tabloski ch15 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Cardiovascular System

15

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe changes in the cardiovascular system that occur with aging.

2. List focus areas of assessment for cardiovascular patients.


Learning Objectives

3. Relate physiological concepts to the diagnosis and management of common cardiovascular risks and conditions, including hypertension, angina, heart failure, and peripheral vascular disease.

4. Formulate common nursing diagnoses for the cardiovascular patient.


Learning Objectives

5. Identify specific nursing interventions used with cardiovascular patients.

6. Outline an education plan for cardiovascular patients.


Introduction

• By understanding key principles of physiology, the nurse can understand how to assist persons in preventing cardiovascular diseases and how new treatment modalities work to reduce symptoms and improve function and quality of life.


Introduction

• This chapter reviews the cardiovascular changes related to aging, the pattern of specific cardiovascular conditions, and the medical and nursing interventions used to support older patients who have, or are at risk for, these conditions.


Structure and Function

• The cardiac cycle is the mechanical sequence and timing of contraction and relaxation in the heart. It is determined by the electrical system of the heart.

• The cardiac output is affected by the heart rate and by the volume of venous blood returned to the heart.


Structure and Function

• With aging and the diagnosis of cardiovascular disease, it is important to know how efficiently the heart is able to pump blood throughout the body.


Regulation of Blood Flow

• Blood flow in any area of the body is under several types of control.


Cardiac Circulation

• The function of the heart muscle depends on adequate circulation to provide oxygenated blood and prevent pain caused by myocardial ischemia or angina.


Normal Changes of Aging

• A decrease in cardiovascular reserve or a decrease in cardiac output may be the result of deconditioning and/or disease or the result of natural aging processes.

• Changes in other body systems may occur with aging and can affect the cardiovascular system.



• How an individual person ages is determined by genetic factors as well as by physical and social environments.



• By staying physically active, avoiding obesity, avoiding smoking, and controlling blood pressure and cholesterol levels, many older persons can lead healthy lives without significant cardiovascular problems.



• Because of normal aging changes, the older person has a decreased capacity to adapt to physiologic stressors to the cardiovascular system and these older adults will need careful monitoring of cardiac function.


Hypertension

• An estimated 1 in 3 adults or 68 million Americans have hypertension, and only 50% of those with hypertension have their hypertension under control.

• The definition and cutoff readings for the diagnosis of hypertension are revised as new research is evaluated.


Hypertension

• It is essential to check postural blood pressures in older patients to detect postural hypotension and teach patients to prevent falls by changing positions slowly.


Hypertension

• For persons with normal blood pressure, screening measurement every 2 years is sufficient.

• For those with prehypertension, blood pressure should be assessed annually.

• The nurse should record pressures in both upper extremities and in the positions of lying, sitting, and standing.


Hypertension

• The nurse’s role in caring for older patients with hypertension is to screen for high blood pressure in a variety of community settings and to promote healthy lifestyles through low-fat and low-sodium diets, weight control, exercise, smoking cessation, and controlled alcohol consumption.


Hypertension

• Monitoring the effect of medication and determining barriers to healthy living are important in supporting the patient in self-management.


Hypotension

• Low blood pressure, or hypotension, can occur in the older person.


Hyperlipidemia

• The Adult Treatment Panel (ATP III) made recommendations for evaluating and managing elevated cholesterol. It recommended lifestyle and drug therapies based upon an individual’s cardiovascular risk factors and recommended how aggressive to be in lowering cholesterol levels.


Nursing Management

• Pharmacology and nursing implications:–Many patients have more than one

disease and require multiple medications to control cardiovascular conditions. This can lead to a common problem in the older person known as polypharmacy.

–The nurse and the pharmacist are often the only providers to see the full range of medications a patient is taking.


Nursing Management

• Nonpharmacological treatments:–One of the most useful methods to help

patients adjust to cardiovascular problems is the concept of rehabilitation.


Older Women and Heart Disease

• Heart disease is the primary killer of women in the United States.

• The symptoms of heart disease in an older women may be vague and often go unreported.


Nursing Management

• The nurse is in an ideal situation to intervene with older persons with cardiac problems.


Nursing Assessment

• Nursing assessment of cardiovascular function for the older person follows the same principles as health assessment in general.

• The history is the most important part of the assessment.


Nursing Interventions

• Risk factor reduction can be done in a variety of settings from home, to hospital, to long-term care.

• The creativity of nursing is to reach each patient as an individual.

• Counseling and nursing presence can help patients who are making decisions about major cardiac interventions or end-of-life care.

tabloski ch15 lecture

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