Reece Sharps, Caralyn Sirard, Michael Steminsky
University of New England
Title: Nursing interventions used to promote increased tissue perfusion
Background of practice/clinical problem: Tissue perfusion is an accurate way to determine how well the tissues of the body are being oxygenated (Cheever 2017.) Tissue perfusion can be altered as a complication of various cardiac issues. This includes hypertension, coronary artery disease, hyperlipidemia, venous or arterial disorders, heart failure, and valve disorders. When vital organs aren’t getting perfused they begin to lose function. Problems with tissue perfusion have been highlighted as a key indicator of cardiac problems. Consequences of decreased perfusion include impaired skin integrity, impaired kidney function, increased risk for paralytic ileus, and increased risk for myocardial infarctions. Many patients who have a cardiac issue will have tissue perfusion problems as well. If the heart is unable to pump blood effectively related to some cardiac issue, the blood won’t be circulating as efficiently as a healthy working heart. With that said, increasing tissue perfusion in these patients can improve the parenchyma of vital organs, level of consciousness, and overall well-being of these patients. Nurses need to identify their priority nursing interventions, in terms of increasing tissue perfusion, to prevent these complications from happening.
Project aim: This project aims to identify priority nursing interventions that can be implemented to increase tissue perfusion and better the overall recovery of cardiac patients.
Method: This project was created through synthesis of a quasi-experimental study, a retrospective study, and a descriptive study using cross-mapping and a specific case study.
Findings/conclusions/implications for practice: Cardiac conditions like hypertensive cardiomyopathy is directly associated with decreased peripheral tissue perfusion (De Silva et al 2006.) Nurses on cardiac floors should assess for relevant characteristics pertaining to impaired peripheral tissue perfusion. This includes assessing for diminished lower extremity pulses, intermittent claudication, and diminished skin moisture. Assessment is vital because it allows for early intervention to improve tissue perfusion. A cross-mapping study of the nursing diagnosis “ineffective peripheral tissue perfusion” compared interventions written by nurses to the results in the NIC and NOC. The Nursing Interventions Classification (NIC) describes the most common nursing intervention categories that have to do with improving peripheral tissue perfusion as circulatory care: arterial insufficiency, prevention of pressure ulcers, pressure ulcer care, and teaching of disease processes (Morais, da Nóbrega, Miriam, de Carvalho 2018.) An important factor in improving peripheral tissue perfusion is to reduce the pressure that may be reducing blood flow. A quasi-experimental study used statistics to support their hypothesis that a heel placed on a pillow showed increased signs of blood flow and temperature when compared to a heel subjected to pressure – no support (Gómez‐González et al. 2019.) On cardiac med-surg floors, the workload and flow throughout the day are very strenuous which sometimes allows for minimal interventions related to tissue perfusion. Many issues arise when nurses do not take the time to adequately assess and intervene for proper tissue perfusion. A retrospective study of nursing interventions and diagnoses discusses the most common nursing interventions utilized for cardiac patients. The study revealed that the most common nursing interventions include weight management, vital signs monitoring, medication management, exercise promotion, education on diet and exercise, and energy management (Alessandra, Silla, Marilisa 2011.) Interventions to improve tissue perfusion should be included in this, but they are commonly overlooked.
Implementation plan: The staff of the MS4 telemetry unit will be educated on these interventions. There will be posters in the break room on MS4 reviewing the key points taken from the educational program where staff can refresh their understanding of the importance of these interventions. The main focus of this project is to establish a set plan of care with specific patient-related interventions to improve tissue perfusion. Staff on the unit can ask questions through email if they have any concerns about implementing these interventions.
Method of evaluating outcome: Evaluation of these outcomes will be measured by asking the staff how likely they are to implement these findings in their current nursing practice? We will also assess the nurses understanding of the material by asking “please rate the likelihood of you using this material in your nursing practice on a scale of: 1(will never use), 2(unlikely to use), 3(maybe will use), 4(will probably use), 5(will implement every shift)?”
References
Alessandra, Z., Silla, A., & Marilisa, C. (2011, April 20). A Retrospective Study of Nursing
Diagnoses, Outcomes, and Interventions for Patients Admitted to a Cardiology Rehabilitation Unit. Retrieved October 12, 2020, from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1744-618X.2011.01184.x
Cheever, J.L.H.K. H. (2017). Lippincott’s CoursePoint for Hinkle & Cheever: Brunner &
Suddarth’s Textbook of Medical-Surgical Nursing. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781496379054/
Gómez‐González, A.J., Morilla‐Herrera, J.C., Lupiáñez‐Pérez, I., Morales-Asencio, J.M.,
Garcia-Mayor, S., Leon-Campos, A., Marfil-Gomez R., Aranda-Gallardo, Marta., Moya-Suarez, A.B., Kaknani-Uttumchandani, S. (2019, October). Perfusion, tissue oxygenation and peripheral temperature in the skin of heels of healthy participants exposed to pressure: a quasi‐experimental study. J Adv Nurs. 2020; 76: 654– 663. Retrieved October 12, 2020, from https://doi-org.une.idm.oclc.org/10.1111/jan.14250
Morais, S. C. R. V., da Nóbrega, M., Miriam Lima, & de Carvalho, E. C. (2018). Cross-mapping
of results and nursing interventions: Contribution to the practice. Revista Brasileira De Enfermagem, 71(4), 1883-1890. Retrieved October 12, 2020, from doi:http://dx.doi.org.une.idm.oclc.org/10.1590/0034-7167-2017-0324
Rita de Cassia Gengo de Silva, Diná de Almeida Lopes Monteiro da Cruz, Bortolotto, L.,
Irigoyen, M., Krieger, E., Palomo, J., & Consolim‐Colombo, F. (2006, July 12). Ineffective Peripheral Tissue Perfusion: Clinical Validation in Patients With Hypertensive Cardiomyopathy. Retrieved October 12, 2020, from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1744-618X.2006.00024.x
