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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).