COMP3_Tissue Perfusion2

• Preload: pressure inside the ventricle caused by filling
• Afterload: pressure that the heart has to pump against to get blood out

• Assess: syncolpolt episodes, SOB/ dysnic
• Causes:
• - fever: give PRN meds, acetaminophen/ ibuprofen
•  - pain
•  - hypovolemia
• O2 supplement, 2L nasal cannula
• Patient Safety:
• - syncopolt episode
• - valsalva maneuver
•  - cardioversion

• S&S: syncopolt episodes, LOC changes, SOB/ dysnea
• Pt safety: falls
• O2 supplement

• Assessment: risk for stroke, irreg pulse, pooling of blood
• Medications: anticoagulants, Calcium channel blockers- diltiazem
• O2 supplement

• Assess: xtra heart beat, determine how frequent
• ECG
• Continuous monitoring
• O2 supplement

• Assess pulse
• call code if no pulse
• Chest compression - 30/ 2 breaths or 100/ 1min
• De-fibrillation
• Meds: epinephrine

• Assess:
• VS,
• IV access,
• patent air way,
• BLS if needed,
• 12 lead EKG (10 electrodes,
• ICD (implantable cardioversion defib),
• ACLS (synchronized cardioversion, defib), telementery,
• pace maker status
• Meds:
• metoprolol,
• fursosemide,
• nitroglycerin,
• epinephrin,
• glucagon,
• lidocane,
• albuterol

• caused by: heart's inability to pump blood to satisfy body's demand
• -MI
• -demand > supply
• lead to: fluid overload

• Left: fluid backs up into respiratory circulation
• - pink, phrothy sputum
• -lung sounds
• -SOB
• Right: fluid backs up into systemic circulation,
• - peripheral edema
• - JVD

• Decrease preload:
• - diuretics
• - fluids & sodium restriction
• - positioning, sit up
• Decrease afterload:
• - vasodilators
• -HTN drugs
• Increase contractility: digoxin

• Assess: Respiratory status, peripheral edema, vital signs, fatigue
• Medications: diuretics, digoxin, O2 supplement
• Pt teaching: weight loss, diet, decrease demand on heart, schedule activity & rest
• monitor I & O
• decrease fluids & electrolytes (Na & IV intake)
• Diagnostic testing: BNP, chest xray, EKG, echocardiogram

• Discharge instructions
• monitor left ventricular systolic function
• ARB & ACE inhibitors
• smoking cessation counseling

• stable: predictable, occurs with exertion, nitro works
• prizmetal: vasospasms
• unstable: occurs at rest, nitro does not work

• Assess:
• -pain ( where is it? radiating? what were you doing? quality/ quanity)
• - SOB
• - Diaphoresis
• Meds: aspirin, nitro, beta blockers, statin, ACE inhibitors, heparin, cardiac cathederization
• Diagnostic testing:
• -troponin x3 Q6H
• -ECG
• - chest xray
• - Hemoglobin
• - hematocrit
• -lipid panel
• - electrolytes

• Assess:
• -vital signs
• -chest pain
• - SOB
• - anxiety
• PCI: percutaneous coronary intervention
• Diagnostic testing:
• -troponin x3 Q6H
• -ECG
• - chest xray
• - Hemoglobin
• - hematocrit
• -lipid panel
• - electrolytes

• Aspirin upon arrival
• Fibrinolysis within 30 mins
• PCI within 90 mins
• ACE inhibitors/ ARB for Left ventricular systolic dysfunction
• Discharge meds: Aspirin, beta blocker, statin, ACE inhibitor/ ARB

• Hypo:
• -dehyrdation
• -hemorrhage
• -obstruction at the venous end
• -decreased vasculature
• - shock
• Hyper:
• - edema
• - fluid overload

• Hypo:
• - VS - O₂ - I&O - Daily weight
• -give IV fluids/ blood products
• - orthostatic hypotension
• -hemoccult/gastrocult
• -pt. teaching & safety

• Hyper:
• - VS - O2 - I&O - Daily weight
• - dietary & fluid restriction
• - slow IV/ blood product intake
• - pt teaching & safety

• Assess:
• -vs - I&O - daily weight - medication

• Pt. teaching:
• - lifestyle changes
• - nutrition
• - medication
• - take blood pressure at home
• - smoking cessation

• Assess: fatigue, O2 supplement, CBC, rest
• maybe blood products

• Neutropenic precautions
• Avoid raw meats, vegies & fruits
• No live plants/ flowers
• PPE to protect patient
• Avoid dehydration
• PT & family teaching

Assess: bruising - petichiae - bleeding nose/ gums - occult bloodd

Avoid Injury: razors, needle sticks, suppositories, wear shoes

hold firm after blood drawn

• Assess:
• -Pain (lower extremities, intermittent claudication)
• - pulse
• - cap refill
• - wound care, possible complications
• - amputations
• - ABI
• Pt Teaching:
• - avoid standing/ sitting in dependent positions
• - do not cross legs
• Life style risk modifications:
• - exercise - smoking cessation - ideal weight - hyperlipidedemia - glucose & BP monitoring

• Assess: lower extremities, wound, vital signs
• wound vac
• wear compression stockings
• Pt Teaching/ safety
• - compression stockings for life
• - avoid standing/ sitting for prolonged period of time
• - nutrition (protein, vit A & C, zinc)
• - weight loss
• - foot & leg care
• - avoid additional trauma
• - moisturizers

• venous stasis
• endothielial damage
• hypercoagulable state

• Assess: high risk patients/ immobile pts/ pts in pain.
• Immobile pts:
• -move Q2H
• -ROM exercises
• - wear TED hose/ compression stockings
• - intermittent compression machine

• assess bleeding
• avoid needle stick
• humidify oxygen
• skin moisturizers
• electric razors
• minimize use of tape
• stool softener
• avoid moving pts with already established clots

• Inferior vena cava filter
•  stops clots from going into the heart

Prophylaxis & discharge intructions

• Ischemic: blockage of blood
• - blot buster
• Hemorrhagic: HTN/ Hypertensive crisis
• - want the blood to clot
• -craniotomy to evacuate blood

• LOC
• gaze
• visual fields
• facial palsy
• ataxia
• language; dysarthria
• drifting extremities
• sensory
• extinction/ attention
• distal motor function

• CT
• CTA
• MRI
• MRA

• manage HTN
• seizure precaution
• monitor neuro
• constipation & incontinence
• aspiration precaution
• speech therapy
• communication needs
• sensory perception alterations
• psychosocial needs
• Assess: VS VTE skin breakdown

• Prophylaxis VTE
• Assessed for rehab
• At Discharge:
• -stroke education
• - statin
• -therapies (thombolytic, antithrombotic, anticoagulant for afib)