Quiz 51: Circulation


Mrs. Gloria Papadopolis is suffering from severe pain in her calf muscles and has difficulty in walking. She reports that her feet feel cold and her skin appears pale. She also reports that her posterior tibial and pedal pulses cannot be felt and her femoral pulses are difficult to palpate. This appears to be a case of impaired tissue perfusion. This condition arises due to impaired flow of blood from heart to the body organs and tissues. In such cases, the distal tissues such as muscles in the lower leg receive less blood, oxygen and nutrients because of narrowing out of the blood vessels. The risk factors associated with impaired tissue perfusion that should be checked in the client's history for confirmation includes high fat intake, cigarette smoking, sedentary lifestyle and obesity. Diabetes and hypertension also increases the chances, especially when the client's blood glucose level and blood pressure are not maintained within the normal limits.

Preload is the degree of stretching of muscle fibers in the ventricles at the end of diastole or relaxation period. It is an initial stretching of fibers of cardiac muscle prior to the contraction. It depends on various factors such as rate of venous return and venous blood pressure, which are affected by volume of circulating blood and venous tone. Left ventricle of the heart is primarily affected by the preload. Increased volume of the venous blood returning to the heart causes increased stretching of the myocardium. This leads to forceful contractions of the cardiac muscle fibers. This relationship is called as Frank- Starling law of heart. This law states that at the end of a diastole, the length of the ventricular muscle fibers or the stretching of the fibers affects the force or strength of contraction. An increase inside venous pressure or any decrease inside venous resistance will cause an increased venous return to the heart. Physical activities like running, swimming or walking can promote increased venous return by a mechanism of muscle pump.

A person who is at high risk of encountering cardiovascular disorder must be provided with a teaching guide to explain the measures for maintenance of proper health and avoiding development of any disorder. Measures for maintenance of renal perfusion and formation of urine are presented in guides to persons who are at risk of developing renal disorders. Measures related to oxygen carrying capacity of white blood cells, effective breathing and airway clearance are not of primary concern to the patients who are at risk of cardiovascular disease. Hence, the options 2, 3 and 4 are incorrect. A patient with the risk of developing a cardiovascular disorder must follow the teaching guide provided by the nurse. This guide typically comprises of measures to maintain tissue perfusion and cardiac output of the person. It emphasizes on the importance of maintaining regular physical activity in order to improve vascular health and promote circulation. The person is advised to follow a routine of certain exercises and physical activities like swimming and walking with gradual increase in time duration. Hence, the correct answer is option img .

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