2TERMS TO KNOW Arrhythmia: abnormal heart rate or rhythm Atherosclerosis: hardening and narrowing of arteries due to plaque buildup in vessel wallsPhysical deconditioning: decline in cardiovascular function due to physical inactivityHomans’ sign: pain when the affected leg is dorsiflexed, usually associated with deep phlebitis of the legHypertension: consistent blood pressure reading >140 mm Hg systolic and >90 mm Hg diastolicPostural hypotension: decline in systolic blood pressure of 20 mm Hg or more after rising and standing for 1 minute
3IntroductionImproved technology and increased public awareness resulted in decline in heart diseaseCardiovascular disease has become the major cause of disability and death in older populationNursing interventions for prevention address potential problems related to circulation
4Effects of Aging on Cardiovascular Health Heart valves become thicker and rigidAorta becomes dilatedSlight ventricular hypertrophyThickening of left ventricular wallMyocardial muscle less efficientDecreased contractile strengthDecreased cardiac output when demands increasedCalcification, reduced elasticity of vesselsLess sensitive to baroreceptor regulation of blood pressure
5Effects of Aging on Cardiovascular Health Conditions altering tissue perfusionCardiovascular diseasesDiabetes, cancer, renal failureBlood dyscrasiasHypotensionMedication side effectsOther issues of concern
6Question Is the following statement True or False? Symptoms of age-related changes in the cardiovascular system become most apparent when the older adult is faced with unusual physiological stress.
7AnswerTrueAge-related changes in the cardiovascular system are typically gradual and become most apparent when the older adult is faced with unusual physiological stress, such as heightened activity or infection.
8Cardiovascular Health Promotion Alterations modified by lifestyle and dietIdentify and lower risks through educationImportant practices: proper diet, exercise, no cigarette smoking, manage stress, and proactive interventions
9Proper Nutrition Proper diet and weight Control of cholesterol Reduced cardiovascular and cerebrovascular incidentsNutritional supplementsVarious dietsLifestyle modifications
10Adequate Exercise Exercise important for optimal health Regular exercise versus spurts of activityPhysical deconditioning related to functional declineEnhance circulation with aerobic exercise, yoga, strengthening exercises, balance exercises, t’ai chi
11Question Is the following statement True or False? Regular exercise can decrease or limit the age- related functional declines that aging people can experience.
12AnswerTrueRegular exercise has a positive impact on functional status of the older adult. Lack of physical exercise, known as physical deconditioning, can heighten many of the age- related functional declines that aging people can experience.
13Cigarette Smoke Avoidance Smokers aware of risksBreaking habit difficultSupport and assistance needed for cessationKeep trying after failureEducate about limiting exposure to cigarette smoke
14Stress Management Stress normal part of life Educate regarding identification of stressors, reactions to stress, and effective managementInterventions for handling stress: relaxation exercises, yoga, meditation, and other stress-reducing activities
15Proactive Interventions Low-dose aspirin daily: preventive measureAlcohol: light drinking may be beneficialNutritional supplementsComprehensive assessment of the cardiovascular system includes C-reactive protein screening
16Cardiovascular Disease and Women Prevalence increases with ageSigns differ with womenEducation regarding cardiovascular disease and promotion of cardiovascular healthGuide women about not ignoring symptoms
18Hypertension Incidence and prevalence increases with age Evaluation of blood pressureSystolic blood pressure ≥ 140 mm HgDiastolic blood pressure ≥ 90 mm HgFactors to consider when monitoring blood pressure: anxiety, stress, and activity before assessmentSymptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremorWide range of treatment
19HypotensionDecline in systolic blood pressure of 20 mm Hg or more after changing positionsPostural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivityConsequences: falls, stroke, syncope, other coronary complications
20QuestionPostural and postprandial hypotension is most often related toVasoactive medications and decreased baroreceptor activityAntibiotics and increased cardiac outputAntispasmodic drugs and increased levels of potassiumAntibiotics and decreased renal function
21Answer Vasoactive medications and decreased baroreceptor activity Studies have shown that many older adults experience problems related to postural and postprandial hypotension due to the increased intake of vasoactive medications and concomitant decrease in physiologic function, such as baroreceptor activity.
22Congestive Heart Failure Incidence increases with ageLeading cause of hospitalizationComplication of arteriosclerotic heart diseaseCoronary artery disease responsible for most casesSymptoms: shortness of breath, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and edema
23QuestionWhich of the following breath sounds heard on auscultation would indicate an exacerbation of congestive heart failure?a. Cracklesb. Vesicularc. Bronchovesiculard. Rhonchi
24AnswerCracklesSome of the symptoms of congestive heart failure in older patients include dyspnea on exertion, confusion, insomnia, weakness, shortness of breath, bilateral ankle edema, and moist crackles on auscultation.
25Pulmonary Emboli Incidence high Detection and diagnosis challenging Risk factors: fractures, congestive heart failure, arrhythmias, history of thrombosis, and immobilizationSigns/symptoms: confusion, apprehension, shortness of breath, temperature elevation, pneumonitis, and elevated sedimentation rate
26Coronary Artery Disease Ischemic heart diseasePrevalence increase with ageAnginaAtypical presentation: coughing, syncope, sweating, and confusionNitroglycerin effectiveEducationMyocardial infarctionAtypical presentation: confusion, decreased blood pressure, shortness of breath, elevated temperature, and sedimentation rate
27HyperlipidemiaRisk of coronary artery disease with elevated total cholesterolEvaluate full lipid profile, triglycerides, high- density lipoprotein, low-density lipoproteinFamilial tendencyTreatment: dietary changes, medications, and alternative and complementary therapies
28ArrhythmiasCauses: digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome, and coronary insufficiencySymptoms: weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, and syncopeTreatment: antiarrhythmic drugs, digitalis, potassium supplements, and cardioversionEducation: modify diet, smoking cessation, decrease alcohol, and activity
29Question Is the following statement True or False? Hypokalemia, acute infections, hemorrhage, and coronary insufficiency are potential causes of arrhythmias in the older adult population.
30AnswerTrueIn addition to digitalis toxicity as the most common cause or arrhythmia, hypokalemia, acute infections, hemorrhage, anginal syndrome, and coronary insufficiency are potential causes of arrhythmias in the older adult population.
31Peripheral Vascular Disease Arteriosclerosis: common especially among those with diabetesAffects smaller vessels furthest from heartDiagnosis: arteriography, radiography, and oscillometric testingTreatment: warmth, exercises, and vasodilators
32Special Problems Associated with Diabetes High risk for peripheral vascular problemsArterial insufficiencyResting pain: intermittent claudicationArterial pulses: absent or difficult to palpateSkin discoloration, ulcerations, and gangreneDiagnostic measuresTreatment selected per extent of disease
33Aneurysms Advanced arteriosclerosis aids in development of aneurysms Some seen, some palatable, and others detected by radiographyThrombosis can developVarious treatments
34Varicose Veins Common problem Dilated, tortuous nature of vein Dull pain, cramping, can interfere with sleepDizziness may occurSusceptible to trauma and infectionTreatment aimed at reducing venous stasis
35Venous Thromboembolism Increased incidenceHigh risk: restricted to bed rest, recent surgery, and fracturesEdema, warmth over affected area, pain in foot, cyanosis, aching, and engorgement of superficial veinsAnticoagulants, surgery, elastic stockings, bandages, and elevation of extremities
36General Nursing Considerations for Cardiovascular Conditions PreventionKeep the patient informedPrevent complicationsPromote circulationProvide foot careManage problems associated with peripheral vascular diseasePromote normalityIntegrate complementary therapies
37PreventionIncorporation of preventive measures of planning and caregivingEducation, counseling, coaching, rehabilitative/restorative activities enables prevention on three levels:PrimarySecondaryTertiary
38Keeping the Patient Informed Full explanations with reinforcement necessary for educating about diagnostic and treatmentSensory deficits, anxiety, poor memory, and illness can affect comprehensionOpportunities to ask questions and discuss concerns
39Preventing Complications Edema can promote skin breakdownChange position frequentlyProper alignment of bodyMonitor conditions that increase chances of edemaProtect from skin breakdownMonitor, observe, and documentFluid balanceAssessment of vital signsCareful administration of oxygenPotential for anorexiaPotential for vagal stimulation
40Promoting Circulation Increased risk of altered tissue perfusionInterventions that improve tissue circulationPrevention of peripheral vascular problemsEducation about appropriate health practicesEnhancement of circulation
41Providing Foot CarePeople with peripheral vascular disease must pay special attention to their feetBathe and inspect dailyAvoid injuryPrompt attention for any lesionsPotential for fungal infectionsInterventions to prevent injury to feet
42QuestionWhich of the following foot care interventions is essential to older adults who have peripheral vascular disease?a. Daily inspection of the feetb. Wearing tight-fitting shoes for comfortc. Application of heat to areas of infectiond. Vaccination to prevent varicella zoster
43Answer Daily inspection of the feet Persons with peripheral vascular disease must pay special attention to the care of their feet, which should be bathed and inspected daily. To avoid injury, patients should not walk in bare feet and shoes should be large enough to avoid pressure and injury to the feet.
44Managing Problems Associated with Peripheral Vascular Disease Care of ischemic foot lesionsMedical and nursing managementLoss of a limbLoss of independenceAltered body image
45Promoting NormalityConsideration of impact of cardiovascular function on sexualityOften subject of interest in sex not discussed with health care providersNursing interventions that include teachingRelaxation and rest vital to treatmentConsiderations of stressors
46Integrating Complementary Therapies Various herbs and spices considered for preventing and treating cardiovascular disordersSome nonconventional measuresMeditationBiofeedbackGuided imageryT’ai chiYogaFull benefit of complementary therapies is in process of discovery: less intrusive, less expensive, and minimal risks