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BIAZ Samenvatting - Circulatie

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  • Course
  • BIAZ
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  • BIAZ
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  • Anatomie en fysiologie, met MyLab NL toegangscode 6e editie

Deze samenvatting is gemaakt ter voorbereiding voor de Basis Inleiding Acute Zorg (BIAZ) maart 2021 vanuit de Erasmus MC Academie. De theorie is afkomstig uit de volgende boeken: - Anatomie en fysiologie een inleiding - ProActive Nursing: klinische problematiek inzichtelijk

Last document update: 3 year ago

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  • No
  • Hoofdstuk 3, 11, 12, 13, 16 en 18
  • March 31, 2021
  • April 10, 2021
  • 46
  • 2020/2021
  • Summary

Subjects

  • embryologie hart
  • foetale circulatie
  • circulatiestoornissen
  • ritme
  • shock
  • urogenitaal stelsel
  • anatomie amp fysiologie cardiovasculaire stelsel

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BIAZ - Circulatie
Inhoudsopgave
1. Begrippenlijst...............................................................................................................................................4
2. Plaatsaanduidingen.....................................................................................................................................5
3. Circulatiestoornissen...................................................................................................................................6
3.1. Embryogenese.......................................................................................................................................6
3.2. De foetale circulatie...............................................................................................................................7
3.2.1. Transitie naar extra-uterien....................................................................................................................7
3.3. Anatomie en fysiologie hart...................................................................................................................7
3.3.1. Hartwand................................................................................................................................................8
3.3.2. Hartkleppen............................................................................................................................................8
3.3.3. Circulatie................................................................................................................................................8
3.3.4. Coronaire circulatie................................................................................................................................9
3.4. Normaalwaarden....................................................................................................................................9
3.4.1. Harttonen.............................................................................................................................................10
3.4.2. Effect sympathicus en parasympathicus.............................................................................................10
3.4.3. Bloeddruk.............................................................................................................................................10
3.5. Pompfunctie.........................................................................................................................................11
3.5.1. Preload en afterload.............................................................................................................................11
3.5.2. Frank Starling Curve............................................................................................................................12
3.5.3. Veneuze return.....................................................................................................................................12
3.5.4. Compensatiemechanisme...................................................................................................................12
3.6. Hemodynamische drukken..................................................................................................................12
3.7. Decompensatio Cordis........................................................................................................................13
3.7.1. Backward en forward failure................................................................................................................14
3.7.2. Links/Rechts decompensatio cordis....................................................................................................14
3.8. Acuut coronair syndroom.....................................................................................................................15
3.9. Stappenplan beoordelen circulatie......................................................................................................15
3.9.1. Veneus aanbod....................................................................................................................................15
3.9.2. Hartritme..............................................................................................................................................16
3.9.3. Pompfunctie.........................................................................................................................................17
3.9.4. Arteriële vaatstelsel..............................................................................................................................17
3.9.5. Microcirculatie......................................................................................................................................18
4. Inleiding ritme............................................................................................................................................18
4.1. Actiepotentiaal.....................................................................................................................................18
4.2. Geleidingssysteem..............................................................................................................................19
4.3. Driehoek van Einthoven.......................................................................................................................20
4.4. Weergave van de geleiding op het ECG.............................................................................................20
4.5. Normaalwaarden..................................................................................................................................21

,5. Cardioversie en defibrilleren......................................................................................................................21
5.1. Defibrilleren = niet synchroon..............................................................................................................21
5.2. Cardioversie = synchroon....................................................................................................................21
6. Shock.........................................................................................................................................................22
6.1. Herkennen vitaal bedreigde patiënt.....................................................................................................22
6.1.1. EWS.....................................................................................................................................................22
6.1.2. SIRS / qSOFA......................................................................................................................................22
6.2. Shock...................................................................................................................................................22
6.2.1. Symptomen..........................................................................................................................................23
6.3. Hypovolemische shock........................................................................................................................23
6.4. Obstructieve shock..............................................................................................................................23
6.5. Cardiogene shock................................................................................................................................24
6.6. Distributieve shock...............................................................................................................................24
7. Stolling.......................................................................................................................................................25
7.1. Primaire hemostase.............................................................................................................................25
7.2. Secundaire hemostase (coagulatie)....................................................................................................26
7.3. Stollingsfactoren..................................................................................................................................26
7.4. Fibrinolytisch systeem.........................................................................................................................26
7.5. Verhoogde bloedingsneiging...............................................................................................................26
7.6. Verhoogde stollingsneiging.................................................................................................................26
7.7. Bloedingen en stolling..........................................................................................................................27
7.7.1. Bloedtransfusie....................................................................................................................................28
7.7.2. Bloedgroepen.......................................................................................................................................28
7.8. Laboratoriumonderzoek.......................................................................................................................29
7.9. Stolling beïnvloedende geneesmiddelen.............................................................................................29
8. Elektrolyten en vocht.................................................................................................................................30
8.1. Homeostase.........................................................................................................................................30
8.2. Diffusie en osmose..............................................................................................................................31
8.3. Osmolariteit..........................................................................................................................................31
8.3.1. Kristallijne osmolariteit.........................................................................................................................31
8.3.2. Colloïdale osmolariteit..........................................................................................................................31
8.3.3. Hydrostatische en colloïd-osmotische druk.........................................................................................32
8.4. Elektrolyten..........................................................................................................................................32
8.5. Kenmerken verschillende elektrolytenstoornissen..............................................................................33
8.5.1. Natrium.................................................................................................................................................33
8.5.3. Kalium..................................................................................................................................................33
8.5.4. Calcium................................................................................................................................................34
8.5.5. Fosfaat.................................................................................................................................................34
8.5.6. Magnesium...........................................................................................................................................34
8.5.7. Ureum...................................................................................................................................................34
8.5.8. Creatinine.............................................................................................................................................34


2

, 8.6. Relatie elektrolytstoornis en kenmerk op het ECG.............................................................................34
8.7. Verpleegkundige bewaking en interventies.........................................................................................34
8.8. Ondervulling.........................................................................................................................................35
8.9. Overvulling...........................................................................................................................................35
9. Afweersysteem..........................................................................................................................................35
9.1. Specifieke en niet-specifieke afweer...................................................................................................35
9.1.1 Aspecifiek / niet-specifieke afweer.......................................................................................................36
9.1.2. Specifieke /verworven afweer..............................................................................................................36
9.2. Cellulaire en humorale afweer.............................................................................................................36
9.2.1 Cellulaire afweer...................................................................................................................................36
9.2.2. Humorale afweer..................................................................................................................................37
10. Temperatuurregulatie..............................................................................................................................37
10.1. Hypothermie.......................................................................................................................................38
10.1.1. Fasen van onderkoeling....................................................................................................................38
10.2. Vormen van warmteafgifte.................................................................................................................38
11. Tractus digestivus....................................................................................................................................39
11.1. Anatomie en fysiologie.......................................................................................................................39
11.1.1. Lagen spijsverteringskanaal..............................................................................................................39
11.1.2. Anatomie spijsverteringskanaal.........................................................................................................40
11.2. Ileus....................................................................................................................................................41
11.2.1. Mechanische ileus.............................................................................................................................41
11.2.2. Paralytische ileus...............................................................................................................................42
11.3. Appendicitis........................................................................................................................................42
11.4. Ontstekingen tractus digestivus.........................................................................................................43
11.4.1. Gastro-enteritis...................................................................................................................................43
11.4.2. Peritonitis...........................................................................................................................................43
11.4.3. Pancreatitis........................................................................................................................................43
11.5. Bloedingen tractus digestivus............................................................................................................43
11.5.1. Hoge tractus digestivusbloeding........................................................................................................44
11.5.2. Lage tractus digestivusbloeding........................................................................................................44
11.6. Obesitas.............................................................................................................................................44
11.6.1. Lichamelijke gevolgen........................................................................................................................44
12. Urogenitaal..............................................................................................................................................45
12.1. Bovenste urinewegen........................................................................................................................45
12.1.1 Nieren..................................................................................................................................................45
12.1.2. Filteren van bloed..............................................................................................................................46
12.1.3. Plasmaklaring.....................................................................................................................................46
12.1.4. pH regulatie........................................................................................................................................46
12.1.5. Nierperfusie........................................................................................................................................46
12.1.6. Ureters (urineleiders).........................................................................................................................46
12.2. Onderste urinewegen........................................................................................................................46


3

, 12.2.1. Blaas..................................................................................................................................................46
12.2.2. Urethra (urinewegen) en prostaat......................................................................................................46

1. Begrippenlijst
 A. coronaire = kransslagaders
 A. femoralis = dijbeenslagader
 A. pulmonalis = longslagader
 A. radialis = spaakbeenslagader
 A. renalis = nierslagader
 A. vertebrales = wervelslagader
 Adhesie = hechting bloedplaatjes aan endotheel, hiervoor is o.a. de von willebrand factor nodig
 Adrenaline = bijniermerghormoon
 Afterload = de weerstand waartegen het ventrikel zich moet leegknijpen in de aorta in de ejectiefase.
 Aggregatie = hechting bloedplaatjes aan elkaar
 Aldosteron = bijnierschorshormoon
 Annuli fibrosi = bindweefselringen die de atria en ventrikels scheiden
 Aorta adbominalis = buikaorta
 Aorta ascendes = omhooglopende deel wat uit het linkerventrikel komt
 Aorta descendes = omlaaglopende deel
 Apex = hartpunt
 Arcus aorta = aortaboog
 AV-klep = atrioventriculaire klep, mitralisklep en tricuspidalisklep
 Baroreceptoren = registreren de mate van uitrekking in de wanden van rekbare organen
 Bifurcatie = splitsing
 Cardiac output/hartminuutvolume (HMV) = het volume dat het hart in 1 minuut uitpompt
 Carotis communis dextra = rechter gemeenschappelijke halsslagader
 Carotis communis sinistra = linker gemeenschappelijke halsslagader
 Chemoreceptoren = reageren op veranderingen van de concentratie van koolstofdioxide of zuurstof en
op pH-veranderingen van het bloed en liquor.
 Conductie = het direct afgeven van warmte aan de omgeving. Warmteverlies wat ontstaat door de
overdracht van warmte tussen 2 vast stoffen met een andere temperatuur (bijv. door aanraking).
 Convectie = het afgeven van warmte aan de omringende koelere lucht. Naarmate de temperatuur van
de omgevende lucht lager is en de luchtstroomsnelheid toeneemt (wind), neemt deze vorm van
warmteverlies toe.
 Contractiliteit = samentrekbaarheid. Afhankelijk van de sterkte van de hartspiervezels en het aantal
hartspiervezels.
 Cytolyse = het celmembraan kan de osmotische druk van het water binnen de cel niet weerstaan
waardoor de celwand barst.
 CVD = centraal veneuze drukmeting
 Diastole = relaxatiefase / onderdruk / vullingsfase
 DIS = diffuse intravasale stolling
 Ejectiefase = het moment dat de druk in de kamers hoger wordt dan in de longslagader en de aorta,
gaan de halvemaanvormige kleppen open en wordt bloed in de longslagader en de aorta gepompt.
 Evaporatie = afgifte door het verdampen van water op de huid (bijv. door zweten)
 Fagocyteren = opnemen van bestanddelen
 Fibrinolyse = werkt de bloedstolling tegen
 Filtratie = de bloeddruk perst het vocht door de semipermeabele wand van het capillair
 Frank Sterling mechanisme = toegenomen preload stijgt de cardiac output
 Hartslagvolume = slagvolume x aantal slagen per minuut
 Mitralisklep = tweeslippige klep tussen linker atrium en ventrikel
 Preload = de druk van de ventrikels aan het eind van de diastole, het moment dat het ventrikel
ontspannen is. De mate van rek in de hartspiervezels aan het eind van de diastole.
 Pulsus paradoxus = wegvallen van de pols tijdens inademing door veranderde intrathoracale druk
 Radiatie = de overdracht van hitte via elektromagnetische hittegolven door de lucht. Warmteverlies wat
ontstaat van een warm oppervlak naar een kouder oppervlak wat niet in direct contact met elkaar is.
 Renine = hormoon in de nieren
 Septum cordis = harttussenschot



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