NCM-118-7-PERFUSION (Nursing Care of Clients with Altered Tissue Perfusion))

all about the "Nursing Lesson"

1. EFTIZAM A. LANGA, RN, MAN
BASC-FACULTY
Nursing Care of Clients
with Altered Tissue
Perfusion

2. PERFUSIONis the flow of blood
or fluid to tissues and organs
TISSUEPERFUSIONisimportantin
maintainingtheorganfunction
andisdefinedasacertainblood
volumeflowingthroughagiven
tissuevolumeoveraperiodof
time.

3. HOW DOES BLOOD
MOVE THROUGH
THE BODY?

4. R-T-M-A
Respiratory Therapist Loves Me
Right Side –Tricuspid Valve
Left Side –Mitral Valve
TPMA
ToiletPaper My Asset
Tricuspid Valve →Pulmonary Valve
→Mitral Valve →Aortic Valve

5. 2 ASPECTS
1.Central Perfusion
2.Peripheral (tissue) Perfusion
Good CV Health
= Optimal Perfusion

6. DIRECT IMPACT OF PERFUSION
1.Brain
2.Heart
3.Lungs
Mean Arterial Pressure (MAP) should be
greater than 60 in order to maintain
adequate tissue perfusion

7. SYSTOLICBLOODPRESSUREisthetop
numberandreferstotheamountof
pressureexperiencedbythearteries
whiletheheartisbeating.
DIASTOLICBLOODPRESSUREisthe
bottomnumberandreferstothe
amountofpressureinthearteries
whiletheheartisrestinginbetween
heartbeats.

8. HOW MEASURE ARTERIAL BLOOD
PRESSURE?
Is through your
Blood Pressure.
MAP= SBP + DBP + DBP / 3

9. Example:
BP:120/60mmHg
MAP=120+60+60/3
MAP=240/3
MAP=80mmHg

10. AnormalMAPisabout90mmHg.
MAPismaintainedatleast60
mmHgtoensurethatbloodcan
reachalltissues.
IfMAPdropsbelowthispointfora
longtime,itcanleadtoischemia
andinfarction.

11. CENTRAL PERFUSION
-Amount of blood pumped by the
heart each minute (cardiac output)
-Returns blood to the heart through
the veins.
-Normal Should be 4-6 L/min

12. CENTRAL PERFUSION
-Impacted by:
•Stroke Volume (amount ejected with
contraction) & rate
•Preload(amount left in the ventricles
after contraction)
•Systemic Vascular Resistance
(resistance within the vessels) AKA
afterload.

13. PERIPHERAL OR TISSUE PERFUSION
-Volume of blood that reaches specific
tissues
-Force of the contraction creates
pressure called Capillary Hydrostatic
Pressure.
-That pressure allows nutrients to reach
capillary beds.

14. BPisthemostimportantindicatorofthe
hemodynamicstability
WhydoyoucareifBPislow?
BP=80/40mmHg
MAP=80+40+40=160/3
MAP=53mmHg=hemodynamicallyinstable
becausetissuesarenotbeingperfused.

15. BP =
Cardiac Output (CO) X Vascular Resistance (PVR)
CO = Heart Rate (HR) X Systemic Volume (SV)
Therefore
BP = (HR x SV) x PVR

17. NORMAL ASSESSMENT FINDINGS
-CENTRAL
•Adequate HR & BP
•Alert & Oriented x4 (A & O X 4 )
A&Ox4,meansthepatientisalertand
orientedtoperson,place,time,
situation.
•Bilateral Sensation
•Clear Speech
•Carotid Pulses

18. NORMAL ASSESSMENT FINDINGS
-PERIPHERAL/ TISSUE
•Warmth
•Appropriate color
•Strong Pulses
•Regular Rhythm
•Capillary Refill < 2-3 seconds
•Absence of pain

19. ABNORMAL ASSESSMENT
FINDINGS
-IMPAIRED CENTRAL PERFUSION
•Result of Mechanical Delivery Problem
-IMPAIRED PERIPHERAL/ TISSUE PERFUSION
•Diminished/decrease amount of blood
available.

20. IMPAIRED CENTRAL PERFUSION
•Myocardial Conduction
•Diseased Heart Muscle
•Congenital defects
•Increased systemic vascular resistance initially.
Eventually will wear out and drop cardiac
output.
•Problems with central perfusion = systemic
effects (EVERYWHERE)
•Significant drop= shock

21. SO WHAT IF I DON’T HAVE CENTRAL PERFUSION?
Decreased Cardiac Output
•Low Perfusion to heart→Myocardial Infarction
(Heart Attack)
•Inadequate impulses →Disorganized electricity
(arrhythmias)
•Bad Heart Valves →Impairs blood flow to
the heart
•Shock →Nothing gets perfused

22. IMPAIRED PERIPHERAL/ TISSUE
PERFUSION
•Poor Central Perfusion
•Blocked Vessels
•Edema
•Increase pressure/ constriction

23. SO WHAT IF I DON’T HAVE TISSUE
PERFUSION?
•Occlusion →atherosclerosis,
thrombi
•Constriction→frostbite
•Dilation →varicose veins or
aneurysms

24. SO WHAT IF I DON’T HAVE TISSUE PERFUSION?
-All lead to ischemia (decreased blood supply)
•Can be reversible if treated/ risk modification
-2 issues
•Lack of oxygen causes anaerobic metabolism
in order to function (increases lactic acid)
•Cannot maintain Na/K pumps, increases
capillary permeability which will lead to
cellular death if continued.

25. RISK FACTORS
•Age
•Gender (male)
•Genetics
•Smoking (vasoconstriction)
•High Cholesterol (atherosclerosis)
•Sedentary (Obesity)
•DM (atherosclerosis)
•Hypertension (increased workload)

26. PROBLEMS
•Pain (chest, leg pain)
•Dyspnea
•Edema
•Dizziness & Fainting

27. ABNORMAL FINDINGS
-Central Perfusion
•Hypertension/Tachycardia
•Murmur
•Change in mental status
•SOB
•Altered Cardiac electricity
•Peripheral edema
•Anxiety/ Diaphoresis

28. ABNORMAL FINDINGS
-Age Related
•Infants: low weight, FTT, weak
suck, dyspnea, murmur
•Children: squatting

29. ABNORMAL FINDINGS
-TissuePerfusion
•Basedonareaofthebody
•Lowerextremities:nohaironlower
legs,pale/coolskin,diminishedpulses,
lowcaprefill
•Kidney: lessurine(stimulatesrenin-
angiotensin which causes
vasoconstrictioncausinghypertension,
water/saltretention

30. BLOOD WORKS RELATED TO ABNORMAL
PERFUSION
•Elevated creatine kinase & troponin after a
myocardial infarction
•Elevated lactate dehydrogenase after
damage to myocardium and erythrocytes
•Elevated natriuretic peptides to detect heart
failure (ANP, BNP)

31. BLOOD WORKS RELATED TO
ABNORMAL PERFUSION
•Elevatednatriureticpeptidestodetectheart
failure(ANP,BNP)
•RiskFactors:ElevatedCRPandlipids/
triglyceridescanpredictfuturecardiacevents
thatleadtopoorperfusion

32. MANAGEMENT
•Primary Prevention: based on a health
lifestyle
•Secondary Prevention: screening, early
diagnosis and fast treatment
•Nutrition
•Activity/Exercise
•Smoking Cessation
•Pharmacology

33. COMMON DISORDERS OF
PERFUSION
•Atherosclerosis
•Angina
•High Cholesterol
•Hypertension
•Heart Failure
•Pulmonary Emboli
•Peripheral Vascular Disease

34. •Vasodilators
•Vasopressors
•Diuretics
•Antidysrhythmic
•Cardiac Glycosides
•Anticoagulants
•Antiplatelet
•Thrombolytic
•Lipid Lowering
MEDICATIONS RELATED TO PERFUSION

35. Ineffective Tissue Perfusion
Nursing Diagnosis & Care Plans

36. COMMON CAUSES OF INEFFECTIVE TISSUE
PERFUSION (RELATED TO):
-Hypervolemia & hypovolemia
(excess fluid & dehydration/blood loss)
-Low hemoglobin -Insufficient blood flow
-Hypoventilation -Trauma
-Infection -Shock
-Cardiac disorders-Respiratory disorders
-Vascular disorders

37. Patientwillmaintainadequate
peripheralperfusionasevidenced
bystrongpedalpulses,warmskin
temperature,andintactskin
withoutedema.
COMMON NURSING CARE PLANNING GOALS AND
EXPECTED OUTCOMES FOR INEFFECTIVE TISSUE
PERFUSION:

38. •Patient will maintain cardiopulmonary
perfusion as evidenced by normal sinus
heart rhythm, heart rate within normal
limits, no complaints of shortness of
breath and normal Sa02.
•Patient will demonstrate appropriate
lifestyle modifications to support
adequate tissue perfusion.

39. •Patient will have an
improvement in cerebral
perfusion as evidenced
by intact orientation to
person, place, and time.

40. NURSE
Just another word to describe a
person strongenough to
tolerate everything
and softenough to
understand everyone.