nur-410-nursing-care-for-patients-with-complex-perfusion-issues Nursing
Care Complex Perfusion Alterations
Perfusion: Passage of Oxygenated capillary blood through body tissues. Depends on cardiac output and correct
blood flow distribution.
• Central Perfusion: Blood flow to MAJOR body organs
• Peripheral Perfusion: Blood flow to the extremities
Altered perfusion: The inability to adequately oxygenate organs and tissues. It can range from minimal to severe.
Tissue ischemia: Results from decreased perfusion
• Altered peripheral perfusion can result in skin ulcers and cell death like gangrene.
• Altered central perfusion can result in life-threatening events like acute MI, heart failure,
stroke, and shock.
Blood Flow
A client with a tricuspid valve disorder has impaired blood flow. Which part of the heart is experiencing circulatory
problems?
• Vena cava and left ventricle o The aortic valve is between the right ventricle and the pulmonary artery.
• Left atrium and left ventricle. o The bicuspid valve is between the Left atrium and the Left ventricle.
• The right ventricle and pulmonary artery o The pulmonic valve is between the Right Ventricle and the
pulmonary artery.
• The right atrium and right ventricle o The tricuspid valve is between the Right atrium and the Right
ventricle. A stenotic or incompetent valve can lead to impaired blood flow.
In which part of the vascular system does disruption initiate the coagulation cascade, forming a blood clot?
Endothelial layer of the arteries
• Smooth muscle of the arterial wall
• Elastic middle layer of the veins
• Thin capillary vessels
Arterioles are lined with endothelium that maintains homeostasis, promotes blood flow, and
inhibits coagulation. When the endothelial surface is disrupted, the coagulation cascade is initiated
and a clot forms.
Arterioles contain smooth muscle with little elasticity. They respond to low oxygen and increased
carbon dioxide by dilating and constricting.
Capillaries connect the arterioles to the venules. Cellular nutrients are exchanged in these
thinwalled vessels.
Veins return blood to the right atrium. The venous system is a low-pressure, high-volume system.
The amount of blood in this system is affected by arterial flow, venous compression, and right
arterial pressure.
,A client presents to the emergency department with chest pain and shortness of breath. Which subjective data
related to the cardiovascular system should be obtained from the client? Select all that apply. Dependent
edema in the lower extremities (objective)
Dizziness when moving from lying to standing. • o Symptoms such as dizziness with position
changes, fatigue, syncope, and heart palpitations must be explored.
• Number of pillows required for sleep. o Cardiovascular problems can disrupt sleep. It is important to
assess the number of pillows needed to sleep or the need to sleep upright in a chair.
• Smoking history o Past health history, including smoking and alcohol use, and acute and chronic illness
may affect the cardiovascular system.
• Neck vein distention (objective)
A nurse is discussing the dangers of a sedentary lifestyle with a client who has risk factors for coronary artery
disease (CAD). Increasing physical activity will directly contribute to reducing which risk factor?
• Hyperlipidemia and obesity
• Diabetes and hypertension
• Bradycardia and physical stress
• Hypotension and emotional stress
Factors Affecting Cardiac Output
Cardiac Output
Cardiac output (CO) is the amount of blood pumped by each ventricle in 1 minute. It is calculated
by multiplying the stroke volume (SV) times the heart rate (HR). CO = SV x HR The normal adult
at rest has a CO in the range of 4–8 L/min.
Factors Affecting Heart Rate
Many factors can affect heart rate or stroke volume, therefore impacting CO.
Rapid heart rate reduces diastolic filling and perfusion of the coronary arteries.
Stroke volume is affected by preload, contractility, and afterload.
Cardiac Reserve
Health (exercise) and illness (hypovolemia, stress) affect the cardiovascular system. The ability to respond
to demands by altering CO is called cardiac reserve.
Preload, Contractility, and Afterload
The volume of blood stretching the ventricles at the end of diastole is called preload.
• Increased by aortic valve disease, hypervolemia, and heart failure
• Decreased by rapid heart rate and hypovolemia
Afterload is the peripheral resistance which the left ventricle must pump against.
, • Affected by the size of the ventricle, wall tension, and elevated arterial blood pressure Over
time, increased resistance to eject blood results in ventricular hypertrophy.
• Increased by hypertension (vasoconstriction)
Contractility is increased by epinephrine and norepinephrine released by the sympathetic nervous system.
Increased contractility increases the stroke volume by increasing ventricular emptying.
Regulation of the Cardiovascular System
The autonomic nervous system consists of the sympathetic nervous system and the parasympathetic nervous
system.
• Stimulation of the sympathetic nervous system increases the heart rate, the speed of impulse
conduction through the atrioventricular (AV) node, and the force of arterial and ventricular
contractions. Stimulation of alpha-1 adrenergic receptors in the vascular smooth muscles results in
vasoconstriction; decreased stimulation causes vasodilation.
• Stimulation of the parasympathetic nervous system slows the heart rate by decreasing impulses from
the sinoatrial (SA) node and thus conduction through the AV node.
Factors that affect the heart rate impact cardiac output and perfusion. Systemic vascular resistance (SVR)
influences blood pressure and therefore cardiac output and perfusion.
A nurse in a provider’s office is teaching a female client about the risks and incidence of heart disease. Which
information should be included?
• Estrogen replacement therapy in postmenopausal women decreases the risk of heart disease.
Heart disease is the leading cause of death for women in the United States.
• Women seek treatment sooner than men when experiencing heart-related symptoms.
Smoking is not as significant a risk factor in women as in men.
Effects of Aging on the Cardiovascular System
• Age is the greatest risk factor for the cardiovascular system. o Cardiovascular disease (CVD) is the
leading cause of death in adults older than 65 years in 2019
Care Complex Perfusion Alterations
Perfusion: Passage of Oxygenated capillary blood through body tissues. Depends on cardiac output and correct
blood flow distribution.
• Central Perfusion: Blood flow to MAJOR body organs
• Peripheral Perfusion: Blood flow to the extremities
Altered perfusion: The inability to adequately oxygenate organs and tissues. It can range from minimal to severe.
Tissue ischemia: Results from decreased perfusion
• Altered peripheral perfusion can result in skin ulcers and cell death like gangrene.
• Altered central perfusion can result in life-threatening events like acute MI, heart failure,
stroke, and shock.
Blood Flow
A client with a tricuspid valve disorder has impaired blood flow. Which part of the heart is experiencing circulatory
problems?
• Vena cava and left ventricle o The aortic valve is between the right ventricle and the pulmonary artery.
• Left atrium and left ventricle. o The bicuspid valve is between the Left atrium and the Left ventricle.
• The right ventricle and pulmonary artery o The pulmonic valve is between the Right Ventricle and the
pulmonary artery.
• The right atrium and right ventricle o The tricuspid valve is between the Right atrium and the Right
ventricle. A stenotic or incompetent valve can lead to impaired blood flow.
In which part of the vascular system does disruption initiate the coagulation cascade, forming a blood clot?
Endothelial layer of the arteries
• Smooth muscle of the arterial wall
• Elastic middle layer of the veins
• Thin capillary vessels
Arterioles are lined with endothelium that maintains homeostasis, promotes blood flow, and
inhibits coagulation. When the endothelial surface is disrupted, the coagulation cascade is initiated
and a clot forms.
Arterioles contain smooth muscle with little elasticity. They respond to low oxygen and increased
carbon dioxide by dilating and constricting.
Capillaries connect the arterioles to the venules. Cellular nutrients are exchanged in these
thinwalled vessels.
Veins return blood to the right atrium. The venous system is a low-pressure, high-volume system.
The amount of blood in this system is affected by arterial flow, venous compression, and right
arterial pressure.
,A client presents to the emergency department with chest pain and shortness of breath. Which subjective data
related to the cardiovascular system should be obtained from the client? Select all that apply. Dependent
edema in the lower extremities (objective)
Dizziness when moving from lying to standing. • o Symptoms such as dizziness with position
changes, fatigue, syncope, and heart palpitations must be explored.
• Number of pillows required for sleep. o Cardiovascular problems can disrupt sleep. It is important to
assess the number of pillows needed to sleep or the need to sleep upright in a chair.
• Smoking history o Past health history, including smoking and alcohol use, and acute and chronic illness
may affect the cardiovascular system.
• Neck vein distention (objective)
A nurse is discussing the dangers of a sedentary lifestyle with a client who has risk factors for coronary artery
disease (CAD). Increasing physical activity will directly contribute to reducing which risk factor?
• Hyperlipidemia and obesity
• Diabetes and hypertension
• Bradycardia and physical stress
• Hypotension and emotional stress
Factors Affecting Cardiac Output
Cardiac Output
Cardiac output (CO) is the amount of blood pumped by each ventricle in 1 minute. It is calculated
by multiplying the stroke volume (SV) times the heart rate (HR). CO = SV x HR The normal adult
at rest has a CO in the range of 4–8 L/min.
Factors Affecting Heart Rate
Many factors can affect heart rate or stroke volume, therefore impacting CO.
Rapid heart rate reduces diastolic filling and perfusion of the coronary arteries.
Stroke volume is affected by preload, contractility, and afterload.
Cardiac Reserve
Health (exercise) and illness (hypovolemia, stress) affect the cardiovascular system. The ability to respond
to demands by altering CO is called cardiac reserve.
Preload, Contractility, and Afterload
The volume of blood stretching the ventricles at the end of diastole is called preload.
• Increased by aortic valve disease, hypervolemia, and heart failure
• Decreased by rapid heart rate and hypovolemia
Afterload is the peripheral resistance which the left ventricle must pump against.
, • Affected by the size of the ventricle, wall tension, and elevated arterial blood pressure Over
time, increased resistance to eject blood results in ventricular hypertrophy.
• Increased by hypertension (vasoconstriction)
Contractility is increased by epinephrine and norepinephrine released by the sympathetic nervous system.
Increased contractility increases the stroke volume by increasing ventricular emptying.
Regulation of the Cardiovascular System
The autonomic nervous system consists of the sympathetic nervous system and the parasympathetic nervous
system.
• Stimulation of the sympathetic nervous system increases the heart rate, the speed of impulse
conduction through the atrioventricular (AV) node, and the force of arterial and ventricular
contractions. Stimulation of alpha-1 adrenergic receptors in the vascular smooth muscles results in
vasoconstriction; decreased stimulation causes vasodilation.
• Stimulation of the parasympathetic nervous system slows the heart rate by decreasing impulses from
the sinoatrial (SA) node and thus conduction through the AV node.
Factors that affect the heart rate impact cardiac output and perfusion. Systemic vascular resistance (SVR)
influences blood pressure and therefore cardiac output and perfusion.
A nurse in a provider’s office is teaching a female client about the risks and incidence of heart disease. Which
information should be included?
• Estrogen replacement therapy in postmenopausal women decreases the risk of heart disease.
Heart disease is the leading cause of death for women in the United States.
• Women seek treatment sooner than men when experiencing heart-related symptoms.
Smoking is not as significant a risk factor in women as in men.
Effects of Aging on the Cardiovascular System
• Age is the greatest risk factor for the cardiovascular system. o Cardiovascular disease (CVD) is the
leading cause of death in adults older than 65 years in 2019
