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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. All rights reserved. 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. All rights reserved. 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 Copyright ©2011 by Pearson Education, Inc. All rights reserved. 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. All rights reserved. Normal Heart Sounds • Closure of valves creates heart sounds – AV valve produces S1 – Semilunar produces S2 • • • • • 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. All rights reserved. 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 Copyright ©2011 by Pearson Education, Inc. All rights reserved. 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 Copyright ©2011 by Pearson Education, Inc. All rights reserved. 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 North Carolina Concept-Based Learning Editorial Board Copyright ©2011 by Pearson Education, Inc. All rights reserved. Transition from Fetal to Pulmonary Circulation • Flow of blood • Foramen ovale • Blood pumped into aorta, systemic circulation • System vascular resistance 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. 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. All rights reserved. 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. All rights reserved. Conduction System of the Heart • Sinoatrial node (SA node) – Creates impulse – Depolarization causes myocardial contraction • • • • 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 Copyright ©2011 by Pearson Education, Inc. All rights reserved. Pulse • • • • 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. All rights reserved. Blood Pressure • Measure of pressure of blood flow through arteries – Systolic – Diastolic • • • • 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. All rights reserved. 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. All rights reserved. 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. All rights reserved. Developmental Aspects • Cardiovascular changes in pregnancy, continued – Blood volume increases – Leukocyte production increases – Fibrin and plasma fibrinogen increase 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. 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. All rights reserved. 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 Copyright ©2011 by Pearson Education, Inc. All rights reserved. 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. All rights reserved. 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. All rights reserved. Assessing the Pulse • Techniques • Assess for – Rate – Volume • • • • – 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. All rights reserved. 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. All rights reserved. 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. All rights reserved. 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 Copyright ©2011 by Pearson Education, Inc. All rights reserved. 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. All rights reserved. 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. All rights reserved. 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. All rights reserved. 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. All rights reserved. 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.