Transcript Chapter 20 Circulation

CHAPTER 20
CIRCULATION
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
INTRODUCTION
Improved technology and increased public
awareness resulted in decline in heart disease
in the population as a whole
Cardiovascular disease has become the major
cause of disability and death in older
population
Nursing interventions for prevention address
potential problems related to circulation
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
EFFECTS OF AGING ON
CARDIOVASCULAR HEALTH CONT’D
Conditions altering tissue perfusion
Cardiovascular diseases
Diabetes, cancer, renal failure
Blood dyscrasias
Hypotension
Medication side effects
Other issues of concern
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.
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.
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
PROPER NUTRITION
Proper diet and weight
Control of cholesterol
Reduced cardiovascular and cerebrovascular
incidents
Nutritional supplements
Various diets
Lifestyle modifications
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
QUESTION
Is the following statement True or False?
Regular exercise can decrease or limit the
age-related functional declines that aging
people can experience.
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.
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
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 stressreducing activities
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
CARDIOVASCULAR DISEASE AND WOMEN
Prevalence increases with age (45-54 years)
Signs differ with women
Education regarding cardiovascular disease and
promotion of cardiovascular health
Guide women about not ignoring symptoms
SELECTED CARDIOVASCULAR CONDITIONS
Hypertension
Hypotension
Congestive heart failure
Pulmonary emboli
Coronary artery disease
Hyperlipidemia
Arrhythmias
Peripheral vascular disease
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
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
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
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.
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
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
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.
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
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
HYPERLIPIDEMIA
Risk of coronary artery disease with elevated
total cholesterol
Evaluate full lipid profile, triglycerides, highdensity lipoprotein, low-density lipoprotein
Familial tendency
Treatment: dietary changes, medications, and
alternative and complementary therapies
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
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.
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.
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
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
ANEURYSMS
Advanced arteriosclerosis aids in development of
aneurysms
Some seen, some palatable, and others detected by
radiography
Thrombosis can develop
Various treatments
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
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
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
PREVENTION
Incorporation of preventive measures of planning and
caregiving
Education, counseling, coaching,
rehabilitative/restorative activities enables
prevention on three levels:
Primary
Secondary
Tertiary
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
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
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
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
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
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.
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
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
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