Ch 17: Cardiovascular Flashcards
abnormal heart rate or rhythm
Arrhythmia
hardening and narrowing of arteries due to plaque buildup in vessel walls
Atherosclerosis
consistent blood pressure reading >120 systolic and >80 diastolic
Hypertension
decline in cardiovascular function due to physical inactivity
Physical Deconditioning
decline in systolic blood pressure of 20 mm Hg or more after rising and standing for 1 minute
Postural (Orthostatic) Hypotension
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
Conditions altering tissue perfusion
Cardiovascular diseases
Diabetes, cancer, and renal failure
Blood dyscrasias
Hypotension
Medication side effects
Other issues of concern
age-related changes in cardiovascular disease
-more prominent arteries in head, neck, and extremities
-valves become thicker and more rigid
-stroke volume decreases by 1% per year
-heart pigmented with lipfuscin granules
-less efficient O2 utilization
-aorta becomes dilated and elongated
-cardiac output decreases
-resistance to peripheral blood flow increases by 1% per year
-blood pressure increase to compensate for increased peripheral resistance and decreased cardiac output
-less elasticity of vessels
cardiovascular health promotion
proper diet
exercise
avoid cigarette smoke
manage stress
proper nutrition for cardiac function
Control of cholesterol – HDL, LDL, VLDL, Triglycerides
Reduced intake of fried and fatty foods, red meat, sugar, and highly processed foods
Reduced cardiovascular and cerebrovascular incidents
Nutritional supplements
Fish Oil, Omega-3 Fatty Acids, Vitamin B6, Garlic
Various diets – low saturated fat, Mediterranean Diet. Diet low in saturated fat and high in fiber, fruits, and vegetables
Dr. Ornish’s Dietary Program for reversing Heart Disease
adequate exercise for cardiovascular health
Regular exercise versus spurts of activity
Physical deconditioning related to functional decline – decreased efficiency utilizing available oxygen.
Enhance circulation with aerobic exercise, yoga, strengthening exercises, balance exercises, and tai chi
evaluation of blood pressure
Systolic blood pressure greater than 120 mm Hg
Diastolic blood pressure greater than 80 mm Hg
Factors to consider when monitoring blood pressure: anxiety, stress, and activity before assessment
symptoms of hypertension in older adults
from no symptoms, dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor
wide range of treatment
DASH diet
non-pharmacological measures
pharmacological
Decline in systolic blood pressure of 20 mm Hg or more after changing positions
hypotension
occurs due to increased intake of vasoactive medications, baroreceptor sensitivity, and diseases of the heart
postural or orthostatic hypotension
consequences of hypotension
falls
stroke
syncope
other coronary complications
what is responsible for most CHF cases
coronary artery disease
leading cause of hospitalization of older adults
CHF
CHF is a complication of:
arteriosclerotic heart disease
what happens in CHF
reduced elasticity and lumen size of the vessels, and increase in BP that interferes with blood supply to the heart
symptoms of CHF
shortness of breath, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and bilateral ankle edema
crackles are also heard on auscultation
New York Heart Association Classification (NYHA)
Class 1 - no physical
limitations
Class 2 - light limitations with ordinary physical activity
Class 3 - symptoms limit ordinary physical activities
Class 4 - symptoms with any activity and rest
nursing care considerations for older adults with cardiovascular disease
-cluster activities allowing for rest period
-monitor for edema and subsequent skin breakdown
-daily weight - report gain of greater than 3 pounds in less than several days or 10 in a month
-low salt diet
-watch cough, fatigue, DOE, and changes in skin color and pulse
what number do we want of total cholesterol number
under 200
what number for HDL
greater than 60
what number for LDL
less than 100
what number for VLDL
between 2 and 30
what number for triglycerides
less than 150
cardiac diet
decreased alcohol
decrease saturated fat
decrease
occurs when a clump of material, most often a blood clot, gets stuck in an artery in the lungs, blocking the flow of blood.
pulmonary emboli
how often for moderate vs high intensity exercise
moderate = 5x a week
high = 3x a week
risk factors for pulmonary emboli
fractures, congestive heart failure, arrhythmias, history of thrombosis, and immobilization
s/s of pulmonary emboli
confusion, apprehension, shortness of breath, temperature elevation, pneumonitis, and elevated sedimentation rate
how to confirm diagnosis of PE
lung scan or angiography
important lab value for PE
D-Dimer usually elevated
ischemic heart disease
coronary artery disease
Vague discomfort under the sternum after exertion or a large meal
angina
atypical presentation of angina
coughing
syncope
sweating
confusion
treatment of angina
nitro - can lead to orthostatic hypotension
education
midsternal chest heaviness, radiation, associated with nausea/vomiting, diaphoresis
MI
atypical presentation of an MI
confusion, decreased blood pressure, shortness of breath, elevated temperature, fatigue, and sedimentation rat
number 1 symptom of CHF
dyspnea on exertion
what are you at risk for with elevated cholesterol
cardiovascular disease
what to evaluate with hyperlipidemia
full lipid profile, triglycerides, high-density lipoprotein, and low-density lipoprotein
treatment for hyperlipidemia
dietary changes, niacin, medications, and alternative and complementary therapies
causes of arrythmias
digitalis toxicity
hypokalemia
acute infections
hemorrhage
anginal syndrome
CHF
coronary insufficiency
Afib
symptoms of arrythmias
weakness
fatigue
SOB
palpitations
confusion
dizziness
hypotension
bradycardia
syncope
treatment of arrythmias
antiarrhythmic drugs
digitalis
potassium supplements
cardioversion
surgical ablations
education for arrythmias
modify diet
smoking cessation
decrease alcohol and activity
take pulse
common especially among those with diabetes
Affects smaller vessels furthest from heart
arteriosclerosis
blood vessels that carry oxygen and nutrients from the heart to the rest of the body (arteries) become thick and stiff — sometimes restricting blood flow to the organs and tissues.
arteriosclerosis
diagnosis of arteriosclerosis
arteriography
radiography
oscillometric testing
treatment of arteriosclerosis
warmth
exercises
vasodilators
are active postural exercises in which gravity alternately deflates and fills blood vessels to increase blood flow to the lower limbs
beurger-allen exercises
special cardiac problems associated with diabetes
-high risk for peripheral vascular problems
-arterial insufficiency
-
characteristics of arterial insufficiency
Resting pain: intermittent claudication
Arterial pulses: absent or difficult to palpate
Skin discoloration, ulcerations, and gangrene
Loss of hair and/or shiny skin on the extremities***
diagnostic measures of associated diabetic problems
arteriography
outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall
aneurysms
locations of aneurysms
aorta, brain, mesenteric, renal arteries, but mostly seen in the abdominal aorta in older adults
what aids in the development of aneurysms
advanced arteriosclerosis
treatments of aneurysms
stents
endovascular surgery
characteristics of varicose veins**
dilated, tortuous nature of vein
dull pain, cramping, can interfere with sleep
dizziness may occur
makes the skin more susceptible to trauma and infection - rupture and bleeding
treatment aimed at reducing venous stasis = pooling
high risk patients for venous thromboembolism
restricted to bed rest, recent surgery, and fractures of lower extremities
**orthopedic sx
s/s of venous thromboembolism
Edema, warmth over affected area, pain in foot, cyanosis, aching, and engorgement of superficial veins
treatment for venous thromboembolism
Anticoagulants, surgery, elastic stockings, bandages, and elevation of extremities
General Nursing Considerations for Cardiovascular Condition
Prevention
Keep the patient informed
Prevent complications
Promote circulation
Provide foot care
Manage problems associated with peripheral vascular disease
Promote normality
Integrate complementary therapies
foot care for PVD***
Bathe and inspect daily
Avoid injury - can lead to amputations
Prompt attention for any lesions
Potential for fungal infections - take off socks and shoes throughout the days
Wear socks with shoes
