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PERFUSION RNSG 1533 Health Care Concepts II Concept – PERFUSION Concept Definition Perfusion is the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular wastes. Exemplars Basic ECG Rhythms Congestive Heart Failure Hypertension Gestational Hypertension Mitral Valve Prolapse Coronary Artery Disease (CAD) Peripheral Vascular Disease (PVD) Objectives 1. Explain the correlation between each of the listed exemplars to the concept of Perfusion (including compromised antecedents, deficit measurement in attributes, a list of negative consequences, and the interrelated concepts which may be involved). 2. Identify conditions that place an individual at risk for imbalance leading to compromised Perfusion resulting in the listed exemplars (exception of Basic ECG Rhythms), 3. Apply the nursing process with collaborative interventions for individuals experiencing the listed exemplars (exception of Basic ECG Rhythms). Sub Objectives Basic ECG Rhythms 1. Explain the electrical conduction of the heart. 2. Discuss the correlation of the ECG waves to the cardiac conduction. 3. Describe the lead placement for an ECG. 4. Calculate the heart rate from an ECG paper strip. 5. Identify a normal sinus rhythm, sinus bradycardia, sinus tachycardia, and a sinus arrhythmia. Peripheral Vascular Disease (PVD) 1. Describe the pathophysiology, risk factors and clinical manifestations for a patient with PVD. 2. Identify the current treatments for a patient with PVD 3. Identify two priority nursing diagnosis for a patient with PVD 4. Identify two priority education topics for a patient with PVD Hypertension 1. Explain the correlation between primary hypertension to the concept of perfusion (including compromised antecedents, deficit measurement in attributes, a list of negative consequences, and the interrelated concepts which may be involved). 51 PERFUSION 2. Identify conditions that place an individual at risk for imbalance leading to a compromised concept(s) resulting in hypertension. 3. Apply the nursing process with collaborative interventions for individuals experiencing Primary hypertension. Gestational Hypertension 1. Differentiate among gestational hypertension, preeclampsia/eclampsia, and chronic hypertension. Identify patient education, medications, interventions and collaborative management required by patients with gestational hypertension. 2. Identify the pathophysiological process underlying gestational hypertension. 3. Compare care management for patients with mild pre-eclampsia vs. care with severe preeclampsia. 4. Identify current medication therapy for patients with gestational hypertension. Congestive Heart Failure 1. Explain the pathophysiology, clinical manifestations and risk factors for congestive heart failure 2. Identify the types of congestive heart failure 3. Describe the current treatments for congestive heart failure 4. Develop a plan of care for a patient with congestive heart failure 5. Identify the top 2 nursing diagnosis for a patient with congestive heart failure Mitral Valve Prolapse 1. Explain the pathophysiological process underlying MVP and its clinical manifestations. 2. Describe the patient teaching, nursing interventions, and collaborative activities likely to be required for patients who have MVP. 3. Explain the preventative techniques patients with MVP need to follow. Coronary Artery Disease (CAD) 1. Explain the etiology and pathophysiology of CAD and how it progresses to Coronary Artery Occlusions. 2. Enumerate the preventative measure than can be taken at the primary, secondary, and tertiary levels to prevent CAD or maximize the person’s health and quality of life. 3. Explain the screening measures that can be taken to assess a person for early stages of Coronary Artery Disease. 4. Describe the major areas where patient teaching is required: Diet, Exercise, Stress Reduction, Smoking Cessation, Weight Control, and management of comorbidities such as Diabetes Mellitus Type I or II. 5. Explain the treatment modalities and how they work from Stress, Cholesterol and Blood Pressure Control, Angina, Coronary Angiograms, PTCA, Stints, to CABG. 52 PERFUSION Assignments Review the following content from previous courses Perfusion Concept Analysis Diagram Giddens text: Chapter 15 - Perfusion Prior to class: *Page numbers, assignments, and other lecture information will be posted on blackboard in a READ ME file. Complete the assigned reading. Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O’Brien, P.G., & Bucher, L. (2014). Medical surgical nursing (9th ed). St. Louis: Mosby Elsevier. Chapter 32: Nursing Assessment of Cardiovascular System Chapter 33: Hypertension Chapter 34: Coronary Artery Disease Chapter 35: Heart Failure Chapter 36: Dysrhythmias Chapter 37: Inflammatory and Structural Heart Disorder; Mitral Valve Prolapse Chapter 38: Vascular Disorders; Peripheral Vascular Disease (PVD/PAD) McKinney, E, James, S., Murray, S., Nelson, K., & Ashwill, J. (2013). Maternal-child nursing (4th ed). St. Louis: Elsevier Saunders. Chapter 25: Pregnancy-Related Complications; Gestational Hypertension Burchum, J. & Rosenthal, L. (2015). Lehne’s pharmacology for nursing care (9th ed). St Louis: Elsevier Saunders Chapter 18: Adrenergic Antagonists Chapter 19: Indirect-Acting Antiadrenergic Agents Chapter 41: Diuretics Chapter 44: Drugs Acting on the Renin-Angiotensin-Aldosterone System Chapter 45: Calcium Channel Blockers Chapter 46: Vasodilators Chapter 47: Drugs for Hypertension Chapter 48: Drugs for Heart Failure Chapter 50: Prophylaxis of Atherosclerotic Cardiovascular Disease Internet Heart Failure https://www.youtube.com/watch?v=3YddwXPWVSc https://www.youtube.com/watch?v=hi9J1ayWsbQ https://www.youtube.com/watch?v=uReH_8TL_gU Hypertension https://www.youtube.com/watch?v=GpuZHv60Fj8 https://www.youtube.com/watch?v=wjTMdYT6kXo https://www.youtube.com/watch?v=4jRy-YlZONA CAD https://www.youtube.com/watch?v=vUVljd0vweU https://www.youtube.com/watch?v=Ta_HNfU5aDM Vascular Disorder: PAD 53 PERFUSION https://www.youtube.com/watch?v=yvLL-fBE-yg Vascular Disorder: PVD https://www.youtube.com/watch?v=D2q6vTqR-jc ECG Rhythm Learning https://www.youtube.com/watch?v=4vkbywows-o Concept Content Outline For Each Exemplar: Pathophysiology Risk Factors Nursing Process Assessment: Comprehensive history Physical assessment Cultural, behavioral, social assessment Physical and psychological clinical manifestations Diagnostic tests Planning Implementation: Nursing; Primary, Secondary, & Tertiary, Teaching Collaborative, Pharmacological therapy, Non-Pharmacological therapy, Procedural therapies Positive Outcomes: Oriented Appropriate organ function Warmth Negative Outcomes: Physiological Psychological Rev. 11/2015 54