Samenvatting – BIAZ-toets 1 - Circulatie
1
,Inhoudsopgave
Embryogenese van het cardiovasculaire stelsel.............................................................................................. 8
Embryogenese......................................................................................................................................................8
Het hart................................................................................................................................................................8
De foetale circulatie.............................................................................................................................................9
Placenta..............................................................................................................................................................10
Na de geboorte...................................................................................................................................................10
Anatomie van het hart................................................................................................................................. 11
Atria en ventrikels..............................................................................................................................................11
Hartwand...........................................................................................................................................................12
Hartkleppen........................................................................................................................................................12
Atrioventriculaire kleppen (AV-kleppen):......................................................................................................12
Halvemaanvormige kleppen..........................................................................................................................12
Coronairen..........................................................................................................................................................13
Circulatie..................................................................................................................................................... 14
De kleine circulatie.............................................................................................................................................14
De grote circulatie..............................................................................................................................................14
Optimale pompfunctie.......................................................................................................................................14
Normaalwaarden volwassenen (hartfrequentie, bloeddruk, harttonen, effect sympathicus en parasympaticus
op de vitale functies)..........................................................................................................................................15
Effect Sympathicus (gaspedaal van het lichaam)..........................................................................................15
Effect parasympaticus (rempedaal en acculader van het lichaam)...............................................................15
Hemodynamische drukken........................................................................................................................... 16
Verschillende drukken in het lichaam................................................................................................................17
Centraal veneuze druk (CVD).........................................................................................................................17
Cardiac Output (OC) / Hartminuutvolume (Hartfrequentie x slagvolume)...................................................17
Mean Aterial Pressure (MAP)........................................................................................................................17
Slagvolume.....................................................................................................................................................17
Pulmonal arterial pressure (PAP)...................................................................................................................17
Pulmonal vascular resistance (PVR)...............................................................................................................17
Pulmonaal veneuze druk (wedge).................................................................................................................17
Systematische vaatweerstand (SVR).............................................................................................................17
Lactaat...........................................................................................................................................................18
Frank Starling Curve...........................................................................................................................................19
Decompensatio cordis.................................................................................................................................. 20
Pathofysiologie...................................................................................................................................................20
Oorzaken............................................................................................................................................................20
4 categorieën van hartfalen...............................................................................................................................20
Lichamelijke kenmerken.....................................................................................................................................20
Links decompensatio cordis...............................................................................................................................21
Backward failure............................................................................................................................................21
Forward failure..............................................................................................................................................21
2
, Astma cardiale...............................................................................................................................................21
Rechts decompensatio cordis.............................................................................................................................21
Backward failure............................................................................................................................................21
Verpleegkundige observaties.............................................................................................................................22
Algemeen:......................................................................................................................................................22
Ademhaling....................................................................................................................................................22
Pols.................................................................................................................................................................22
Bloeddruk.......................................................................................................................................................22
Overvulling.....................................................................................................................................................22
Diagnostiek.........................................................................................................................................................22
Behandeling van hartfalen.................................................................................................................................23
Medicatie.......................................................................................................................................................23
Leefstijladviezen............................................................................................................................................23
Angina pectoris (AP).................................................................................................................................... 24
Pathofysiologie...................................................................................................................................................24
Prognose.............................................................................................................................................................24
Diagnostiek.........................................................................................................................................................25
Behandeling........................................................................................................................................................26
Medicamenteuze therapie............................................................................................................................26
Onderhoudsbehandeling...............................................................................................................................26
Hartinfarct................................................................................................................................................... 27
Pathofysiologie...................................................................................................................................................27
............................................................................................................................................................................27
Diagnostiek.........................................................................................................................................................28
Behandeling........................................................................................................................................................28
Algemene behandeling..................................................................................................................................28
Complicaties.......................................................................................................................................................29
Maatregelen bij verdenking hartinfarct.............................................................................................................29
Postmyocardinfarctsyndroom (syndroom van Dressler)................................................................................29
Shock........................................................................................................................................................... 30
Herkennen vitaal bedreigde patiënt..................................................................................................................30
Vroege herkenning........................................................................................................................................30
Sepsis.............................................................................................................................................................30
Screeningsinstrumenten................................................................................................................................30
Shock algemeen.................................................................................................................................................30
Definitie.........................................................................................................................................................30
Verschillende fases........................................................................................................................................31
Soorten shock.....................................................................................................................................................32
Hypovolemische shock..................................................................................................................................32
Behandeling...................................................................................................................................................33
Obstructieve shock........................................................................................................................................33
Cardiogene shock..........................................................................................................................................34
Distributieve shock.......................................................................................................................................35
Inleiding ritme............................................................................................................................................. 38
3
, Ritmestrook........................................................................................................................................................38
Normaalwaarden van een sinusritme................................................................................................................38
ECG.....................................................................................................................................................................39
Het maken van een correct en leesbaar ECG.....................................................................................................40
Plaatsen van de borstafleidingen:.................................................................................................................40
Driehoek van Einthoven............................................................................................................................... 41
Beoordeling van het ECG.............................................................................................................................. 42
ST-segment.........................................................................................................................................................42
ST-elevatie.....................................................................................................................................................42
ST-depressie...................................................................................................................................................42
Het geleidingssysteem................................................................................................................................. 43
Actiepotentiaal............................................................................................................................................ 44
Ecg-papier, QRS-complex en bepalen van de frequentie...............................................................................45
Frequentie van een regelmatig ritme.................................................................................................................45
Frequentie van een onregelmatig ritme............................................................................................................45
Bloedstolling................................................................................................................................................ 46
Primaire homestase...........................................................................................................................................46
Secundaire hemostase.......................................................................................................................................47
Stollingsfactoren................................................................................................................................................48
Fibrinolytisch systeem........................................................................................................................................48
Verhoogde bloedingsneiging.........................................................................................................................48
Bloedingsstoornissen.....................................................................................................................................48
Oorzaken van een veranderde stolling...............................................................................................................49
Trombose.......................................................................................................................................................49
Post trombotisch syndroom..........................................................................................................................49
DIS (Diffusie intravasale stolling)...................................................................................................................49
Symptomen veranderde stolling........................................................................................................................49
Bloedtransfusie...................................................................................................................................................50
Bloedproducten.............................................................................................................................................50
Plasmaproducten...........................................................................................................................................50
Verhoogde stollingsneiging (vorming van trombose)........................................................................................50
Trias van Virchow...........................................................................................................................................51
Behandeling trombose met anticoagulantia.................................................................................................51
Preventie van trombose................................................................................................................................51
Laboratoriumonderzoek.....................................................................................................................................52
Activated partial thromboplastin time (aPTT)...............................................................................................52
Prothrombinetijd (PT)....................................................................................................................................52
International Normalized Ratio (INR)............................................................................................................52
Trombocyten (bloedplaatjes)........................................................................................................................52
Fibrinogeen....................................................................................................................................................52
D-Dimeer........................................................................................................................................................53
Bewaking en verpleegkundige observaties...................................................................................................53
Bloedtransfusie............................................................................................................................................ 54
4
1
,Inhoudsopgave
Embryogenese van het cardiovasculaire stelsel.............................................................................................. 8
Embryogenese......................................................................................................................................................8
Het hart................................................................................................................................................................8
De foetale circulatie.............................................................................................................................................9
Placenta..............................................................................................................................................................10
Na de geboorte...................................................................................................................................................10
Anatomie van het hart................................................................................................................................. 11
Atria en ventrikels..............................................................................................................................................11
Hartwand...........................................................................................................................................................12
Hartkleppen........................................................................................................................................................12
Atrioventriculaire kleppen (AV-kleppen):......................................................................................................12
Halvemaanvormige kleppen..........................................................................................................................12
Coronairen..........................................................................................................................................................13
Circulatie..................................................................................................................................................... 14
De kleine circulatie.............................................................................................................................................14
De grote circulatie..............................................................................................................................................14
Optimale pompfunctie.......................................................................................................................................14
Normaalwaarden volwassenen (hartfrequentie, bloeddruk, harttonen, effect sympathicus en parasympaticus
op de vitale functies)..........................................................................................................................................15
Effect Sympathicus (gaspedaal van het lichaam)..........................................................................................15
Effect parasympaticus (rempedaal en acculader van het lichaam)...............................................................15
Hemodynamische drukken........................................................................................................................... 16
Verschillende drukken in het lichaam................................................................................................................17
Centraal veneuze druk (CVD).........................................................................................................................17
Cardiac Output (OC) / Hartminuutvolume (Hartfrequentie x slagvolume)...................................................17
Mean Aterial Pressure (MAP)........................................................................................................................17
Slagvolume.....................................................................................................................................................17
Pulmonal arterial pressure (PAP)...................................................................................................................17
Pulmonal vascular resistance (PVR)...............................................................................................................17
Pulmonaal veneuze druk (wedge).................................................................................................................17
Systematische vaatweerstand (SVR).............................................................................................................17
Lactaat...........................................................................................................................................................18
Frank Starling Curve...........................................................................................................................................19
Decompensatio cordis.................................................................................................................................. 20
Pathofysiologie...................................................................................................................................................20
Oorzaken............................................................................................................................................................20
4 categorieën van hartfalen...............................................................................................................................20
Lichamelijke kenmerken.....................................................................................................................................20
Links decompensatio cordis...............................................................................................................................21
Backward failure............................................................................................................................................21
Forward failure..............................................................................................................................................21
2
, Astma cardiale...............................................................................................................................................21
Rechts decompensatio cordis.............................................................................................................................21
Backward failure............................................................................................................................................21
Verpleegkundige observaties.............................................................................................................................22
Algemeen:......................................................................................................................................................22
Ademhaling....................................................................................................................................................22
Pols.................................................................................................................................................................22
Bloeddruk.......................................................................................................................................................22
Overvulling.....................................................................................................................................................22
Diagnostiek.........................................................................................................................................................22
Behandeling van hartfalen.................................................................................................................................23
Medicatie.......................................................................................................................................................23
Leefstijladviezen............................................................................................................................................23
Angina pectoris (AP).................................................................................................................................... 24
Pathofysiologie...................................................................................................................................................24
Prognose.............................................................................................................................................................24
Diagnostiek.........................................................................................................................................................25
Behandeling........................................................................................................................................................26
Medicamenteuze therapie............................................................................................................................26
Onderhoudsbehandeling...............................................................................................................................26
Hartinfarct................................................................................................................................................... 27
Pathofysiologie...................................................................................................................................................27
............................................................................................................................................................................27
Diagnostiek.........................................................................................................................................................28
Behandeling........................................................................................................................................................28
Algemene behandeling..................................................................................................................................28
Complicaties.......................................................................................................................................................29
Maatregelen bij verdenking hartinfarct.............................................................................................................29
Postmyocardinfarctsyndroom (syndroom van Dressler)................................................................................29
Shock........................................................................................................................................................... 30
Herkennen vitaal bedreigde patiënt..................................................................................................................30
Vroege herkenning........................................................................................................................................30
Sepsis.............................................................................................................................................................30
Screeningsinstrumenten................................................................................................................................30
Shock algemeen.................................................................................................................................................30
Definitie.........................................................................................................................................................30
Verschillende fases........................................................................................................................................31
Soorten shock.....................................................................................................................................................32
Hypovolemische shock..................................................................................................................................32
Behandeling...................................................................................................................................................33
Obstructieve shock........................................................................................................................................33
Cardiogene shock..........................................................................................................................................34
Distributieve shock.......................................................................................................................................35
Inleiding ritme............................................................................................................................................. 38
3
, Ritmestrook........................................................................................................................................................38
Normaalwaarden van een sinusritme................................................................................................................38
ECG.....................................................................................................................................................................39
Het maken van een correct en leesbaar ECG.....................................................................................................40
Plaatsen van de borstafleidingen:.................................................................................................................40
Driehoek van Einthoven............................................................................................................................... 41
Beoordeling van het ECG.............................................................................................................................. 42
ST-segment.........................................................................................................................................................42
ST-elevatie.....................................................................................................................................................42
ST-depressie...................................................................................................................................................42
Het geleidingssysteem................................................................................................................................. 43
Actiepotentiaal............................................................................................................................................ 44
Ecg-papier, QRS-complex en bepalen van de frequentie...............................................................................45
Frequentie van een regelmatig ritme.................................................................................................................45
Frequentie van een onregelmatig ritme............................................................................................................45
Bloedstolling................................................................................................................................................ 46
Primaire homestase...........................................................................................................................................46
Secundaire hemostase.......................................................................................................................................47
Stollingsfactoren................................................................................................................................................48
Fibrinolytisch systeem........................................................................................................................................48
Verhoogde bloedingsneiging.........................................................................................................................48
Bloedingsstoornissen.....................................................................................................................................48
Oorzaken van een veranderde stolling...............................................................................................................49
Trombose.......................................................................................................................................................49
Post trombotisch syndroom..........................................................................................................................49
DIS (Diffusie intravasale stolling)...................................................................................................................49
Symptomen veranderde stolling........................................................................................................................49
Bloedtransfusie...................................................................................................................................................50
Bloedproducten.............................................................................................................................................50
Plasmaproducten...........................................................................................................................................50
Verhoogde stollingsneiging (vorming van trombose)........................................................................................50
Trias van Virchow...........................................................................................................................................51
Behandeling trombose met anticoagulantia.................................................................................................51
Preventie van trombose................................................................................................................................51
Laboratoriumonderzoek.....................................................................................................................................52
Activated partial thromboplastin time (aPTT)...............................................................................................52
Prothrombinetijd (PT)....................................................................................................................................52
International Normalized Ratio (INR)............................................................................................................52
Trombocyten (bloedplaatjes)........................................................................................................................52
Fibrinogeen....................................................................................................................................................52
D-Dimeer........................................................................................................................................................53
Bewaking en verpleegkundige observaties...................................................................................................53
Bloedtransfusie............................................................................................................................................ 54
4
