Level of health (acute and/or chronic illness)
Physical changes of aging
-decreased gas exchange and increased work of breathing (decrease elastic recoil in lungs, required need to use accessory muscles to exhale, fewer tissues in alveoli, decreased thoracic skeletal muscle strength and increased residual volume)
-decreased ventilation and ineffective cough (less air exchange, more residual secretions in the lungs, mucus membranes drier, altered pain sensation, fever can be atypical, greater risk for aspiration due to slow gastric motility, impaired mobility, inactivity and meds)
-decreased CO and a decreased ability to respond to stress (reduced cardiac muscle elasticity, heart muscles become less efficient, vessel experience the effects of progressive atherosclerosis and loss of elasticity, thickening of capillary walls so there is slowing of the exchange of gases, nutrients and wastes to and from cells)
Medications: medications have difference effects, some on CNS, some directly affect HR by slowing it impairing blood flow
Lifestyle: activity levels and habits; steady activity improves lung and heart fitness
Ischemia to heart muscle occurs which can lead to
1. Angina pectoris (chest pain)
2. Sudden death (loss of blood supply)
1. Epigastric distress (sharp, gnawing, dull)
2. Pain radiation to jaw/left arm
3. SOB (in those with diabetes and heart failure)
4. Women report: Nausea, indigestion, palpitations and numbness
1. CAD produces symptoms and complications according to the location and degree of narrowing of the arterial lumen, thrombus formation and obstruction of blood flow to the myocardium.
2. The progressive loss of blood flow through the coronary arteries causes an inadequate blood supply to be delivered to the heart muscle when there is insufficient blood going to the heart muscle, there is insufficient oxygen being delivered to the heart muscle, impacting the heart muscle survival.
Ischemia is the term used to describe the lack of blood and oxygen in tissues, and in this case its the heart.
3. When heart muscle is starved of oxygen (ischemia) it is experienced as chest pain (angina)
4. If the decrease in blood supply is great enough, or long enough duration or both irreversible damage and death of myocardial cells may result.
5. Over time a irreversible damage myocardium undergoes degeneration and is replaced by scar tissue, causing various degrees of myocardial dysfunction.
6. Significant myocardial damage may result in persistently low CO and heart failure where the heart cannot supply the body's needs for blood. A decrease in blood supply from CAD may cause the heart to abruptly stop
Diet: low saturated fats, high soluble fiber, fish and veggies, limited red meat, limiting eggs to reduce cholesterol is no longer a dietary recommendation (1 egg per day is permitted)
Physical activity: controls triglycerides and increases HDLs (moderate physical activity of 150 min/week or intense aerobic activity for more than 5 min/week). Always include muscle strengthening 2 days per week. Nurse to help to set realistic goals for their patients. Instruct to exercise early am, indoors and wear loose clothing. Activity should be slowed down is unable to carry on a conversation and stopped is chest pain, dizziness, lightheadedness and nausea.
Medications: STATINS (lipid lowering agents and best to take at night due to side effects of muscle pain), FIBRATES (decrease synthesis of triglycerides), BILE SEQUESTRANTS (work in liver to convert cholesterol to bile acids), CHOLESTEROL ABSORPTION INHIBITORS (prevents absorption of cholesterol in SI), and newest agent: PROPROTEIN CONVERTASE, SUBTILSIN-KEXIN TYPE 9 (PCSK9) which binds to LDLs and degrades them in the liver to prevent attachment in vessel walls. This is very expensive and more research is required. Fish oil is used to decrease triglycerides
HTN, Hyperlipidemia, Cigarette smoking, Obesity, Sedentary lifestyle, DM, Familial predisposition, Female, Age older than 65, Elevated C-Reactive protein, Hyperhomocysteinemia Goal: Attainment/maintenance of skin integrity
Nursing interventions: instruct on way to avoid trauma to extremities, encourage wearing protective shoes and padding for pressure areas, encourage meticulous hygiene (no location between toes), instruct to avoid scratching or rubbing vigorously, promote goal nutrition (protein, vitamin A, C, Zinc); weight reduction
Expected outcomes: Inspects skin daily for evidence of injury or ulceration, avoids trauma and irritation to skin, wears protective shoes, adheres to meticulous hygiene regimen, eats a healthy diet with adequate proteins and vitamin A and C
Compromised circulation means supply is unable to meet demand-includes interventions to protect extremities from trauma, wear protective footwear to include padding at pressure points; if new shoes wear only for short periods of time then inspect feet for signs of injury (redness, abrasions, blisters). Individuals with PAD are encouraged to use neutral pH soaps to prevent drying, apply lotions except between toes as this causes too much moisture leading to maceration of tissue. In addition individuals with the diagnosis of PAD should be instructed to use extreme caution to avoid injury when trimming toenails individuals should avoid scratching or vigorously rubbing extremities to avoid injury and bacterial infection.
Angina, SOB, altered speech, altered vision, epistaxis, headaches (usually in morning), vertigo, balance problems, fainting, nocturia, facial flushing To increase consumption of potassium-rich foods (eg bananas, potatoes, dried fruits, nuts, spinach, citrus fruits) when taking loop and thiazide diuretics; restrict high potassium food when taking potassium sparring diuretics
Encourages to keep appointments with provider to monitor efficacy of medications and evaluate for electrolyte imbalances (hyponatremia, hyperkalemia, hypomagnesemia, hypocalcemia, low HDL, high LDL, hyperglycemia)