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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 20 Circulation.

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Presentation on theme: "Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 20 Circulation."— Presentation transcript:

1 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 20 Circulation

2 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins TERMS TO KNOW Arrhythmia: abnormal heart rate or rhythm Atherosclerosis: hardening and narrowing of arteries due to plaque buildup in vessel walls Physical deconditioning: decline in cardiovascular function due to physical inactivity Homans’ sign: pain when the affected leg is dorsiflexed, usually associated with deep phlebitis of the leg Hypertension: consistent blood pressure reading >140 mm Hg systolic and >90 mm Hg diastolic Postural hypotension: decline in systolic blood pressure of 20 mm Hg or more after rising and standing for 1 minute

3 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Improved technology and increased public awareness resulted in decline in heart disease Cardiovascular disease has become the major cause of disability and death in older population Nursing interventions for prevention address potential problems related to circulation

4 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Aging on Cardiovascular Health Heart valves become thicker and rigid Aorta becomes dilated –Slight ventricular hypertrophy –Thickening of left ventricular wall Myocardial muscle less efficient –Decreased contractile strength –Decreased cardiac output when demands increased Calcification, reduced elasticity of vessels Less sensitive to baroreceptor regulation of blood pressure

5 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Effects of Aging on Cardiovascular Health Conditions altering tissue perfusion –Cardiovascular diseases –Diabetes, cancer, renal failure –Blood dyscrasias –Hypotension –Medication side effects –Other issues of concern

6 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 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.

7 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Age-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.

8 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiovascular Health Promotion Alterations modified by lifestyle and diet Identify and lower risks through education Important practices: proper diet, exercise, no cigarette smoking, manage stress, and proactive interventions

9 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Proper Nutrition Proper diet and weight Control of cholesterol –Reduced cardiovascular and cerebrovascular incidents Nutritional supplements Various diets Lifestyle modifications

10 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Adequate Exercise Exercise important for optimal health Regular exercise versus spurts of activity Physical deconditioning related to functional decline Enhance circulation with aerobic exercise, yoga, strengthening exercises, balance exercises, t’ai chi

11 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Regular exercise can decrease or limit the age- related functional declines that aging people can experience.

12 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Regular 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.

13 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cigarette Smoke Avoidance Smokers aware of risks Breaking habit difficult Support and assistance needed for cessation Keep trying after failure Educate about limiting exposure to cigarette smoke

14 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Management Stress normal part of life Educate regarding identification of stressors, reactions to stress, and effective management Interventions for handling stress: relaxation exercises, yoga, meditation, and other stress-reducing activities

15 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Proactive Interventions Low-dose aspirin daily: preventive measure Alcohol: light drinking may be beneficial Nutritional supplements Comprehensive assessment of the cardiovascular system includes C-reactive protein screening

16 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiovascular Disease and Women Prevalence increases with age Signs differ with women Education regarding cardiovascular disease and promotion of cardiovascular health Guide women about not ignoring symptoms

17 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Selected Cardiovascular Conditions Hypertension Hypotension Congestive heart failure Pulmonary emboli Coronary artery disease Hyperlipidemia Arrhythmias Peripheral vascular disease

18 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hypertension Incidence and prevalence increases with age Evaluation of blood pressure –Systolic blood pressure ≥ 140 mm Hg –Diastolic blood pressure ≥ 90 mm Hg –Factors to consider when monitoring blood pressure: anxiety, stress, and activity before assessment Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor Wide range of treatment

19 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hypotension Decline in systolic blood pressure of 20 mm Hg or more after changing positions Postural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivity Consequences: falls, stroke, syncope, other coronary complications

20 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Postural and postprandial hypotension is most often related to a.Vasoactive medications and decreased baroreceptor activity b.Antibiotics and increased cardiac output c.Antispasmodic drugs and increased levels of potassium d.Antibiotics and decreased renal function

21 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a.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.

22 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Congestive Heart Failure Incidence increases with age Leading cause of hospitalization Complication of arteriosclerotic heart disease Coronary artery disease responsible for most cases Symptoms: shortness of breath, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and edema

23 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following breath sounds heard on auscultation would indicate an exacerbation of congestive heart failure? a. Crackles b. Vesicular c. Bronchovesicular d. Rhonchi

24 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a.Crackles Some 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.

25 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonary Emboli Incidence high Detection and diagnosis challenging Risk factors: fractures, congestive heart failure, arrhythmias, history of thrombosis, and immobilization Signs/symptoms: confusion, apprehension, shortness of breath, temperature elevation, pneumonitis, and elevated sedimentation rate

26 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Coronary Artery Disease Ischemic heart disease Prevalence increase with age Angina –Atypical presentation: coughing, syncope, sweating, and confusion –Nitroglycerin effective –Education Myocardial infarction –Atypical presentation: confusion, decreased blood pressure, shortness of breath, elevated temperature, and sedimentation rate

27 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hyperlipidemia Risk of coronary artery disease with elevated total cholesterol Evaluate full lipid profile, triglycerides, high- density lipoprotein, low-density lipoprotein Familial tendency Treatment: dietary changes, medications, and alternative and complementary therapies

28 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Arrhythmias Causes: digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome, and coronary insufficiency Symptoms: weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, and syncope Treatment: antiarrhythmic drugs, digitalis, potassium supplements, and cardioversion Education: modify diet, smoking cessation, decrease alcohol, and activity

29 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Hypokalemia, acute infections, hemorrhage, and coronary insufficiency are potential causes of arrhythmias in the older adult population.

30 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True In 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.

31 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Peripheral Vascular Disease Arteriosclerosis: common especially among those with diabetes Affects smaller vessels furthest from heart Diagnosis: arteriography, radiography, and oscillometric testing Treatment: warmth, exercises, and vasodilators

32 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Problems Associated with Diabetes High risk for peripheral vascular problems Arterial insufficiency –Resting pain: intermittent claudication –Arterial pulses: absent or difficult to palpate –Skin discoloration, ulcerations, and gangrene Diagnostic measures Treatment selected per extent of disease

33 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Aneurysms Advanced arteriosclerosis aids in development of aneurysms Some seen, some palatable, and others detected by radiography Thrombosis can develop Various treatments

34 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Varicose Veins Common problem Dilated, tortuous nature of vein Dull pain, cramping, can interfere with sleep Dizziness may occur Susceptible to trauma and infection Treatment aimed at reducing venous stasis

35 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Venous Thromboembolism Increased incidence High risk: restricted to bed rest, recent surgery, and fractures Edema, warmth over affected area, pain in foot, cyanosis, aching, and engorgement of superficial veins Anticoagulants, surgery, elastic stockings, bandages, and elevation of extremities

36 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins General Nursing Considerations for Cardiovascular Conditions Prevention Keep the patient informed Prevent complications Promote circulation Provide foot care Manage problems associated with peripheral vascular disease Promote normality Integrate complementary therapies

37 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevention Incorporation of preventive measures of planning and caregiving Education, counseling, coaching, rehabilitative/restorative activities enables prevention on three levels: –Primary –Secondary –Tertiary

38 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Keeping the Patient Informed Full explanations with reinforcement necessary for educating about diagnostic and treatment –Sensory deficits, anxiety, poor memory, and illness can affect comprehension Opportunities to ask questions and discuss concerns

39 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Preventing Complications Edema can promote skin breakdown –Change position frequently –Proper alignment of body –Monitor conditions that increase chances of edema –Protect from skin breakdown –Monitor, observe, and document Fluid balance Assessment of vital signs Careful administration of oxygen Potential for anorexia Potential for vagal stimulation

40 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Circulation Increased risk of altered tissue perfusion Interventions that improve tissue circulation Prevention of peripheral vascular problems Education about appropriate health practices Enhancement of circulation

41 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Providing Foot Care People with peripheral vascular disease must pay special attention to their feet –Bathe and inspect daily –Avoid injury –Prompt attention for any lesions –Potential for fungal infections Interventions to prevent injury to feet

42 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following foot care interventions is essential to older adults who have peripheral vascular disease? a. Daily inspection of the feet b. Wearing tight-fitting shoes for comfort c. Application of heat to areas of infection d. Vaccination to prevent varicella zoster

43 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a.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.

44 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Problems Associated with Peripheral Vascular Disease Care of ischemic foot lesions –Medical and nursing management Loss of a limb –Loss of independence –Altered body image

45 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Normality Consideration of impact of cardiovascular function on sexuality –Often subject of interest in sex not discussed with health care providers Nursing interventions that include teaching Relaxation and rest vital to treatment Considerations of stressors

46 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Integrating Complementary Therapies Various herbs and spices considered for preventing and treating cardiovascular disorders Some nonconventional measures –Meditation –Biofeedback –Guided imagery –T’ai chi –Yoga Full benefit of complementary therapies is in process of discovery: less intrusive, less expensive, and minimal risks


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