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Perfusion ( 2-3 layers = simple) (Nursing Assessment (Techniques…
Perfusion ( 2-3 layers = simple)
Physiology/ Pathophysiology
Neural Control
Controlled by reticular formation of medulla & lower third of pons
Intrinsic reflex
Baroreceptors; Short term & rapid; responds to CVS stimuli;
Chemoreceptors = Regulate ventilation; Monitor O2, CO2, H+ in blood
↓ BP -> ↓ O2 -> ↑CO2/ H+ -> Stim chemoreceptors -> HTN
Extrinsic reflex
From outside CVS; pain & temp. change; response through hypothalamus
Baroreceptors
Located in carotid sinus, aortic arch & aortic sinus
Stretch (tension) in artery walls causes HR change/ vasodilate/ vasoconstrict
Hormonal Control
Vasopressin (Anti-diuretic hormone)
Produced by pituitary gland
Responds to ↓ Blood volume/ BP
Vasoconstrictor to ↑ BP/ Blood volume
Catecholamines
Released from adrenal gland
Epinephrine & norepinephrine vasoconstricts to ↑ BP/ Blood volume
Renin-angiotensin-aldosterone system
Renin
Enzyme made & stored in juxtaglomerular cells (kidney)
Released in response to ↑ SNS activity/ ↓ BP/ ↓ [Na+]
Converts
Angiotensinogen (Inactive) from liver
Angiotensin I
Angiotensin II
Strong vasoconstrictor; acts on arterioles to ↑ BP
↑ Na+ reabsorption in Proximal convoluted tubules of Kidney to ↑ BP
Aldosterone secretion
From adrenal cortex - kidney
Promoting Na+ & water retention by kidneys to ↑ BP & Blood volume
Blood Pressure
Cardiac Output
CO = HR * SV
Peripheral Vascular Resistance
Vessel elasticity
Arteriosclerosis = Hardening
Vessel radius/ diameter
Vasomotor tone
Vasoconstrict OR vasodilate
Vasodilation = Hormonal factors, ANS, Kidney vasodilators
Vasoconstriction = ANS, Kidney RAAS, adrenal medulla hormones
Smooth muscle
Blood viscosity
RBC #, plasma proteins, hydration
"Force that must be overcome to push blood through CVS"
Mean Arterial Pressure (MAP) = Diastolic pressure + 1/3 pulse pressure
Exemplar of HTN
Types of HTN
Primary (Essential) HTN
Poor Kidney Function
High Dietary Sodium
Secondary HTN
Kidney disease
Nephrosclerosis
Tumors
Pheochromocytoma
Atherosclerosis
Contributing Factors
Lack exercise
Smoking
Obesity
Increase vessel length
Stress
Target Organ Damage
Arteries: Atherosclerosis -> CAD, CVD/ Stroke, PVD; Heart: CAD (Angina), left ventricular hypertrophy; Brain: Cerebrovascular disease (stroke/ dementia); Kidneys: Nephropathy & renal failure; Eye: retinopathy
Nursing Assessment
Signs
Examination, measurement, diagnostic tests
Symptoms
Perceived by patient
Pain, edema, dizziness, LOC, SOB, cough, cramping, numbness/ tingling, headache, impaired vision
Techniques
Interview
Risk factors, Pmhx
Inspect
General appearance, skin colour, breathing
Auscultate
HR & rhythm
Palpate
Pulses
Measure
HR, BP, Capillary refill, BMI
Normal Findings = Oriented, At ease, 60-100 BPM regular; <120/80 mmHg, pulses present, warm, pink, elastic skin turgor, Cap refill <2 sec, pink nail beds, BMI 18.5 - 24.9 kg/m^2
Abnormal findings = Pallor/ cyanosis; Cool skin; No pulse; slow cap refill; poor skin turgor; tachycardia; hypotension; abnormal heart sounds/ rhythm; DLOC; edema
Management
Types of Prevention
Primary prevention
Relax, Non-Smoking, Swim, Vegetables
Secondary prevention
Screening (BP, lipids)
Tertiary prevention
Cardiac rehab, medication, quit smoking, CABG
Antihypertensive medication
"flow of blood through arteries & capillaries to tissues that deliver nutrients & oxygen to cells"
Angiotensin-converting enzyme
Found in endothelium of lungs
Objective
Subjective
Unclear (95%)
identifiable