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Acute Impaired Tissue Perfusion

Introduction

The ability of blood to circulate unimpeded throughout the body is what is known as perfusion, it involves the process of hemoglobin in the blood binding with oxygen through respiration in the lungs, in cases where the process is unable to be complete a perfusion state is said to exist. This deficiency can be identified through the diagnosis of the inadequate tissue perfusion symptoms and signs of organ failure, mainly due to lack or inadequate circulation of oxygenated blood through body organs or system. It is with this above understanding of its importance that this article seeks to address its effects on patients with acute impaired tissue perfusion, characteristic, other related factors, outcomes in both patient and caregiver diagnosis, relevant interventions and rationales and the family and patient teachings.

The perfusion within the ineffective tissues can occur in various body systems like the peripheral, cerebral, renal, gastrointestinal, and cardiopulmonary. It can be described as a condition that exhibits a reduction in the blood flow which results in the capillary tissues failure to nourish, since it causes less nutrition and oxygenation at the cellular level. There are divergent effects on a patient if the condition persists mainly if it is an acute condition can turn tragic and cause tissue or organ damage or even death, if it is a mild condition it will have no or few effects on the patient (Maylor ME, 2005).

Acute Impaired Tissue Perfusion

The main defining characteristics for diagnosing the condition include peripheral issues such as clammy skin, absent or absent peripheral pulses, edema, numbness or pain, cerebral issues like seizures, lethargy, restlessness, confusion decrease to light reaction, and cardiopulmonary effects such as angina or hypertension. The renal system can also have impacts like hematuria and blood pressure change or problems in the gastrointestinal like abdominal pain, nausea or absent or decreased bowel sounds.

Indicators of tissue perfusion on patient would include symptoms of possible impaired blood clotting capabilities and blood flow, and decreased tissue perfusion. Also by monitoring and comparing the patients pulse to ensure that it is steady. Other indicators could be identified through performing therapeutic interventions that have diagnostic testing characteristics like vasodilator therapy and angiograms indicators like heparinization or embolectomy.  It can also be done by performing a possible cardiac output test like by using an anti-embolism device or raising an affected limb as necessary. Other specific interventions would include administration of oxygen, range of motion exercises or often change of body positions (Gardiner SM et, al, 1990).

Other related factors that also lead to perfusion of tissues would include mismatch of blood flow with ventilation, Hypovolemia, venous flow interruption, hypoventilation, altered affinity of hemoglobin for oxygen, interruption of arterial flow, impaired transport of oxygen across capillary membrane or alveolar, enzyme poisoning; hypervolemia, decreased hemoglobin concentration in blood, exchange problems, mechanical reduction of arterial blood or venous flow (Kupper N, et.al, 2011).

The care givers expected outcomes would include improvement in the Urinary Elimination, Circulation Status, Fluid Balance, Cardiac Pump Effectiveness: cardiac and Tissue Perfusion, Tissue Perfusion: Peripheral and Tissue Perfusion: Cerebral. On the other hand the expected client outcome would include them demonstrating an adequate and efficient perfusion in their tissues as demonstrated by them having dry and warm skins, an absence in respiratory distress, palpable peripheral pulses, verbalized treatment regimen knowledge, adequate urinary output, recognize change in lifestyle that would encourage tissue perfusion, include appropriate medication and exercise and their possible actions and side effects.

Patients who exhibit acute cerebral perfusion symptoms would include them showing signs of orthostatic hypertension which causes them to experience dizziness while getting up; the interventions would include teaching them on remedies of addressing the dizziness like rising slowly, while seated they flex their feet upwards, they set for a while before standing, trying to have someone present while trying to stand and sitting immediately they start feeling dizzy. The rational for emphasizing on addressing this condition would be that it leads to a decrease in the cerebral perfusion fusions or stroke which if addressed early can be treated.

It can also be diagnosed by monitoring the neurological status, mainly by performing an examination of the neurological functions, or in cases where symptoms of a (CVA) cerebrovascular accident are present like in hemiplegia, hemiparesis or dysphasia. Feeling the temperature and skin color for signs of mottling, skin pallor, absent of pulse, cold skins or cool temperature could signify obstruction within the arteries, which would signify urgency for immediate intervention (Makhsous, M et.al, 2007).

The main lessons for the family and the client would be them being taught on importance and ways of avoiding getting exposed to cold conditions in any kind of weather condition by stressing on their dressing. They will have a better understanding of proper foot care and the need to inspect and wash their feet daily since they will be aware of its relevance to a diabetic patient and as such implement the  recommended special insoles, padded socks and jogging shoes. The diabetic client will be more knowledgeable on the relevance of undertaking a comprehensive foot examination annually that comprises of a Semmes-Weinstein monofilaments sensation assessment where they will be referred to a footwear professional for therapeutic inserts and shoes fitting, in which the incurred costs are covered by the Medicare (Wipke-Tevis D,et.al,2004).

In patients with arterial disease they are taught on the importance of following proper weight loss programs, not smoking, controlling hypertension and hyperlipidemia, careful control of their diabetic conditions and stress reduction. For the patients with venous disease, they are taught on the relevance of maintaining the recommended procedures of elevating their legs at intervals, wearing support hose and watching for skin breakdown on their legs as stipulated by the physician. The client/family are also taught on ways of recognizing symptoms/signs that the physician should be notified about example presence of a new foot lesion, change in skin temperature or abnormal sensation.

Reference
  • Maylor ME.(2005) Signs and symptoms of hypothetical wound assessment by nurses. Br J Nurs (6):S14-20.
  • Makhsous, M, Priebe, M, Rowles D, Zeigler M, Chen D, Lin F. (2007)“Measuring Tissue Perfusion During Pressure Relief Maneuvers: Insights into Preventing Pressure Ulcers.” Journal of Spinal Cord Medicine, (5): 63-73.
  •  Kupper N , Mitchell D , et al:(2011) Nursing management: inflam-matory and structural heart disorders . In Lewis S , editor: Medical-surgical nursing: assessment and management of clinical problems, ed 8 , St Louis , Mosby/Elsevier , p
  •  Wipke-Tevis D , Rich K , et al: (2004)Nursing management: vascular disorders . In Lewis S , editor: Medical-surgical nursing: assess-ment and management of clinical problems, ed 8 , St Louis ,Elsevier , pp 866 –
  • Gardiner SM, Sompton AM, Bennett T, Palmer RMJ, Moncada S (1990) Control of regional blood flow by endothelium-derived nitric oxide. Hypertension 15:486–492

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