Week 3: Nursing Care - Complex Perfusion Alterations
UPDATED ACTUAL Questions and CORRECT Answers
Cardiac output - Volume of blood the heart pumps to systemic circulation
- Equation: CO = SV X HR
- Cardiac output increases during exercise and significant physical or emotional
stress
- Stroke volume increases by stronger ventricular contraction and increased
ventricular filling before contraction (more blood in left ventricle)
- This meets the body's higher oxygen and metabolic demands during
exertion
Preload - Amount of ventricular stretch at the end of diastole
- Ventricular filling
- More ventricular stretch = stronger contraction = increased CO
- Increased preload causes are heart failure and fluid volume excess
- How to decrease preload: diuretics and vasodilators
- Decreased preload causes are tachycardia (less filling time) and fluid
volume deficit
- How to increase preload: oral fluids, IV fluids, and blood products
Afterload - Resistance the left ventricle must overcome to eject blood into systemic
circulation
- Pressure or resistance in the arteries
- Increased afterload caused by hypertension, vasoconstriction (heart has to
work harder to pump blood)
- How to decrease afterload: vasodilators (hydralazine)
- Decreased afterload is caused by hypotension
- How to increase afterload: epinephrine, dopamine, norepinephrine
Contractility - Ability of the myocardium to contract and eject blood independent of
preload
- Reflects the strength of heart muscle contraction
- Decreased contractility due to sepsis and pancreatitis
- Increased contractility due to B adrenergic (SNS) stimulation, leads to
stronger cardiac contractions and improved cardiac output
Effects of aging on the cardiovascular system - Increased collagen and decreased elastin in heart leads to impaired ability
of the heart to stretch and contract
- Impaired response to physical and emotional stress leads to decreased CO
and SV
- Blunted sympathetic nerve response leads to decreased HR with position
changes
- Thickened stiff heart valves lead to valve regurgitation or stenosis
- Decreased pacemaker cells lead to sinus and atrial dysrhythmias, heart
blocks
- Thickened arteries and veins with reduced elasticity lead to increased
systolic BP and widened pulse pressure
- Reduced venous return from leg veins lead to dependent edema
, Exercise and diet changes to reduce cardiovascular Exercise:
disease risk - Aerobic exercise
- Muscle strengthening activities at least 2 days per week
- Moderate intensity: breathing harder but able to talk, 150 min/week
- Vigorous intensity: only a few words before breathing, 75 min/week
Diet and weight:
- Maintain healthy body weight
- Limit salt and saturated fats
- DASH diet: focus on portion control and nutritious foods to reduce BP
- Eat fruits, vegetables, and whole grains
What does smoking do to the cardiovascular system? - Leading cause of preventable death!
- Raises triglycerides
- Lowers HDL
- Increases blood clot risk
- Damages blood vessel lining
- Thickens and narrows blood vessels
Impaired peripheral perfusion - Reduced cardiac output = decreased tissue perfusion
- Caused by arterial blockage from embolus or plaque buildup
Findings:
- Intermitted claudication (pain with activity)
- Paresthesia
- Pale or cyanotic skin
- Diminished or absent pedal pulses
- Prolonged capillary refill
- Impaired nail growth
- Decreased hair distribution
- Complications: skin ulcers, tissue death (gangrene)
Impaired central perfusion - Can lead to: myocardial infarction, heart failure, stroke, and shock
Findings:
- Dyspnea
- Diaphoresis
- Dizziness or syncope
- Chest pain (may radiate to neck, back, or arm)
- Cyanosis
- Impaired cognition
- Hypotension
- Tachycardia
Medical and nursing management for decreased - Medications to increase vasodilation: nitrates, ACE inhibitors, beta blockers,
perfusion CCBs
- Percutaneous coronary intervention (PCI) with intracoronary stent
- Procedures to open coronary, peripheral, or carotid arteries
- Bypass surgery to reroute blood around occluded or narrowed arteries
- Frequent vitals, pulse oximetry
- Continuous cardiac monitoring
- Deterioration of perfusion requires: admin O2, position in semi or high
fowlers, cluster care, admin meds
UPDATED ACTUAL Questions and CORRECT Answers
Cardiac output - Volume of blood the heart pumps to systemic circulation
- Equation: CO = SV X HR
- Cardiac output increases during exercise and significant physical or emotional
stress
- Stroke volume increases by stronger ventricular contraction and increased
ventricular filling before contraction (more blood in left ventricle)
- This meets the body's higher oxygen and metabolic demands during
exertion
Preload - Amount of ventricular stretch at the end of diastole
- Ventricular filling
- More ventricular stretch = stronger contraction = increased CO
- Increased preload causes are heart failure and fluid volume excess
- How to decrease preload: diuretics and vasodilators
- Decreased preload causes are tachycardia (less filling time) and fluid
volume deficit
- How to increase preload: oral fluids, IV fluids, and blood products
Afterload - Resistance the left ventricle must overcome to eject blood into systemic
circulation
- Pressure or resistance in the arteries
- Increased afterload caused by hypertension, vasoconstriction (heart has to
work harder to pump blood)
- How to decrease afterload: vasodilators (hydralazine)
- Decreased afterload is caused by hypotension
- How to increase afterload: epinephrine, dopamine, norepinephrine
Contractility - Ability of the myocardium to contract and eject blood independent of
preload
- Reflects the strength of heart muscle contraction
- Decreased contractility due to sepsis and pancreatitis
- Increased contractility due to B adrenergic (SNS) stimulation, leads to
stronger cardiac contractions and improved cardiac output
Effects of aging on the cardiovascular system - Increased collagen and decreased elastin in heart leads to impaired ability
of the heart to stretch and contract
- Impaired response to physical and emotional stress leads to decreased CO
and SV
- Blunted sympathetic nerve response leads to decreased HR with position
changes
- Thickened stiff heart valves lead to valve regurgitation or stenosis
- Decreased pacemaker cells lead to sinus and atrial dysrhythmias, heart
blocks
- Thickened arteries and veins with reduced elasticity lead to increased
systolic BP and widened pulse pressure
- Reduced venous return from leg veins lead to dependent edema
, Exercise and diet changes to reduce cardiovascular Exercise:
disease risk - Aerobic exercise
- Muscle strengthening activities at least 2 days per week
- Moderate intensity: breathing harder but able to talk, 150 min/week
- Vigorous intensity: only a few words before breathing, 75 min/week
Diet and weight:
- Maintain healthy body weight
- Limit salt and saturated fats
- DASH diet: focus on portion control and nutritious foods to reduce BP
- Eat fruits, vegetables, and whole grains
What does smoking do to the cardiovascular system? - Leading cause of preventable death!
- Raises triglycerides
- Lowers HDL
- Increases blood clot risk
- Damages blood vessel lining
- Thickens and narrows blood vessels
Impaired peripheral perfusion - Reduced cardiac output = decreased tissue perfusion
- Caused by arterial blockage from embolus or plaque buildup
Findings:
- Intermitted claudication (pain with activity)
- Paresthesia
- Pale or cyanotic skin
- Diminished or absent pedal pulses
- Prolonged capillary refill
- Impaired nail growth
- Decreased hair distribution
- Complications: skin ulcers, tissue death (gangrene)
Impaired central perfusion - Can lead to: myocardial infarction, heart failure, stroke, and shock
Findings:
- Dyspnea
- Diaphoresis
- Dizziness or syncope
- Chest pain (may radiate to neck, back, or arm)
- Cyanosis
- Impaired cognition
- Hypotension
- Tachycardia
Medical and nursing management for decreased - Medications to increase vasodilation: nitrates, ACE inhibitors, beta blockers,
perfusion CCBs
- Percutaneous coronary intervention (PCI) with intracoronary stent
- Procedures to open coronary, peripheral, or carotid arteries
- Bypass surgery to reroute blood around occluded or narrowed arteries
- Frequent vitals, pulse oximetry
- Continuous cardiac monitoring
- Deterioration of perfusion requires: admin O2, position in semi or high
fowlers, cluster care, admin meds
