NMNC 4410 - EXAM #1 STUDY GUIDE
Ischemia - Answers -occurs when blood supply is decreased but still available to the
target tissue.
- cells don't die and we have a warning system that tells us something isn't right.
- reversible.
Infarction - Answers -tissue death due to inadequate blood supply.
Red blood cell - Answers -acts as a train car for hemoglobin - Hb picks up oxygen.
When does impairment of central perfusion occur? - Answers -when cardiac output is
inadequate.
Populations at greatest risk for impaired tissue perfusion? (4) - Answers -- middle-aged
and older adults
- men (genetics and cortisol levels)
- African Americans
- infants w/ congenital heart defects
Signs of inadequate central perfusion in infants? (4) - Answers -- poor feeding/inability
to latch onto breast
- poor weight gain
- failure to thrive
- dusky color
Signs of inadequate perfusion in children? (2) - Answers -- squatting and fatigue
- developmental delay (failure to hit milestones)
Common diagnostic tests (inadequate perfusion)? (4) - Answers -- lab tests -> lactate
(byproduct of anaerobic metabolism, if >2, we worry about perfusion problem at tissue
level)
- ECG (shows if we have ischemia or infarction)
- cardiac stress test
- radiographic studies (chest x-ray, US, arteriogram)
Lab Tests? (3) - Answers -- Natriuretic peptides (atrial and brain - released based on
overstretching of the heart - seen in pts w/ HF)
- Creatine kinase (elevated muscle breakdown)
- TROPONIN (enzyme released by cardiac muscle when it lyses)
Primary Prevention - inadequate perfusion? (4) - Answers -- smoking and nicotine
cessation
- diet
- exercise
, - weight control
BP Screening:
What age should it begin?
How often should it occur? - Answers -- should begin at age 18.
- if BP is <120/80, done every 2 years.
if BP is higher, needs to be screened every year.
Lipid Screening:
When should men have it done? Women? - Answers -- if no risk for CAD,
recommended for men >35, if risk start at about age 20
- if no risk for CAD. recommended for women age 45, if risk start at about age 20.
Pharmacotherapy for impaired central perfusion? (5) - Answers -- antihypertensives
(thiazide diuretic - hydrochlorothiazide, ACE inhibitors, ARBs, calcium channel blockers,
beta blockers)
- vasodilators (nicardipine, nitroglycerin, siduym nitroprusside)
- antiarrhythmics (amiodarone, calcium channel blockers, beta blockers)
- antianginal agents (nitroglycerin)
- vasopressors (norepi, dopamine, phenylephrine)
Pharmacotherapy for impaired tissue perfusion? (4) - Answers -- anticoagulants
(heparin, warfarin, apixaban)
- thrombolytics (alteplase)
- lipid-lowering agents (statins)
- antiplatelet agents and platelet inhibitors (aspirin, clopidogrel)
Collaborative Interventions for inadequate central perfusion? (6) - Answers --
pacemaker insertion
- electrical cardioversion (people who are stable but are in lethal rhythms)
- ablation therapy
- intraaortic balloon pump (afterload reducer to hep w/ severe cardiogenic shock)
- cardiac valve surgery (tissue more common than mechanical valves)
- cardiac transplant
Collaborative interventions for inadequate tissue perfusion? (3) - Answers -- bypass
and/or graft surgery
- stent or angioplasty
- endarterecotomy (go in and suck out the plaque)
Systemic vascular resistance? - Answers -force opposing the movement of blood w/in
the blood vessels
2 big things involved in affecting BP? - Answers -SNS and RAAS
BP categories:
Ischemia - Answers -occurs when blood supply is decreased but still available to the
target tissue.
- cells don't die and we have a warning system that tells us something isn't right.
- reversible.
Infarction - Answers -tissue death due to inadequate blood supply.
Red blood cell - Answers -acts as a train car for hemoglobin - Hb picks up oxygen.
When does impairment of central perfusion occur? - Answers -when cardiac output is
inadequate.
Populations at greatest risk for impaired tissue perfusion? (4) - Answers -- middle-aged
and older adults
- men (genetics and cortisol levels)
- African Americans
- infants w/ congenital heart defects
Signs of inadequate central perfusion in infants? (4) - Answers -- poor feeding/inability
to latch onto breast
- poor weight gain
- failure to thrive
- dusky color
Signs of inadequate perfusion in children? (2) - Answers -- squatting and fatigue
- developmental delay (failure to hit milestones)
Common diagnostic tests (inadequate perfusion)? (4) - Answers -- lab tests -> lactate
(byproduct of anaerobic metabolism, if >2, we worry about perfusion problem at tissue
level)
- ECG (shows if we have ischemia or infarction)
- cardiac stress test
- radiographic studies (chest x-ray, US, arteriogram)
Lab Tests? (3) - Answers -- Natriuretic peptides (atrial and brain - released based on
overstretching of the heart - seen in pts w/ HF)
- Creatine kinase (elevated muscle breakdown)
- TROPONIN (enzyme released by cardiac muscle when it lyses)
Primary Prevention - inadequate perfusion? (4) - Answers -- smoking and nicotine
cessation
- diet
- exercise
, - weight control
BP Screening:
What age should it begin?
How often should it occur? - Answers -- should begin at age 18.
- if BP is <120/80, done every 2 years.
if BP is higher, needs to be screened every year.
Lipid Screening:
When should men have it done? Women? - Answers -- if no risk for CAD,
recommended for men >35, if risk start at about age 20
- if no risk for CAD. recommended for women age 45, if risk start at about age 20.
Pharmacotherapy for impaired central perfusion? (5) - Answers -- antihypertensives
(thiazide diuretic - hydrochlorothiazide, ACE inhibitors, ARBs, calcium channel blockers,
beta blockers)
- vasodilators (nicardipine, nitroglycerin, siduym nitroprusside)
- antiarrhythmics (amiodarone, calcium channel blockers, beta blockers)
- antianginal agents (nitroglycerin)
- vasopressors (norepi, dopamine, phenylephrine)
Pharmacotherapy for impaired tissue perfusion? (4) - Answers -- anticoagulants
(heparin, warfarin, apixaban)
- thrombolytics (alteplase)
- lipid-lowering agents (statins)
- antiplatelet agents and platelet inhibitors (aspirin, clopidogrel)
Collaborative Interventions for inadequate central perfusion? (6) - Answers --
pacemaker insertion
- electrical cardioversion (people who are stable but are in lethal rhythms)
- ablation therapy
- intraaortic balloon pump (afterload reducer to hep w/ severe cardiogenic shock)
- cardiac valve surgery (tissue more common than mechanical valves)
- cardiac transplant
Collaborative interventions for inadequate tissue perfusion? (3) - Answers -- bypass
and/or graft surgery
- stent or angioplasty
- endarterecotomy (go in and suck out the plaque)
Systemic vascular resistance? - Answers -force opposing the movement of blood w/in
the blood vessels
2 big things involved in affecting BP? - Answers -SNS and RAAS
BP categories:
