Factors That Can Alter Tissue Perfusion • Cardiovascular Disease • Arteriosclerotic heart disease, hypertension, congestive heart failure, varicosities • Other Diseases • Diabetes mellitus, cancer, renal failure • Blood Dyscrasias • Anemia, thrombus, transfusion reactions
Factors That Can Alter Tissue Perfusion (cont.) • Hypotension • Anaphylactic shock, hypovolemia, hypoglycemia, hyperglycemia, orthostatic hypotension • Medication Side Effects • Antihypertensives, vasodilators, diuretics, antipsychotics • Other Conditions • Edema, inflammation, prolonged immobility, hypothermia, malnutrition
Assessing Tissue Circulation • Review the individual’s health history. • Evaluate vital signs. • Inspect the tissues. • Note signs or symptoms.
Indications of Ineffective Tissue Perfusion • Hypotension • Tachycardia; decreased pulse quality • Claudication • Edema • Loss of hair on extremities • Tissue necrosis; stasis ulcers • Dyspnea; increased respirations
Indications of Ineffective Tissue Perfusion (cont.) • Pallor; coolness of skin • Cyanosis • Decreased urinary output • Delirium (altered cognition and level of consciousness) • Restlessness • Memory disturbance
Interventions to Improve Tissue Circulation • Maintain blood pressure within an acceptable range. • Prevent and eliminate sources of pressure on the body. • Remind or assist patients to change positions frequently. • Prevent pooling of blood in the extremities. • Encourage physical activity. • Prevent hypothermia, maintaining body warmth.
Interventions to Improve Tissue Circulation (cont.) • Monitor drugs for the side effect of hypotension. • Educate to reduce risks. • Periodically evaluate physical and mental health to identify signs and symptoms of altered tissue perfusion.
Measures to Prevent Respiratory Infections in Older Adults • Obtain vaccines. • Avoid exposure to people with infections. • Seek medical attention if signs of infection appear. • Report changes in character of sputum.
Using Oxygen with the Elderly • Monitor blood gases. • Observe the patient for symptoms of carbon dioxide narcosis: • Confusion • Muscle twitching • Visual defects • Profuse perspiration
Using Oxygen with the Elderly (cont.) • Hypotension • Progressive degrees of circulatory failure • Cerebral depression
Interventions for Ineffective Breathing Patterns • Instruct patient in breathing exercises. • Control symptoms that could threaten effective respirations. • Raise head of bed at least 30° when patient is lying down.
Interventions for Ineffective Breathing Patterns (cont.) • Instruct patient to turn, cough, and deep breathe at least once every 2 hours. • Monitor rate, depth, and rhythm of respirations; coloring; coughing pattern; blood gases; and mental status.
Source • Eliopoulos, C. (2005). Gerontological Nursing, (6th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).