Perfusion concept Sim Chart PDF

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Concept Notebook Name: Ravshan Dursunov

Concept: Perfusion

Course: BSN 366

Activity:VCBC

Faculty Facilitator: Mel Obasi, MSN, RN

Date/Time: 1/22/21

If you did a notebook for this concept in a previous term, you should add to the content, but you will need to date all new content and expand, using different color and/or font. Submitting the same notebook without noting the changes is considered plagiarism. ANY plagiarism issues noted will result in a 0 grade. The assignment will need to be redone for the ability to pass the course, but your score will remain a 0. Example: Gas Exchange BSN205; Gas Exchange BSN246, Gas Exchange BSN366 This will also serve as a study aide for you as you continue through the program, study for the HESI and NCLEX exams. Your reference should be your course textbooks available via the course link, so please site per APA guidelines. Do NOT copy and paste, it must all be in your own words. Client (virtual or living) background: Please tell us a little about the client you cared for today, either virtual or living, just one sentence telling us about them. For living clients, no personal identifying information needed. I cared for John Solinger who was readmitted after being dischared 6 days ago, who was seen for a femur fracture and open reduction internal fixation with intramedullary rod was performed. He came back because he started experieing redness and swelling in the surgical site, as well as pain.

Related concepts (explain): 1/22/21 Cognition – it is well documented that when someone has a low perfusion, there is a big increased risk of dementia. Gas Exchange – happens between oxygen and carbon dioxide in the alveoli. Oxygen then goes in the blood to be perfused all over the body. Mobility – a big deal to this patient because he had surgery and he is not able to move. Immobility can cause poor perfusion. Nutrition – if perfusion is poor, all of the nutrients and electolytes will have issues being absorbed. This person should eat more iron so there is more hemoglobins to carry oxygen. Patient Education – a big deal to John, as he needs to learn about proper nutrition and exercises while he is immobile to facilitate better perfusion, and prevent blood clots. Inflammation – redness near the surgical site indicates inflammation, therefore will need to be

Related exemplars: 1/22/21 Asystole Third-Degree Heart Block Septic Shock Anaphylactic Shock Endocarditis Deep Vein Thrombosis Atrial Septal Defect

looked at to rule out infection, DVT.

Related Assessments (explain): 1/22/21 Blood Pressure – a really good indicator of poor perfusion, or sepsis. My patients BP jumped up during stay. Heart Rate – the speed of your heart controls perfusion. If it is low, then perfusion will be low, and the same the other way around. Neuro – should be assessed regularly as cerebral tissue perfusion can also be affected. Skin – this patient has redness which indicates inflammation. Skin can be checked for poor perfusion by assessing color of it. History – it is important to gather everything that happened to John after the surgery when he went home, all the medications he took, and how adherent he was with his discharge instructions. Pain – The ultimate sign of impaired perfusion, he is having pain at the surgical site which can be an infection, or a DVT. Edema Assesment – assessing for fluid builup, can be a good indicator for poor perfusion, especially if the reasoning is cardiac related.

Related Lab & Diagnostic Test (explain): from 07/20 and 1/22/21 Ck - elevated after an MI, indicative of poor perfusion and ischemia. Lactate dehydrogenase – elevated after damage to the myocardium and erythrocytes. Natriuertic Peptides- detects heart failure, a perfusion based disorder. Troponin- indicative of myocardial injury. Lipids- hyperlipidemia can increase the risk of MI or poor perfusion due to disorders such as athelosclerosis. Electrocardiogram – a 12 lead can record electronic pulses of the heart, which can show disorders of the cardiac system, which affects perfusion. Chest X- Ray – visualization of the lungs, ribs, clavicles, vertebrae, heart and major thoracic vessels, which can show impaired perfusion. Droppler Test- can be used to rule out DVT. CBC – can be used to rule out an infection.

Related Nursing Interventions (explain): 07/20 and 1/22/21 Asess for signs of decreased tissue perfusion – particular clusters of signs and symptoms occur with differing causes. Evaluation of ineffective tissue perfusion defining characteristics provides a baseline for future comparison. Check Respirations – cardiac malfunction or ischemic pain may result in respiratory distress. Record BP readings for orthostatic – stable bp is needed to keep sufficient tissue perfusion. Monitor higher functions, speed, alertness – indicators of location or degree of cerebral circulation of perfusion are alteration in cognitive and speech content. Use Pulse Ox to monitor oxygen sat and pulse rate – useful in detecting changes in oxygenation, which is part of perfusion. Check HGB levels – low levels reduce the uptake of oxygen at exchange site which reduce the oxygen delivery to the tissues. Monitor intake, observe changes in urine output. Record Specific gravity as necessary – reduced intake may consequence in lowered circulating volume, which negatively affects perfusion and organ function.

Perform ABG- record the results of ABG. Give Pain meds – proper premedicating patient before exercises can improve patient adherence to the exercises. Related Medications (explain): 07/20 and 1/22/21 Vasodilators- increase the diameter of blood vessels in a variety of ways that block normal mechanisms. Lisinopril, nitrate, hydralazine, minoxidil. Vasopressors - decrease the diameter of blood vessels. Epi, nor Epi, dobutamine. Diuretics – reduce blood volume by reabsorption of sodium in the kidneys. ^ urine output. Furosemide, hcthzd, triamterene, spironolactone. Antidysrhythmics – correct erratic electrical impulses to create regular cardiac rhythms, by blocking electrolytes that effect electrical conduction in the heart. Nifedipine, verapamil, diltiazem, Lopressor, metoprololol, and Toprol. Cardioglycosides – have a positive inotropic effect with a lowering of heart rate to increase cardiac output and are used for the treatment of hf. Digoxin. Anticoagulants – prevent blood clotting at several locations in the clotting cascade to suppress the production of fibrin. Prevents venous thrombosis. Heparin, exoprin, warfarin sodium, and ardeparin. Antiplatelet – agents prevent platelets from aggregating to form clots. Prevents arterial thrombosis. Tirofiban,

Potential Complications (explain): 07/20 and 1/22/21 Heart Failure – long standing hypertension, cad, and MI. impaired pumping or filling of the heart. Hypertension – not controlling your blood pressure with antihypertensive meddications can lead to hypertension. Myocardial Infarction – when perfursion from coronary arteries is impaired, ischemia causes irreversible necrosis resulting in MI. Pulmonary Embolism – blood in the lung caused by embolism that impairs perfusion, increasing pulmonary arterial pressure by increasing pulmonary vascular resistance. Stroke – if cebral perfusion is impaired, stroke can occur from obstruction, or hemorrhage, which can be fatal if not controlled right away. Peripheral Artery Disease- if perfusion is impaired for a long time, narrowed blood vessels reduce blood flow to the limbs. DVT – this patient is in the risk of having a blood clot, that can cause pain and swelling in the surgical site, due to immobility, as he said he hasn’t moved since the surgery. Sepsis – this patient has indicators of an infection in the surgical site, and had cultures obtained priorly. If tx for

Collaborative Care (explain): Nutrition Therapy – it is important that John talks to a registered dietation to obtain a better diet. If he has infection, he will need better nutrition to fight of the organism and help the body heal. He is healing from a surgery and proper nutrition is needed for optimal healing. Exercise, Activity, Positioning – John has not had any exercises or performed ADLs post surgery as it was directed due to his pain. John will need to start performing more exercises in order for healing to occur and prevention of poor perfusion issues that can cause DVTs. Pharmacotherapy – John is having lots of pain, it is important that he talks to a pharmacist and gets educated about certain pain medications and their side effects. John needs drug education.

eptifibatide, abciximab, aspirin, ticagelor. Thrombolytics- disrupt blood clots that are impairing perfusion by lysing fibrin. TPA, alteplase, urokinase, streptokinase. Analgesics – this patient is in immense of pain, and needs their pain relieved around the clock. Premedication is very important to ensure comfort when performing ADLs.

infection doesn’t start soon, he may go septic.

References:

Giddens, J. (2017). Perfusion. In Concepts for nursing practice. St. Louis: Elsevier. My patient from Sim Chart....