Chapter 24 Cardiovascular Conditions

1. Chapter 24Cardiovascular Conditions

2. Promoting Cardiovascular Health • Eating properly. • Getting adequate exercise. • Avoiding cigarette smoke. • Managing stress.

3. Reducing the Risk of Cardiovascular Disease • Reduce fried foods, animal fats, and partially hydrogenated fats in diet. • Increase the intake of complex carbohydrates and fiber. • Maintain caloric intake within ideal range. • Use monounsaturated oil and omega-6 oils. • Reduce intake of red meat, sugar, and highly processed foods. • Consume alcoholic beverages in moderation.

4. The Reversal Diet • Less than 10% of calories from fat and very little of those from saturated fat • High fiber intake • Exclusion of all oils and animal products except nonfat milk and yogurt • Exclusion of caffeine and other stimulants • Less than 2 oz of alcohol per day • No calorie restriction

5. Ornish’s Prevention Diet • Similar to the Reversal Diet except 20% of calories can come from fat. • Advocates moderate exercise, increased intimacy, stress reduction, and other healthy practices. • Cons: • Too restrictive of fats; rise in obesity due to excess carbohydrate consumption. • May be difficult to follow on a long-term basis. • Pro: moves people in right direction.

6. Side Effects of Cholesterol Medications • Muscle pain • Weakness • Fatigue • Erectile dysfunction • Memory loss • Burning and tingling in the hands and feet

7. Challenges to an Active Lifestyle • Automobiles, elevators, and modern appliances • Less physically exerting jobs leading to a more sedentary lifestyle • Being physically inactive during the week and then filling weekends with housecleaning, yard work, and sports activities

8. Assessment of the Cardiovascular System • Generalized coloring • Energy level • Breathing pattern • Condition of nails • Status of vessels • Hair on extremities • Edema • Mental status

9. Proactive Interventions • Taking a low-dose aspirin daily • Moderate alcohol intake • Daily multivitamin supplement

10. Cardiovascular Conditions • Congestive heart failure • Pulmonary emboli • Coronary artery disease • Angina • Myocardial infarction • Hypertension • Hypotension • Arrhythmias

11. Peripheral Vascular Disease • Arteriosclerosis • Buerger-Allen exercises • Aneurysms • Abdominal and peripheral aneurysms • Varicose veins • Venous thromboembolism

12. Symptoms of Congestive Heart Failure • Dyspnea on exertion • Confusion • Insomnia • Wandering during the night • Agitation • Depression • Anorexia

13. Symptoms of Congestive Heart Failure (cont.) • Nausea • Weakness • Shortness of breath • Orthopnea; wheezing • Weight gain • Bilateral ankle edema

14. Four Categories Used to Treat Congestive Heart Failure • Class 1: Cardiac disease without physical limitation. • Class 2: Symptoms experienced with ordinary physical activity; slight limitations may be evident. • Class 3: Symptoms experienced with less than ordinary activities; physical activity significantly limited. • Class 4: Symptoms experienced with any activity and during rest; bed rest may be required.

15. Treatment for CHF • Bed rest • Digitalis • Diuretics • Reduction in sodium intake

16. High Risk Factors for Pulmonary Emboli • A fractured hip • CHF • Arrhythmias • History of thrombosis • Immobilization and malnourishment

17. Symptoms of Pulmonary Emboli • Confusion • Apprehension • Increasing dyspnea • Slight temperature elevation • Pneumonitis • Elevated sedimentation rate

18. Angina • Presents atypically in the aged. • Less diffuse pain • Pain similar to indigestion • Confusion

19. Treatment for Angina • Nitroglycerin • Avoidance of factors that may aggravate angina • Cold wind, emotional stress, strenuous activity, anemia, tachycardia, arrhythmias, and hyperthyroidism • Acupuncture

20. Symptoms of MI • Pain radiating to the left arm, the entire chest, the neck, and abdomen • Confusion • Moist, pale skin • Decreased blood pressure • Syncope • Cough • Low-grade fever • Elevated sedimentation rate

21. Nonpharmacological Methods to Control BP • Fish oil supplements • Garlic • Hawthorn berries • Supplements • Biofeedback • Yoga • Meditation

22. Symptoms of Hypertension • Dull headache • Impaired memory • Disorientation • Confusion • Epistaxis • Slow tremor • Elevated blood pressure reading

23. Consequences of Hypotension for Elders • High risk for falls • Stroke • Syncope • Coronary complications

24. Factors Contributing to Arrhythmias • Digitalis toxicity • Hypokalemia • Acute infections • Hemorrhage • Anginal syndrome • Coronary insufficiency

25. Treatment of Arteriosclerosis • Bed rest • Warmth • Buerger-Allen exercises • Vasodilators • Sympathetic ganglionectomy

26. Problems Associated with Diabetes • Resting pain may occur as a result of intermittent claudication. • Arterial pulses may be difficult to find or totally absent. • Skin discoloration, ulcerations, and gangrene may be present.

27. Aneurysms • Abdominal aortic aneurysms are a high risk in persons with a history of arteriosclerotic lesions, angina pectoris, MI, and CHF. •  Aneurysms can develop in peripheral arteries. • The most common sites are the femoral and popliteal arteries.

28. Treatment of Varicose Veins • Reduce venous stasis. • Elevate and rest affected limb. • Promote exercise. • Use elastic stockings and bandages properly.

29. Treatment of Venous Thromboembolism • Use elastic stockings or bandages. • Provide rest and elevate the affected limb. • Use analgesics to relieve pain. • Administer anticoagulants. • Surgery may be performed. • Avoid situations that cause straining. • Keep patient comfortable and well hydrated.

30. Prevention • Primary: prevent disease from developing in healthy elders. • Secondary: strengthen the abilities of persons who are diagnosed with disease. • Tertiary: maximize capabilities through rehabilitative and restorative efforts.

31. Nursing Considerations • Preventing the disease. • Keeping the patient informed. • Preventing complications. • Promoting peripheral circulation. • Performing foot care. • Dealing with problems associated with PVD. • Promoting normality.

32. Complimentary Therapies • Herbs • Hawthorn berry; garlic; ginger • Stress reduction • Meditation; biofeedback; yoga; tai chi • Acupuncture • Lifestyle modifications

33. Source • Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).