Patients with hypertension, coronary heart disease, and congestive heart failure have a high risk of developing impaired tissue perfusion and deep vein thrombosis. In this case, Mr. X, 71 years of age has a history of lower leg cellulitis and venous stasis ulcers in both extremities. Based on clinical and nursing diagnosis, Mr. X was known to have impaired tissue perfusion and the risk of developing deep vein thrombosis. Nursing diagnosis also revealed an altered body image due to psychosocial reasons and current health status (Mitchell C. 2016).
Abnormal flow or maldistribution of blood circulation associated with selective vasoconstriction, increased capillary permeability, vasodilation, and the influence of many inflammatory mediators such as kimins, histamine, cytokines, and complement. Most of the mediators are leases in the infected are owing to impaired tissue perfusion
Excessive fluid loss and decreased fluid intake owing to hypovolemia and fluid volume deficit is linked with diarrhoea, vomiting, diaphoresis, and hyperventilation
Low cardiac output which is linked with myocardial depressant factor, acidosis that causes depressant effect, myocardial contractility associated with inflammatory mediators (Deb, KA, et al. 2014)
In the human body, metabolic processes within the cells are linked with sufficient oxygenation and tissue perfusion which is indicative of resistance of infections and rapid tissue repair. Most researchers have hypothesized the concept of tissue perfusion with that of oxygen delivery, blood flow, and nutritional supply flow which is important for proper body function. Some researchers claim that tissue oxygen transport, consumption, and delivery are linked with all cells and the phenomenon can be termed as tissue oxygen perfusion. The concept of oxygen supply and delivery among cells could have potential usefulness among clinicians utilizing and explaining patients on tissue perfusion and oxygenation. It is recommended that tissue perfusion should be measured and assess at the tissue level. However, it is also suggestive that tissue perfusion represents the situation of all cells and tissues within the body. The measurement of tissue perfusion is thus a key indicator of vital health factors (Fang JS, Angelov SN, Simon AM, Burt JM. 2013 and Mitchell C. 2016).
Figure 1. Concept Map: Relationship between Nursing Diagnosis and Interventions
Nursing Interventions
Based on current evidence, nursing professionals are recommended to follow the health intervention protocol which is as follows: (a) Assess critical signs and symptoms associated with tissue perfusion (Which may include the following: restlessness, decreased blood pressure, confusion, cyanosis/pallor of extremities, restlessness, oedema, low capillary refill, absence of peripheral pulses, and oliguria). (b) In order to provide and implement the following measures nursing professionals would do the following to maintain adequate tissue perfusion (1) Intravenous administration of fluids (such as colloids, crystalloids) (2) Prevention of fluid volume deficit in line with prevention and treatment (3) In order to reduce the rate of inflammatory responses and treat infection, administration of antimicrobial agents is highly recommended (4) In order to maintain cardiac output and perfusion pressure, nurses are recommended to administer positive inotropic agents such as dobutamine and vasopressors such as norepinephrine or dopamine. (c) Post treatment and management, nurses are required to consult a physician for signs and symptoms of tissue perfusion (Goldstein S, et al. 2014)
Based on current evidence for patients suspected with impaired tissue perfusion, the desired outcome by nursing professionals would include the following: (a) Blood pressure in the normal range (b) Normal mental status (c) Absence of cyanosis and pallor in the lower extremities with other physical and clinical factors normal (d) Peripheral pulses are palpable (e) Absence of oedema (f) < 3 second timeframe of capillary refill and (g) 30 ml/hr urine output (Goldstein S, et al. 2014 and Mitchell C. 2016).
References
Deb, KA, et al. Relationship between systemic hypertension, perfusion pressure and glaucoma: A comparative study in an adult Indian population. Indian J Ophthalmol. 2014 September; 62(9): 917–922.
Fang JS, Angelov SN, Simon AM, Burt JM. Compromised regulation of tissue perfusion and arteriogenesis limit, in an AT1R-independent fashion, recovery of ischemic tissue in Cx40(-/) mice. Am J Physiol Heart Circ Physiol. 2013 Mar 15;304(6):H816-27.
Mitchell C. Tissue Oxygenation Monitoring as a Guide for Trauma Resuscitation. Crit Care Nurse. 2016 Jun;36(3):12-70. doi: 10.4037/ccn2016206.
Goldstein S, et al. Pharmacological management of fluid overload. Br J Anaesth. 2014 Nov;113(5):756-63.
