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CHAPTER 15 Lecture Note PowerPoint Presentation The Cardiovascular System Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. LEARNING OUTCOME 1 Describe changes in the cardiovascular system that occur with aging. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart structure – Right atrium – Tricuspid valve – Right ventricle – Pulmonic valve Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 15-3 The capillary network between arterial and venous blood. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart structure – Mitral valve – Left ventricle – Aortic valve – Pericardium Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart function – Diastole – Systole Cardiac output Ejection fraction Autonomic nervous system • Sympathetic: alpha and beta receptors (adrenergic) • Parasympathetic: vagus nerve Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart function – Systole Conduction system • • • • Action potential noting the refractory period Sinoatrial (SA) node Atrioventricular (AV) node Bundle branches Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart function – Electrocardiogram (EKG) P wave P-R interval QRS wave T wave Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart function – Circulatory system structure Arteries • Tunica intima • Tunica media • Tunica adventitia Capillaries • Endothelial layer • Basal lamina Veins • Inferior and superior vena cava Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Structure and Function of Cardiovascular System • Heart function – Circulatory system function Regulation of blood flow • Local conditions • Release of nitric oxide → vasodilation • Metabolic activity Cardiac circulation • • • • Left coronary artery (LCA) Left anterior descending (LAD) Circumflex Right coronary artery (RCA) Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Wide Range of Cardiovascular Function Among Older Adults • Genetics • Conditioning • Effect of other aging organ systems – Different body systems age at different rates – Compensation ability – Comorbidities • Social and physical environments Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aging Changes with the Heart • Myocardium – Hypertrophy Left ventricle wall 25% thicker in an 80-year-old person vs. a 30-year-old person – Increased collagen and connective tissue – Cardiac cells Accumulation of lipofuscin, amyloid Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 15-4 Normal changes of aging in the cardiovascular system. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aging Changes with the Heart • Valves – Fibrosis and calcification → stiffening of valves – Changes in valve rings → contribute to stenosis or incompetence • Resting heart rate unchanged with age – Difficulty responding to stress • Small decline in cardiac output from age 20 Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aging Changes with the Heart • Electrical activity – Decrease in number of normal pacemaker cells in SA node After age 75 < 10% still functional • Supports normal cardiac function – Decrease in number of normal pacemaker cells in AV node and both bundle branches – Refractory period of the AV node increases EKG without specific changes with normal aging Refractory period: the amount of time it takes for an excitable membrane to be ready for a second stimulus once it returns to its resting state following excitation Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aging Changes with the Heart • Electrical activity – Layers Arterial • Thickening of the intimal and medial layers • Lipid deposits • Calcification → medial layer→ collagen deposits→ decreased elasticity + “hardening” Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aging Changes with the Heart • Autonomic nervous system (is a part of prepheral NS, and affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils, micturition (urination), and sexual arousal . – Decreased responsiveness to beta-adrenergic stimulation • Baroreceptors less efficient • Other aging systems that affect cardiovascular function – Pulmonary – Renal – Baroreceptors (or baroceptors) are sensors located in the blood vessels of several mammals.` They are a type of mechanoreceptor that detects the pressure of blood flowing through them, and can send messages to the central nervous system to increase or decrease total peripheral resistance and cardiac output. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. LEARNING OUTCOME 2 List focus areas of assessment for cardiovascular patients. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. History of Cardiovascular Problems • Careful interview is important – Allow patient to share concerns – Gather pertinent information Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. History of Cardiovascular Problems • Comprehensive – Demographic information Patient’s date of birth Source of history, if other than the patient Chief complaint History of the present illness Past history Review of systems Family history Social history Functional health pattern assessment, for nursing planning Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Complete Review of Systems • Focus for an older patient with cardiovascular problems – Presence or absence of chest pain – Shortness of breath – Syncope – Palpitations – Edema Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Complete Review of Systems • Focus for an older patient with cardiovascular problems – Nocturnal dyspnea – Nocturia – Pain in the extremities – Cough – Fatigue Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Women’s Symptoms are Often Vague and Often Not Reported • Symptoms include – Sleep disturbance – Chest discomfort such as tightness, squeezing, fullness, or pressure that can come and go – Discomfort in the back, neck, jaw, or stomach – Shortness of breath – Feelings of nausea, light-headedness, or breaking out in a cold sweat Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. LEARNING OUTCOME 3 Relate physiological concepts to the diagnosis and management of common cardiovascular conditions, including hypertension, angina, heart failure, and peripheral vascular disease. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Heart Disease is the Number-One Cause of Death for Older People • Develops slowly • Takes years to develop Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hypertension • Major risk factor for other cardiovascular conditions • No symptoms of its own Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Statistics • 43 million Americans (24%) have hypertension • Only 69% of people with elevated BP are aware of it Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physiological Mechanisms of Hypertension • Increased systemic vascular resistance → decrease cardiac output • Decrease stroke volume • Stroke volume: The amount of blood pumped by the left ventricle of the heart in one contraction. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Causes • Primary hypertension – No known cause • Secondary hypertension – 5% to 10% of cases – Specific causes Renal artery stenosis Adrenal dysfunction Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Untreated Hypertension • Left ventricular hypertrophy and increased risk of CAD • Proteinuria: High blood pressure can cause damage to the kidneys, which may be reflected as an increase in the amount of protein present in the urine. • Eye • Stroke Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hypotension • Orthostatic hypotension – BP check while lying, sitting, standing • Medications with hypotensive effect – Alpha-adrenergic blockers – Centrally acting antihypertensive agents – Psychotropic drugs and tranquilizers – High-dose antibiotics – Nonsteroidal anti-inflammatory drugs (NSAIDs) Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hyperlipidemia • Lipid classifications – High-density lipoproteins (HDLs) – Low-density lipoproteins (LDLs) – Triglycerides • Risk factors – Elevated cholesterol – Atherosclerosis Peripheral artery disease Abdominal aortic aneurysm Diabetes mellitus Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hyperlipidemia • Medication management – HMG CoA reductase inhibitors (statins) lower LDL cholesterol Anti-inflammatory Antithrombotic Protect intravascular plaque stability – Bile acid sequestrants Attach to bile in the gut and prevent returns to liver HMG CoA reductase is a liver enzyme that is responsible for producing cholesterol Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hyperlipidemia • Medication management – Fibrates Reduce triglycerides – Nicotinic acid Lowers LDL and triglycerides Raises HDL Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Chest Pain • Myocardium deprived of blood supply → ischemia→ pain + loss of function • Chronic pain = angina • Other causes – Aortic stenosis – Pericarditis – GI problems Heartburn, acid reflux, or ulcers Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Chest Pain • Other causes – Pulmonary problems Pulmonary embolus, pneumonia, or pleural effusions – Musculoskeletal – Herpes zoster (shingles): is a nerve infection caused by the chicken-pox virus Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Angina • Ischemic heart disease – Inadequate oxygen supply • Stressed cardiac cells → arrhythmias → ineffective contractions • Categories – Supply: decreased blood flow to the myocardium – Demand: increased demand for oxygen to myocardium Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Angina • Stable angina: relieved by rest – Management: sublingual nitroglycerin • Unstable angina: not relieved with rest of medication – Progression to MI • Prinzmetal’s angina: chest pain at rest – Transient coronary artery contractions, unrelieved by nitroglycerin Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Myocardial Infarction • Cell death → loss of cell contraction → decreased heart function • Damage determined by size and location – LAD: The left anterior descending coronary artery – RCA – Circumflex Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of an MI • History – Atypical symptoms in older adults Complaints of MI symptoms different in older women May include nausea or vomiting Weakness Shortness of breath Diaphoresis Confusion Syncope Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of an MI • Physical assessment: may be unremarkable • Laboratory – CK (creatine kinase) and CK-MB (CK-m band) – Tropinin – LDH (lactic dehydrogen) Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of an MI • EKG analysis – ST segment elevation – Widened QRS complexes – Q wave presence • Other examinations – Hemodynamic monitoring – Echocardiography Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of an MI • Complications of MI – Arrhythmias – Blockages of electrical conduction – Heart failure – Ventricle aneurysms – Pericarditis Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of an MI • Medication management – Anti clot agents – Pain control – Beta-blockers – Calcium channel blockers – Angiotension-converting enzyme inhibitors Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnosis of an MI • Medication management – ASA (aspirin) – Antiarrhythmic drugs – Other management Coronary angioplasty Oxygen Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Valvular Heart Disease • Two categories – Stenosis – Incompetence, regurgitation, or insufficiency Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Valvular Heart Disease • Aortic stenosis – Most common valve disorder in the older adult – Major cause is calcified degenerative stenosis – Can lead to CHF, angina, alterations in BP, and arrhythmias – Risk factors Hyperlipidemia Diabetes Hypertension Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Valvular Heart Disease • Aortic stenosis – Diagnosis History: progressive shortness of breath Physical examination for murmur – Treatment Mechanical intervention Surgical intervention Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure • Statistics – 33% of hospitalizations are for CHF – Men and women develop equally – Incidence for women has increased – Men develop after an MI or longstanding hypertension – Incidence of mortality is declining Long-term prognosis is not good Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure • Pathophysiology – Loss of contractility of the myocardium → inadequate cardiac output → activity intolerance – Frank-Starling Law Overstretching → decreased force of contraction Starling's law states that the greater the volume of blood entering the heart during diastole (end-diastolic volume), the greater the volume of blood ejected during systolic contraction (stroke volume) and vice-versa. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure • Risk factors – Coronary artery disease – Hypertension – Family history – Cardiotoxic drugs eg chemotherapy cardiotoxicity is a condition when there is damage to the heart muscle – – – – – Smoking Obesity Alcohol abuse Diabetes mellitus Sleep disorders Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure • Clinical manifestations – Left-sided heart failure Pulmonary symptoms – Right-sided heart failure System symptoms Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure • Tests – Laboratory CBC Elevated creatinine Thyroid function – Diagnostics EKG Echocardiogram Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure • Treatment – ACE inhibitors – Beta-blockers – Diuretics – Digoxin Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Arrhythmias and Conduction Disorders • Atrial fibrillation – Most common sustained arrhythmia – EKG shows no P wave – Incidence increases with age – Causes Hypertension Valvular stenosis Ischemic heart disease Irregularly irregular heart rate Rapid pulse Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Arrhythmias and Conduction Disorders • Atrial fibrillation – Not life threatening but has complications Embolic CVA – Treatment Correct hemodynamic instability with heparin or Coumadin Monitor Coumadin effects in INR Control ventricular rate with calcium channel blocker Restore sinus rhythm, if possible, with antiarrhythmic drugs Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Heart Block • If results in decreased cardiac output, treat with internal pacemaker Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Arterial Disease • Atherosclerosis: occlusion of specified vessels→ loss of function and symptoms of pain in areas perfused by the artery • Symptoms • Intermittent claudication – Burning pain in legs or buttocks during exercise, which is relieved by rest – Pain at rest with progressive disease Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Arterial Disease • History • Physical examination • Treatment – Medication Antithrombotic agents Prostaglandins Calcium channel blockers – Surgery – Vascular rehabilitation programs Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Venous Disease • Pathophysiology • Venous insufficiency → stasis → ulcers, wide with irregular borders • Risk factors – Obesity – Occupations Long periods of standing or sitting Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Venous Disease • Treatment – Wearing external compression hose – Treat ulcers with multilayer compression bandages Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. LEARNING OUTCOME 4 List common nursing diagnoses for the cardiovascular patient. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Diagnoses for Common Cardiovascular Problems • Fatigue • Activity Intolerance Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Diagnosis for Patients Experiencing, or at Risk for, Heart Failure or Angina • Ineffective Management of Therapeutic Regimen Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Diagnoses for Patients with Heart Failure • Decreased Cardiac Output • Fluid Volume Overload Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Diagnosis for Patients with Orthopnea or Paroxysmal Nocturnal Dyspnea • Sleep Pattern Disturbance Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. LEARNING OUTCOME 5 Describe specific nursing interventions used with cardiovascular patients. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Interventions for Promoting Cardiac Health • Lifestyle modification • Judicious (careful) use of medications • Ongoing assessment of the older person’s cardiac status Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Use High Blood Pressure Instead of Hypertension • May be mistakenly associated with anxiety or tension Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Management of Hypertension and Risk Reduction • • • • • • • Establish blood pressure goals Teach lifestyle modifications Suggest nutritional adjustments Encourage exercise programs Encourage smoking cessation Encourage reduced alcohol intake Manage medications Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Role of Nursing • Community blood pressure screening • Promote healthy lifestyles • Teach importance of consistently taking medications Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patients Taking Statins • Teach importance of reporting muscle aches and symptoms to their healthcare providers • Statins are a class of drug used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patients Taking Coumadin (warfarin) • Limit dietary intake of green leafy vegetables rich in vit k bcz Vitamin K can make Coumadin less effective • Safety precautions Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Interventions for Older Patients with Angina • Support lifestyle changes • Teach proper medication use – Many patients are reluctant to use prescribed medications, particularly when prescribed “as needed” – Present scenarios and ask patients what they would do if they have sudden weakness, or if they take the medication and it does not help Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Risk Factor Reduction • Done across a variety of settings from home to hospital to long-term-care facility • Creativity with approach (what matters to each patient; i.e., sports, grandchildren, etc.) Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Activity and Exercise Support • Supervise increases in activity • Plan rest periods Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diet Therapy • Teaching • Consultation with dietitians Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Smoking Cessation • Ask patient to record cigarettes smoked on a daily basis for a week • Review smoking diary and ask patient to select a time they could avoid smoking Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medication Management • Teach how to open medication bottles • Create a system to remember to take them • Teach when they should report side effects Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Caregiver Support • Teach about medications • Identify respite programs Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Advance Directives • Discuss with family and patient • Assist in preparing an individualized document Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. LEARNING OUTCOME 6 Outline an education plan for cardiovascular patients. Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Importance of Knowledge of Cardiovascular Disorders • Signs and symptoms in older adults • Assists the nurse in assuming the role of teacher and coach Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patient-Family Education • Critical for interpreting and clarifying scientific data to individualize a nursing care plan Gerontological Nursing, Second Edition Patricia A. Tabloski Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.