Exam (elaborations)
Perfusion Exam Questions and Answers 2024
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Exam of 32 pages for the course Perfusion at Perfusion (Perfusion Exam)
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Perfusion ExamPerfusion A&P - answer-promote perfusion of blood thru body
- cary cellular wastes to excretory organs
- promote return of blood to heart for oxygenation
Perfusion Assessment - answer- Health history
History of present illness
past medical history
family history
functional health patterns (nutrition, sleep, activity, sexuality, stress, personal habits)
--- weight loss/gain, special diets
-sleep apnea, dyspnea, fatigue, orthopnea
- sexual difficulty
- sedentary lifestyle, active, or activity intolerance
- caffeine use, alcohol, tobacco, illicit drugs
- stress- coping response
ADL's
Height and weight
Medications--- ALL
- current list of prescriptions
- OTC- decongestants, cold meds, nasal sprays, vitamins, laxatives
- CAM- garlic, fish oil, Curcumin
Risk Factors - answerNon modifiable
- age, family history, gender, race
Modifiable
- smoking
-obesity
- dyslipidemia
- stress
- sedentary life style
- modifiable medical conditions- HTN, DM, Metabolic syndrome
Signs and Symptoms - answerchest pain/discomfort
- location
- radiation
- onset
- duration
- rating
- descriptors
,- causes- Acute coronary syndrome, Inflammatory heart disorders, chest pain non
cardiac issue, leg pain
VS- are they normal
SOB/dyspnea/DOE
edema/weight gain
palpitations
fatigue/weakness
dizziness/syncope/fainting
auscultate heart sounds- s1-s2
Blood pressure - answerMean arterial pressure
pulsus paradoxus
pulse pressure
orthostatic measurement
Mean Arterial pressure - answer-Average pressure
-taking systolic and diastolic pressures into consideration
-MAP of at least 65mmHg= required for adequate perfusion
Pulsus Paradoxus - answer- Systolic BP falls greater than 10mmHg on INSPIRATIONS
- Can indicate excessive fluid in the pericardial sac
- Restricts normal heart contraction- seen in pericarditis/endocarditis
Pulse Pressure - answer- Systolic BP- diastolic BP= pulse pressure
- normal range is 30 to 40mmHg
- Increasing pulse pressure= arteriosclerosis and exercise
- Decreasing pulse pressure= hemorrhage, hypovolemia and shock
- BP 120/80 PP= 120-80= 40
Orthostatic Measurements - answer- include measuring the BP and HR
- HR in three positions- lying or supine, sitting and dangling feet if pt can tolerate, and
standing
- Orthostatic VS are positive if:
- SBP decreases greater than 10mmHg- 20mmHg and/or
- HR increases greater than 15 to 20 and/or
- observation of patient's condition with position changes can also indicate a positive
orthostatic response, such as ℅ dizziness, sudden cool and clammy skin, or
diaphoresis
Pulses - answerpresent or absent
quality/symmetry
pulse alternans
pulse deficit
assess carotid pulse
Skin extremities - answer- color/temperature
,- bruising/petechiae
- edema/CRT
s1 - answerfirst heart sound
closure of mitral and tricuspid valves
S2 - answersecond heart sound
closing of aortic and pulmonic valve
s3 - answerventricular gallor
occurs as blood enters noncompliant ventricles in early diastole
early sign of heart failure
s4 - answeratrial gallop
occurs as blood enters atrium during atrial contraction into noncompliant ventricles at
end of ventricular diastole
s3 with s4 - answersummation gallop
sign of severe heart failure
murmurs - answer-gentle blowing, swooshing sounds
-turbulent blood flow through the valves
Conditions
- velocity of blood increases
- Viscosity of blood decreases
- Structural defects in the valves
- unusual openings in the chambers
Clicks - answerejection clicks
Snaps - answerabnormal motion of stenotic mitral valve
Rubs - answerFriction sound occurring with myocardial contraction
Stroke volume - answeraffected by alteration in any of the following: preload, after load,
and/or contractility
defined as the amount of blood ejected by the left ventricle per beat
Preload - answer- stretch in myocardial muscle fibers before systole
- determined by venous return to the heart and elasticity of cardiac muscle fibers
Afterload - answeramount of resistance as blood is ejected from ventricles
Contractility - answermeans the force at which the myocardial muscle cells contract
, Ejection Fraction - answerpercent of blood the left ventricle ejects with each contraction
Normal- 55-65%
Cardiac Output - answerCO=SV x HR
normal for CO= 4 to 8 L/min
normal SV= 60 to 120ml/beat
CO can be measured by invasive monitoring devices= pulmonary artery catheter
Life Span Considerations - answer- Stiffening and loss of elasticity of vessels
- Thickening of valves and muscles
--- increased size (hypertrophy) of left ventricle and atrium
--- Calcification of aorta
--- results in progressive decrease in CO
- Decreased sensitivity of receptors
--- results in slow response to changes in position (postural hypotension)
- Decreased number of cells conducting electrical impulses
--- less adaptive response to activity
Diversity and Spiritual Considerations - answer- Dietary choices
- Acceptance of blood or blood products
- Health practices (use of herbals)
- description of pain
- Perception of response to medications
Serum blood testing - answerAll serum/blood laboratory testing:
- ordered restrictions on food/fluid intake
- any restriction in medication administration
- specimens obtained on time if being done serially or based on administration of
medications
After blood is drawn:
- monitor venipuncture site for bleeding, hematoma, phlebitis and/or infection
-watch for lab results
- report significant abnormalities in results to MD
B type Natriuretic Peptide (BNP) - answerBNP
- neurohormone secreted from ventricles in response to increased preload
- serum marker for heart failure
- results in elevated ventricular pressure
- Normal level should be <100pg/mL
Synthetic BNP
- available IV
- nesiritide (Natrecor)
- used to treat acute exacerbations of heart failure
- causes arterial and venous dilation and diuresis
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