Fetal monitoring
– Applying SCD
– Applying continuous cardio-respiratory
monitoring
– Obtaining capillary wedge pressures
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Caring Interventions
• Specific skills, continued
– Measuring cardiac output
– Reading central and peripheral blood
pressures
– Caring for arterial pressure monitoring
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
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Pharmacologic Therapies
• Classifications
– Statins
– Antihypertensives
– Adrenergic agonists
– Calcium channel blockers
– Cardiac glycosides
– Phosphodiesterase inhibitors
– Nitrates
– Thrombolytics
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.