TBL 2/22/19
Know the difference between central and tissue perfusion.
When you think tissues – think specific places.
Central is generalized – cardiac output.
First sign of pumping problem is lungs. Left side failure is first right side is later in life.
Exemplars
- Angina (supply of O2 is less than demand)
Stable: relieve with rest and nitro
Unstable: unable to relieve with rest and nitro; its changing. We worry about this.
- Coronary Artery Disease – damage to arteries of heart
- Atherosclerosis: plaque (hardening)
Hyperlipidemia -
- Myocardial Infarction: tissue death; heart attack
STEMI: S-T seg is elevated
NonSTEMI: S-T seg isn’t elevated
- Hypertension:
- Congenital Heart defects: branch down into 4 main categories; two main branches: cyanotic and
non-cyanotic
- Heart Failure:
CASE: R.B. works at large industrial facility. Comes in 10 min ago with chest pain.
Reported feeling tired and weak all morning. Had pain in back and jaw earlier. Now going
down into his left shoulder and arm. “im having a hard time catching my breath. My
chest is hurting, and I feel sick to my stomach.”
What is angina? Discuss stable vs unstable
Discuss o2 demand and supply
How do you measure perfusion?
What are the 3 principal presentation of unstable angina?
Rest angina – angina occurring at rest and prolonged, usually > 20 minutes
New onset angina – new onset angina of at least CCS Class III severity
Increasing angina – previously diagnosed angina that has become distinctly more
frequent, loner in duration, or lower in threshold (i.e. increased by ≥ 1 CCS class to at
least CCS class III severity).
, Learning Issues
Discuss atypical chest pain
Presentation of angina in males and females
Rf for alteration in perfusion
Modifiable and Unmod rf chart
Question 1: Based on the information in a client’s medical record, which topic is the highest priority for
the nurse to include in the initial teaching plan for a 26 year old client who has blood pressures ranging
from 150/84 to 162/90 mm Hg?
Health hx: Denies any chronic health problems, takes no meds currently
Physical Exam: 5 ft 6 in, 115 lb (52.2 kg), BMI 18.6
Social and diet hx: works as an accountant, 1 glass of wine once or twice weekly, eats “fast food”
frequently.
Answers:
A. Symptoms of acute stroke and MI
B. Adverse effects of alcohol on blood pressure
C. Methods for decreasing dietary caloric intake
Know the difference between central and tissue perfusion.
When you think tissues – think specific places.
Central is generalized – cardiac output.
First sign of pumping problem is lungs. Left side failure is first right side is later in life.
Exemplars
- Angina (supply of O2 is less than demand)
Stable: relieve with rest and nitro
Unstable: unable to relieve with rest and nitro; its changing. We worry about this.
- Coronary Artery Disease – damage to arteries of heart
- Atherosclerosis: plaque (hardening)
Hyperlipidemia -
- Myocardial Infarction: tissue death; heart attack
STEMI: S-T seg is elevated
NonSTEMI: S-T seg isn’t elevated
- Hypertension:
- Congenital Heart defects: branch down into 4 main categories; two main branches: cyanotic and
non-cyanotic
- Heart Failure:
CASE: R.B. works at large industrial facility. Comes in 10 min ago with chest pain.
Reported feeling tired and weak all morning. Had pain in back and jaw earlier. Now going
down into his left shoulder and arm. “im having a hard time catching my breath. My
chest is hurting, and I feel sick to my stomach.”
What is angina? Discuss stable vs unstable
Discuss o2 demand and supply
How do you measure perfusion?
What are the 3 principal presentation of unstable angina?
Rest angina – angina occurring at rest and prolonged, usually > 20 minutes
New onset angina – new onset angina of at least CCS Class III severity
Increasing angina – previously diagnosed angina that has become distinctly more
frequent, loner in duration, or lower in threshold (i.e. increased by ≥ 1 CCS class to at
least CCS class III severity).
, Learning Issues
Discuss atypical chest pain
Presentation of angina in males and females
Rf for alteration in perfusion
Modifiable and Unmod rf chart
Question 1: Based on the information in a client’s medical record, which topic is the highest priority for
the nurse to include in the initial teaching plan for a 26 year old client who has blood pressures ranging
from 150/84 to 162/90 mm Hg?
Health hx: Denies any chronic health problems, takes no meds currently
Physical Exam: 5 ft 6 in, 115 lb (52.2 kg), BMI 18.6
Social and diet hx: works as an accountant, 1 glass of wine once or twice weekly, eats “fast food”
frequently.
Answers:
A. Symptoms of acute stroke and MI
B. Adverse effects of alcohol on blood pressure
C. Methods for decreasing dietary caloric intake
