Perfusion

1. 22 Perfusion

2. About Perfusion

3. Normal Presentation Heart Pericardium Layers of the heart wall Epicardium Myocardium Endocardium

4. Figure 22-3 The internal anatomy of the heart, frontal section.

5. 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

6. 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

7. Figure 22-5 Heart sounds in systole and diastole.

8. Normal Heart Sounds, continued Additional Heart Sounds Damaged tissue Mitral stenosis Ejection clicks Nonejection clicks Friction rubs Heart murmurs

9. 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

10. Transition from Fetal to Pulmonary Circulation Flow of blood Foramen ovale Blood pumped into aorta, systemic circulation System vascular resistance

11. The Cardiac Cycle and Cardiac Output One heartbeat of contraction and relaxation Stroke volume Cardiac output Ejection fraction

12. The Cardiac Cycle and Cardiac Output, continued Cardiac output determined by Autonomic stimulation Preload Afterload Contractility Clinical indicators of cardiac output Cardiac index

13. 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

14. Pulse Wave of blood created by LV contraction Peripheral pulse Apical pulse Factors affecting pulse

15. 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

16. 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

17. Figure 22-13 Vena caval syndrome. The gravid uterus compresses the vena cava when the woman is supine. Thisreduces the blood flow returning to the heart and may cause maternal hypotension.

18. Developmental Aspects Cardiovascular changes in pregnancy, continued Blood volume increases Leukocyte production increases Fibrin and plasma fibrinogen increase

19. Developmental Aspects, continued Normal changes of aging Determined by genetics Physical, social environment Cardiovascular system Vascular system Pulmonary system Renal system

20. Figure 22-14 Normal changes of aging in the cardiovascular system.

21. Alterations Alterations in pediatric cardiology Congenital heart defects Congenital anomalies Common cardiovascular illnesses of aging CAD – Cardiomyopathy Dysrhythmia – Valve disease Shock – Hypertension Stroke – PIH

22. Assessment Physical assessment Inspection Palpation Percussion Auscultation Perfusion assessments Apical impulse – Heart sounds Cardiac rate and rhythm – Murmurs

23. Assessing the Pulse Techniques Assess for Rate – Rhythm Volume – Arterial wall elasticity Developmental considerations Pulse sites Apical pulse assessment Apical-radial pulse assessment

24. Assessing Blood Pressure Measured with sphygmomanometer Blood pressure sites Methods Direct Indirect Auscultate, palpate Korotkoff’s sounds 5 phases of blood pressure

25. Assessing Blood Pressure, continued Developmental considerations Care settings Common errors in assessing blood pressure Haste Unconscious bias Hypotension Orthostatic hypotension

26. Health Assessment Interview Explore chief complaint Assessing chest pain Genetic considerations

27. Diagnostic Tests Determining cardiac function Serum cholesterol, triglycerides, lipids Stress/exercise tests X-ray, MRI, CT, PET Echocardiogram Transesophageal echocardiogram Cardiac catheterization, angiography Pericardiocentesis

28. 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

29. 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

30. Caring Interventions, continued Interventions – 3 categories Inputs Outputs Pressure supports Specific skills Assessing pulses Recording and interpreting an ECG Administering CPR

31. 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

32. Caring Interventions Specific skills, continued Measuring cardiac output Reading central and peripheral blood pressures Caring for arterial pressure monitoring

33. Pharmacologic Therapies Classifications Statins Antihypertensives Adrenergic agonists Calcium channel blockers Cardiac glycosides Phosphodiesterase inhibitors Nitrates Thrombolytics