What is perfusion?
What is the difference between central perfusion and tissue perfusion?
Central = force of blood movement generated by cardiac output (needed for tissue perfusion)
Tissue = volume of blood that flows to target tissues
HTN can increase the risk for what 4 complications?
MI, HF, stroke, renal disease
What is PVD?
A condition that develops when leg veins and valves fail to keep the blood moving forward.
Results in ineffective return of blood to the heart causing blood to pool in veins (stasis)
What is PAD?
Interruption of blood flow in the peripheral arteries which could lead to tissue or organ death.
What should ALL of you be doing right now to prevent PVD?
COMPRESSION SOCKS!!!
(hint hint... it's a great Christmas gift idea)
Reduced cardiac output (CO) results in what type of effect?
SYSTEMIC - reduction of oxygenated blood reaching the body tissues
What might be some things you would want to assess for a patient who has HTN?
Nutrition/diet, lifestyle/tobacco use, family hx, personal hx, current medications, elimination/urine output
Objective: BP reading, BMI, neuro status, labs (K+, BUN/Cr)
List the stages of PVD in order from 1-6.
1 - spider veins
2- varicose veins
3 - swelling
4 - skin changes
5/6 - venous ulcer
What is intermittent claudication?
LE skeletal muscle pain that occurs during exercise
Occurs d/t insufficient oxygen delivery to meet the metabolic requirements of skeletal muscles.
What are the 2 main functions of pharmacologic therapy for HTN?
What are 3 classes of medications used to treat HTN?
1) decrease circulating blood volume
2) decrease SVR
Med Classes: thiazide diuretics, CCB, ACE/ARB
When might vasopressors or vasodilators be used for impaired central perfusion?
Vasopressors = to increase BP (increase cardiac contractility, in cases such as shock)
Vasodilators = to decrease BP (to much pressure causing more work on the heart)
List some clinical manifestations of Hypertensive Crisis.
Hypertensive encephalopathy (HA, N/V, seizures, confusion, coma)
Renal insufficiency
Cardiac decompensation (MI, HF, pulm. edema)
Aortic dissection
How might a patient present if they have PVD? (What S/S would they have?)
Dull, achy pain
EDEMA!
Skin changes - brown, thick, hardened, eczema
Venous ulcers - irregular shape, medial malleolus, PAINFUL, drainage
What care management strategies would you expect to perform for a patient with PAD?
Modification of risk factors (smoking cessation!)
Administer antiplatelet medications (clopidogrel)
Exercise and nutrition therapy
What education would you want to provide for a patient who has PAD? (hint: think about the disease process and s/s)
Skin care
Protective foot wear
Avoid extreme temperatures
Think outside of the box: What are some assessments that you could perform to assess perfusion?
Cap. refill, color of skin (cyanosis present?), warmth of skin, presence of hair, O2 saturation, urine output, LOC, pulses, chest pain
Any others??
What 2 systems are DIRECTLY impacted by HTN?
Cardiac system
Renal system
What would you want to assess in a patient who presents with PVD?
5 Ps - pain, pallor, pulse, paresthesia, paralysis
Edema, VS, stasis dermatitis, wounds, varicose veins
How would a patient present if they had PAD? (What S/S would they have?)
Intermittent claudication*
Paresthesia, loss of sensation
Thin, shiny and taut skin w/ hair loss
Decreased LE pulses
Elevation pallor, dependent rubor, rest pain
Intra-aortic Balloon Pump is a collaborative intervention to improve central perfusion. What are some risks/things you would want to monitor? (think: it is in the aorta)
Dislodgement, rupture
*if dislodgement occurs, it could cause damage to a limb d/t a lack of blood flow (ischemia), could slip down and block kidney perfusion
What is the difference between anticoagulants and thrombolytics?
Anticoagulants = prevent blood from clotting (warfarin, lovenox)
Thrombolytics = if a clot is developed, helps break up the blood clot (tPA, retavase)
How might a symptomatic patient present if they have HTN?
Fatigue, dizziness, palpitations, angina, dyspnea
What interventions would you anticipate the need for if a patient has PVD?
COMPRESSION
Skin care
Activity and limb placement - elevate above level of heart. WHY??
Nutrition
surgical intervention
Where are the sores often present in PVD vs. PAD?
PVD = ankles
PAD = toes and feet
BONUS QUESTION: What is the nursing process?
ASSESS
Diagnosis
Planning (interventions)
Implementation (perform)
Evaluation