Chapter 24Cardiovascular Conditions

Chapter 24Cardiovascular Conditions

Promoting Cardiovascular HealthPromoting Cardiovascular Health

• Eating properly.

• Getting adequate exercise.

• Avoiding cigarette smoke.

• Managing stress.

Reducing the Risk of Cardiovascular DiseaseReducing 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 DietThe 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 DietOrnish’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 MedicationsSide Effects of Cholesterol Medications

• Muscle pain

• Weakness

• Fatigue

• Erectile dysfunction

• Memory loss

• Burning and tingling in the hands and feet

Challenges to an Active LifestyleChallenges 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 SystemAssessment of the Cardiovascular System

• Generalized coloring

• Energy level

• Breathing pattern

• Condition of nails

• Status of vessels

• Hair on extremities

• Edema

• Mental status

Proactive InterventionsProactive Interventions

• Taking a low-dose aspirin daily

• Moderate alcohol intake

• Daily multivitamin supplement

Cardiovascular ConditionsCardiovascular Conditions

• Congestive heart failure

• Pulmonary emboli

• Coronary artery disease

– Angina

– Myocardial infarction

– Hypertension

– Hypotension

– Arrhythmias

Peripheral Vascular DiseasePeripheral Vascular Disease

• Arteriosclerosis

– Buerger-Allen exercises

• Aneurysms

– Abdominal and peripheral aneurysms

• Varicose veins

• Venous thromboembolism

Symptoms of Congestive Heart FailureSymptoms of Congestive Heart Failure

• Dyspnea on exertion

• Confusion

• Insomnia

• Wandering during the night

• Agitation

• Depression

• Anorexia

Symptoms of Congestive Heart Failure (cont.)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 FailureFour 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 CHFTreatment for CHF

• Bed rest

• Digitalis

• Diuretics

• Reduction in sodium intake

High Risk Factors for Pulmonary EmboliHigh Risk Factors for Pulmonary Emboli

• A fractured hip

• CHF

• Arrhythmias

• History of thrombosis

• Immobilization and malnourishment

Symptoms of Pulmonary EmboliSymptoms of Pulmonary Emboli

• Confusion

• Apprehension

• Increasing dyspnea

• Slight temperature elevation

• Pneumonitis

• Elevated sedimentation rate

Angina Angina

• Presents atypically in the aged.

– Less diffuse pain

– Pain similar to indigestion

– Confusion

Treatment for AnginaTreatment for Angina

• Nitroglycerin

• Avoidance of factors that may aggravate angina

– Cold wind, emotional stress, strenuous activity, anemia, tachycardia, arrhythmias, and hyperthyroidism

• Acupuncture

Symptoms of MISymptoms 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 BPNonpharmacological Methods to Control BP

• Fish oil supplements

• Garlic

• Hawthorn berries

• Supplements

• Biofeedback

• Yoga

• Meditation

Symptoms of HypertensionSymptoms of Hypertension

• Dull headache

• Impaired memory

• Disorientation

• Confusion

• Epistaxis

• Slow tremor

• Elevated blood pressure reading

Consequences of Hypotension for EldersConsequences of Hypotension for Elders

• High risk for falls

• Stroke

• Syncope

• Coronary complications

Factors Contributing to ArrhythmiasFactors Contributing to Arrhythmias

• Digitalis toxicity

• Hypokalemia

• Acute infections

• Hemorrhage

• Anginal syndrome

• Coronary insufficiency

Treatment of ArteriosclerosisTreatment of Arteriosclerosis

• Bed rest

• Warmth

• Buerger-Allen exercises

• Vasodilators

– Sympathetic ganglionectomy

Problems Associated with DiabetesProblems 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.

AneurysmsAneurysms

• 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 VeinsTreatment of Varicose Veins

• Reduce venous stasis.

• Elevate and rest affected limb.

• Promote exercise.

• Use elastic stockings and bandages properly.

Treatment of Venous ThromboembolismTreatment 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.

PreventionPrevention

• 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 ConsiderationsNursing 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 TherapiesComplimentary Therapies

• Herbs

– Hawthorn berry; garlic; ginger

• Stress reduction

– Meditation; biofeedback; yoga; tai chi

• Acupuncture

• Lifestyle modifications

SourceSource

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