Kozier Ch 51 Circulation

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cswett
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120054
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Kozier Ch 51 Circulation
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2011-12-01 10:37:45
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Kozier 51 Circulation
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Kozier Ch 51 Circulation
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  1. The Heart
    •Cardiac cycle-

    –Systole - contration of atrium

    –Diastole - contraciton of ventricles

    •Conduction system

    –SA & AV node - pace makers
  2. Cardiac Output
    • •Cardiac output (CO)
    • –Amount of blood ejected from the heart each minute
    • •CO= SV X HR

    • •Stroke volume (SV)
    • –Amount of blood ejected from the heart with each
    • beat - should be 70 mL
    • –Contractility of heart affects stroke volume

    • •Heart rate (HR)- beats/min.
    • –Faster HR = CO increases
    • –Slower HR = CO decreases
  3. Blood Vessels
    • •Arterial System
    • –Arteries
    • –Arterioles
    • –Capillaries

    • •Venous System
    • –Veins
    • –Venule
    • –Valves
  4. Blood
    • •Transports oxygen, nutrients, hormones to cells
    • •Transports wastes from tissues
    • •Blood cells suspended in plasma
    • •O2 is transported bound to hemoglobin
    • •Regulates body temperature, pH, fluid volume
  5. Life Span Considerations
    • •Birth-
    • –Closure of opening between two atria
    • –Closure between pulmonary artery & aorta

    • •Pulse rate & BP
    • –Slows from newborn to adult (10 years)
    • –BP rises from newborn to adult (16 Years)

    • •Diseases that occur with age
    • –Athersclerosis- build up of fatty plaque in the arteries
    • –Hypertension - high blood pressure caused by loss of elasticity of the artheries & build-up in the arteries
  6. Factors Affecting Cardiovascular Function
    •Certain factors have been identified as risk factors for:

    –Coronary artery disease (CAD)

    –Hypertension

    –Peripheral vascular disease (PVD)

    * * also called PAD - Peripheral Artery Disease
  7. Risk Factors for Circulation Problems
    Know this card
    • •Non-modifiable risks
    • –Heredity - size of arteries, if family has circulation problems, higher risk
    • –Age
    • –Gender- used to be though that men had higher risk but now known that women have same risk level
  8. Modifiable Risk Factors
    • •Modifiable risks
    • –Elevated serum lipid levels- change diet
    • •diet high in saturated fats

    • –Hypertension
    • •Increases work of heart, increasing O2 demand
    • •Causes enlarged heart
    • •Causes endothelial damage of blood vessels which
    • stimulates atherosclerosis

    • –Cigarette smoking-
    • •increases BP & narrows blood vessels

    • –Diabetes
    • •Accelerates athersclerosis

    • Obesity
    • •Often has elevated lipid levels
    • •Increases workload of heart - every lb of weight adds 7 miles of blood vessels that blood must travel through

    • –Sedentary lifestyle
    • •Exercise benefits:
    • –Increase HR & O2 supply
    • –Heart muscle more efficient
    • –Slows down athersclerosis
  9. Other Risk Factors
    • –Heat and cold
    • •vasodilation & constriction

    –Previous health status

    • –Stress and coping - type A people that dont know how to relax
    • •increases HR

    • –Dietary factors
    • •High salt- may causes hypertension - causes fluid retention
    • •High fat

    • –Alcohol intake
    • •Respiratory depressant
    • •Alcoholics often anemic

    • –Elevated homocysteine level
    • •Amino acid associated with athersclerosis
    • •Decrease homocysteine levels by taking B vitamines
  10. Conditions that Alter Cardiovascular Function
    • •Pumping of heart
    • –Decreased Cardiac Output

    • •Blood flow to organs & tissues
    • –Impaired tissue perfusion

    • •Composition of blood & its transport
    • –Blood alterations

    • •Myocardial infarction (MI)- heart attack
    • –Area of heart muscle dies as result of coronary
    • artery occlusion. Heart losses ability to pump effectively

    • •Heart failure
    • –Result of MI or hypertension

    • •Irregular heart rhythms
    • –Too slow or fast

    • •Structural heart conditions
    • –valves too tight or loose
  11. Conditions that Affect Tissue Perfusion
    •Tissue perfusion: blood flow to organs & peripheral tissues

    •Lack of blood supply leads to ischemia

    •Atherosclerosis- most common cause of impaired tissue perfusion

    • •Most common sites
    • –Coronary arteries (MI)- video on CAD
    • –Brain (TIA & stroke)
    • –Peripheral arterial disease

    You can have dementia from neuro problem or vascualr problem
  12. Atherosclerosis - ASCV
    •Vessels narrow and become constricted

    •Distal tissues receive less oxygen and nutrients

    •Coronary arteries most affected

    •Obstruction of coronary arteries leads to myocardial ischemia leads to angina pectoris

    •Obstruction in vessels supplying brain results in TIA or stroke

    •Decreased blood flow to legs & feet results in PAD
  13. Impaired Peripheral Arterial Circulation - PAD
    •Decreased peripheral pulses

    •Pale skin color

    •Cool extremities

    •Decreased hair distribution

    - Discoloration of distal extremities - caused by nueropathy (nerve damage - Diabeties) or vascular
  14. Other Conditions that Affect Tissue Perfusion
    • •Blood clots - warm, swollen, painful
    • •Tissue edema
    • •Impaired venous circulation
    • –Incompetent valves of veins
  15. Incompetent Venous Valves
    • •May allow blood to pool in veins
    • –Edema
    • –Decreased venous return to heart
    • Blood pools in lower extremities - people who's legs are not swollen in morning but swollen at night

    • •Veins become inflamed
    • –Reduce blood flow
    • –Increased risk of thrombus formation
    • -can be caused by infiltration of IV

    • •Thrombi may break loose
    • –Emboli
    • –Acute pulmonary embolism - short of breath, chest pain, put on blood thinners

    •Sudden onset of SOB

    •Pleuritic chest pain
  16. Conditions that Affect Composition of Blood & Transport
    •O2 transported to tissues with hemogloblin in RBCs

    • •Conditions that affect tissue oxygenation:
    • –Low hemoglobin
    • –Inadequate RBCs
    • –Abnormal hemoglobin

    • •Anemia due to:
    • –Loss of blood
    • –Poor diet (lack of iron or folic acid)
    • •Symptoms
    • –Chronic fatigue
    • –Pallor
    • –Shortness of breath
    • –Hypotension

    • –Hypovolemia- decreased CO & tissue ischemia
    • •Hemorrhage
    • •Dehydration

    • –Hypervolemia- heart failure & tissue ischemia
    • •Fluid retention
    • •Kidney failure
  17. Nursing Management Assessment
    • •History- Interview page 1413
    • –Current or past problems
    • –Medications
    • –Lifestyle

    • •Physical Assessment
    • –BP both arms - sould not be more than 10 points difference
    • –Pulses- AP & peripheral - pedal
    • –Bruits - carotids
    • –Skin
    • –Lungs
  18. Nursing Management: Diagnostic studies
    • •Cardiac monitoring
    • •ECG
    • •Blood work
    • –Hemogloblin

    –Enzymes
  19. Nursing Diagnoses & Expected Outcomes
    • •Ineffective Tissue Perfusion
    • •Decreased Cardiac Output
    • •Activity intolerance

    • •The client will:
    • –maintain or improve tissue perfusion
    • –maintain or restore adequate cardiac output
    • –participate in activities (such as ADLs)
  20. Nursing Implementation
    • •Promote circulation
    • –Vascular
    • –Cardiac

    •Medications

    •Prevent venous stasis
  21. Promote Circulation - Client Teaching
    • •Exercise
    • •No smoking
    • •IBW - Ideal body weight
    • •Low fat diet
    • •Alcohol in moderation
    • •Reduce stress
    • •Manage diabetes & hypertension
    • •Low ASA therapy
  22. Promoting circulation: Vascular
    •Elevate the client’s legs

    •Avoid placing pillows under the knees or providing more than 15° knee flexion

    •Encourage leg exercises for a client on bedrest

    •Promote ambulation as soon as possible

    •Encourage or provide frequent position changes
  23. Promoting circulation: Cardiac
    • •High Fowler’s position
    • •Monitor I & O - Best way to monitor fluid balance is Daily Weight
    • •Fluid restriction
  24. Administering Prescribed Medication
    •Help client understand the purposes, effects, and side effects

    •Assess effects of medications and potential complications

    •Assess intake and output and potassium levels, if appropriate, for clients receiving diuretics

    •Assess BP, HR, peripheral pulses, and lung sounds for clients receiving cardiac meds

    •Monitor BP for client receiving antihypertensive medications
  25. Preventing Venous Stasis
    • •Positioning and leg exercises
    • •Applying antiembolic stockings
    • •Applying sequential compression devices (SCDs)
  26. Importance of Cardiopulmonary Resuscitation
    • •Within 20 to 40 seconds of a cardiac arrest the victim is
    • clinically dead

    •After 4 to 6 minutes the lack of oxygen supply to the brain causes permanent and extensive damage

    •Must initiate CPR immediately

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