Gero Exam 2 Flashcards
What is perfusion?
Flow of blood through arteries and capillaries delivering nutrients and oxygen to the cells
What are the two types of conditions that affect perfusion?
Acute conditions and Chronic conditions
Acute conditions include MI, CVA, and shock; chronic conditions include HTN, CHF, sickle cell, and hemophilia.
Define central perfusion.
Generated by cardiac output (CO)
What is the normal cardiac output for an adult?
4-6 L/min
What variables impact cardiac output?
- Stroke Volume (SV)
- Heart Rate (HR)
What is preload in relation to cardiac function?
Amount of blood in ventricles at end of diastole
What does afterload refer to?
The force the ventricles must exert to open the semilunar valves
What influences systemic vascular resistance (SVR)?
- Length of blood vessels
- Diameter of blood vessels
- Viscosity of blood
What is impaired central perfusion?
Decreased cardiac output
List some physiological changes in older adults’ cardiovascular health.
- Heart valves increase in thickness & rigidity
- Aorta becomes dilated
- Slight ventricular hypertrophy develops
- Myocardial muscle less efficient
What lifestyle changes can promote cardiovascular health in older adults?
- Proper nutrition
- Adequate exercise
- Cigarette smoke avoidance
- Stress management
What dietary recommendations are suggested for cardiovascular health?
- Decrease intake of fried foods and animal fats
- Increase intake of complex carbohydrates and fiber
- Eat fish rich in omega-3 fatty acids twice weekly
What is the recommended duration of exercise for older adults?
30 minutes 5 days/week or 20 minutes of vigorous exercise at least 3 days/week
True or False: Women over 70 years old should consider low-dose ASA daily for cardiovascular health.
False
What is the significance of C-reactive protein (CRP) in cardiovascular health?
Predictor of cardiovascular events
What are common signs of cardiovascular disease observed during assessment?
- Pallor
- Fatigue
- Cold extremities
- Nail condition changes
What are some symptoms of cardiovascular distress?
- Dizziness
- Edema
- Palpitations
- Breathing difficulties
What is the normal blood pressure range?
SBP ≤ 120 and DBP ≤ 80
What defines Stage I Hypertension?
SBP 130-139 and/or DBP 80-89
What is congestive heart failure (CHF)?
A condition where the heart’s ability to pump blood is inadequate
List some risk factors for congestive heart failure.
- Coronary artery disease (CAD)
- Hypertension (HTN)
- Diabetes mellitus (DM)
What are common symptoms of CHF?
- Dyspnea on exertion
- Confusion
- Weakness
- Ankle edema
What is the leading cause of hospitalizations among older adults?
Congestive heart failure (CHF)
What does the NY Heart Association classification system assess?
Severity of heart disease
What classification corresponds to symptoms experienced during rest?
Class 4
What is the primary treatment for hypertension in older adults?
Lifestyle changes and antihypertensive medications
What is postural hypotension?
Decline in SBP ≥ 20 mmHg after rising and standing for 1 minute
What is the incidence of coronary artery disease (CAD) in older adults?
Prevalence increases with advanced age
What are atypical angina symptoms in older adults?
- Diffuse pain
- Less severe discomfort than in younger adults
What can contribute to an increased risk of pulmonary embolism (PE) in older adults?
- Fractured hip
- CHF
- Immobility
What type of pain do older adults typically experience compared to younger adults?
Diffuse, less severe in nature
Pain may be confused with indigestion, especially after large meals.
What are common symptoms experienced by older adults with progressing cardiac conditions?
- Precordial pain radiating down the left arm
- Coughing
- Syncope
- Sweating with exertion
- Episodes of confusion
What does recurrent angina over many years lead to?
Formation of small areas of myocardial necrosis and fibrosis
Eventually leading to diffuse myocardial fibrosis and potential risk of CHF.
What medication is used to prevent and treat angina attacks?
Nitroglycerin
True or False: Older persons are more likely to experience orthostatic hypotension with nitrates.
True
What should older adults be educated to do if pain is not relieved by nitroglycerin?
Notify physician
What is the trend in total cholesterol levels with age?
Increases primarily due to increases in low-density lipoprotein (LDL)
List some conditions that cause increased LDL.
- Uncontrolled DM
- Hypothyroidism
- Uremia
- Nephrotic syndrome
What is the relationship between triglyceride (TG) levels and food intake?
TG levels are sensitive to food and require fasting for 12 hours prior to testing.
What are the desired levels for HDL and TG?
- HDL > 60 mg/dl
- TG > 200 mg/dl (borderline) and > 240 mg/dl (high)
What is the recommended LDL level for patients with CAD or DM?
LDL <100 mg/dl
What dietary changes can help manage hyperlipidemia?
- AHA step 1 diet
- AHA step 2 diet
- Dean Ornish diet
What medications are commonly used to treat hyperlipidemia?
- HMG CoA reductase inhibitors (statins)
- Bile acid sequestrants
- Nicotinic acid (niacin)
- Fibrates
- Omega-3 fatty acids
What is the most common chronic cardiac arrhythmia in persons over 65 years old?
Atrial Fibrillation (Afib)
What are some common causes of Atrial Fibrillation?
- Structural defects
- Comorbidities (HTN, HLD, HF, anemia, arthritis, DM, chronic renal disease)
What are the symptoms of Atrial Fibrillation?
- Palpitations
- Irregular pulse
- Shortness of breath (SOB)
- Chest pain
- Fatigue
- Dizziness
- Delirium
What is the primary goal in controlling and preventing Atrial Fibrillation?
Reduce risk for CVA
How is arteriosclerosis different from atherosclerosis?
Arteriosclerosis affects smaller vessels farther away from the heart, while atherosclerosis primarily affects large vessels coming from the heart.
What are some common symptoms of arterial insufficiency associated with diabetes mellitus?
- Resting pain
- Intermittent claudication
- Skin discoloration
- Ulcerations
- Gangrene
What is a common complication of abdominal aortic aneurysms?
Formation of a thrombus which can occlude the vessel and cause loss of limb.
What factors contribute to the development of varicose veins in older adults?
- Lack of exercise
- Jobs with lots of standing
- Loss of vessel elasticity and strength
What are the common symptoms of venous thromboembolism?
- Edema
- Warmth over affected area
- Pain in sole of foot
What are the general nursing considerations for older adults with vascular issues?
- Prevention
- Keeping the patient informed
- Preventing complications
- Promoting circulation
- Providing foot care
