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Differentiate peripheral perfusion versus central perfusion

  1. In your own words, differentiate peripheral perfusion versus central perfusion
  2. The following patient scenarios reflect peripheral perfusion or central perfusion. Review each case and determine which type of perfusion applies (peripheral or central) and provide three appropriate assessments and three appropriate interventions with rationales that these patients will need (total of four cases).
    A. Patient with a history of coronary artery disease, diabetes, and hypertension presents to the emergency room with complaints of chest pain, nausea, and shortness of breath. The patient is diagnosed and admitted for stable angina. What type of perfusion applies to this case? What are the appropriate assessments and interventions for this patient?

B. Patient with a history of type I diabetes, osteoarthritis, obesity, atherosclerosis and arterial occlusive disease. Patient presents to the doctor’s office with complaints of increased pain when ambulating but states, “The pain goes away when I stop walking.” What type of perfusion applies to this case? What are the appropriate assessments and intervention for this patient?

C. Patient with a right distal radius fracture after a recent motor vehicle crash. A cast was applied and one week later presents to the emergency room with complaints of extreme pain not relieved by prescribed pain medication. Patient rates pain 10/10, unable to move fingers, and has +2 edema. What type of perfusion applies to this case? What are the appropriate assessments and intervention for this patient?

D. Patient post-op for an anterior cervical fusion of the spine has just finished surgery. Report from the operating room (OR) nurse to the post-anesthesia care unit (PACU) nurse includes that during surgery the estimated blood loss (EBL) was 800 mL. Vital signs include: 89/52, 120, 16, and a temperature of 98.6 degrees Fahrenheit. The patient's pulse oximeter reading is 93% on 2 liters nasal cannula (NC). The patient is drowsy, has CRT’s >3 seconds, and is restless. What type of perfusion applies to this case?
What are the appropriate assessments and interventions for this patient? (1 point)

Full Answer Section

      Assessments:
  1. Vital signs:Monitor heart rate, rhythm, blood pressure, and oxygen saturation.
  2. Electrocardiogram (ECG):Check for abnormalities suggestive of ischemia.
  3. Cardiac enzymes:Measure blood levels of enzymes released by damaged heart muscle.
Interventions:
  1. Medications:Administer medications like nitroglycerin to improve blood flow to the heart and manage pain.
  2. Oxygen therapy:Provide supplemental oxygen if needed to maintain saturation.
  3. Cardiac monitoring:Continuously monitor heart rhythm and electrical activity.
  4. Claudication Case:
  • Perfusion type:Peripheral perfusion
  • Rationale:The patient's pain worsens with walking (activity) and improves with rest, indicating insufficient blood flow to the legs when exercising. These are classic symptoms of claudication, a peripheral arterial disease (PAD) condition.
Assessments:
  1. Vascular assessment:Check for pulses in the legs (dorsalis pedis and posterior tibial) and compare their strength bilaterally.
  2. Skin assessment:Look for signs of poor circulation like skin color changes, hair loss, or wounds.
  3. Ankle-brachial index (ABI):This non-invasive test compares blood pressure in the legs with that in the arms, helping diagnose PAD.
Interventions:
  1. Lifestyle changes:Encourage smoking cessation, weight management, and exercise programs suitable for PAD.
  2. Medications:Medications may be prescribed to improve blood flow and manage pain.
  3. Wound care:If present, manage any wounds meticulously due to the increased risk of infection with poor circulation.
  4. Compartment Syndrome Case:
  • Perfusion type:Peripheral perfusion (potentially compromised)
  • Rationale:The extreme pain, inability to move fingers, and swelling (+2 edema) suggest compartment syndrome, a condition where increased pressure within a confined space (muscle compartment) reduces blood flow. This can lead to tissue damage and requires prompt intervention.
Assessments:
  1. Pain assessment:Assess pain level and response to pain medication.
  2. Compartment pressure measurement:Measure pressure within the affected muscle compartment to confirm or rule out compartment syndrome.
  3. Neurovascular assessment:Check for pulses, capillary refill time (CRT), and sensation in the fingers to assess nerve and blood flow function.
Intervention:
  1. Emergent fasciotomy:This is a surgical procedure to release pressure by creating an incision in the fascia (connective tissue) surrounding the muscle compartment.
  2. Post-Operative Patient Case:
  • Perfusion type:Both central and peripheral perfusion
  • Rationale:The patient's vital signs (low blood pressure, tachycardia, and potential hypoxia) suggest hypovolemia (decreased blood volume) which can affect both central and peripheral perfusion. Additionally, drowsiness and prolonged CRT indicate potential compromised perfusion.
Assessments:
  1. Vital signs:Monitor blood pressure, heart rate, respiratory rate, oxygen saturation, and urine output closely.
  2. Skin assessment:Assess skin color, temperature, and moisture for signs of poor perfusion.
  3. Blood tests:Check hemoglobin and hematocrit levels to assess blood volume status.
Interventions:
  1. Fluid resuscitation:Administer intravenous fluids to restore blood volume and improve perfusion.
  2. Blood transfusion:If blood loss is significant or the patient is hemodynamically unstable, a blood transfusion may be needed.
  3. Medication:Medications may be administered to raise blood pressure if necessary.
 

Sample Answer

   

Peripheral vs. Central Perfusion

Peripheral perfusion refers to the circulation of blood to the extremities, skin, and organs furthest from the heart. It ensures adequate delivery of oxygen and nutrients to these tissues.

Central perfusion refers to the circulation of blood throughout the core of the body, supplying vital organs like the brain, heart, and kidneys with oxygen and nutrients.

Here's a breakdown of the patient scenarios:

A. Stable Angina Case:

  • Perfusion type: Central perfusion
  • Rationale: The patient's symptoms (chest pain, nausea, shortness of breath) indicate potential ischemia (lack of oxygen) in the heart muscle, which is a central organ.

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