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Chapter 24
Cardiovascular Conditions
Promoting Cardiovascular Health
• Eating properly.
• Getting adequate exercise.
• Avoiding cigarette smoke.
• Managing stress.
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.
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
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.
Side Effects of Cholesterol Medications
• Muscle pain
• Weakness
• Fatigue
• Erectile dysfunction
• Memory loss
• Burning and tingling in the hands and feet
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
Assessment of the Cardiovascular System
• Generalized coloring
• Energy level
• Breathing pattern
• Condition of nails
• Status of vessels
• Hair on extremities
• Edema
• Mental status
Proactive Interventions
• Taking a low-dose aspirin daily
• Moderate alcohol intake
• Daily multivitamin supplement
Cardiovascular Conditions
• Congestive heart failure
• Pulmonary emboli
• Coronary artery disease
– Angina
– Myocardial infarction
– Hypertension
– Hypotension
– Arrhythmias
Peripheral Vascular Disease
• Arteriosclerosis
– Buerger-Allen exercises
• Aneurysms
– Abdominal and peripheral aneurysms
• Varicose veins
• Venous thromboembolism
Symptoms of Congestive Heart Failure
• Dyspnea on exertion
• Confusion
• Insomnia
• Wandering during the night
• Agitation
• Depression
• Anorexia
Symptoms of Congestive Heart Failure
(cont.)
• Nausea
• Weakness
• Shortness of breath
• Orthopnea; wheezing
• Weight gain
• Bilateral ankle edema
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.
Treatment for CHF
• Bed rest
• Digitalis
• Diuretics
• Reduction in sodium intake
High Risk Factors for Pulmonary Emboli
• A fractured hip
• CHF
• Arrhythmias
• History of thrombosis
• Immobilization and malnourishment
Symptoms of Pulmonary Emboli
• Confusion
• Apprehension
• Increasing dyspnea
• Slight temperature elevation
• Pneumonitis
• Elevated sedimentation rate
Angina
• Presents atypically in the aged.
– Less diffuse pain
– Pain similar to indigestion
– Confusion
Treatment for Angina
• Nitroglycerin
• Avoidance of factors that may aggravate angina
– Cold wind, emotional stress, strenuous activity,
anemia, tachycardia, arrhythmias, and
hyperthyroidism
• Acupuncture
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
Nonpharmacological Methods to Control
BP
• Fish oil supplements
• Garlic
• Hawthorn berries
• Supplements
• Biofeedback
• Yoga
• Meditation
Symptoms of Hypertension
• Dull headache
• Impaired memory
• Disorientation
• Confusion
• Epistaxis
• Slow tremor
• Elevated blood pressure reading
Consequences of Hypotension for Elders
• High risk for falls
• Stroke
• Syncope
• Coronary complications
Factors Contributing to Arrhythmias
• Digitalis toxicity
• Hypokalemia
• Acute infections
• Hemorrhage
• Anginal syndrome
• Coronary insufficiency
Treatment of Arteriosclerosis
• Bed rest
• Warmth
• Buerger-Allen exercises
• Vasodilators
– Sympathetic ganglionectomy
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.
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.
Treatment of Varicose Veins
• Reduce venous stasis.
• Elevate and rest affected limb.
• Promote exercise.
• Use elastic stockings and bandages properly.
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.
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.
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.
Complimentary Therapies
• Herbs
– Hawthorn berry; garlic; ginger
• Stress reduction
– Meditation; biofeedback; yoga; tai chi
• Acupuncture
• Lifestyle modifications
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).