Week Four

Question 1

What are the main cardiovascualr conditions that affect older peoples?

Answer 1

hypertension
CAD
Heart valve disease
Heart Failure / CHF

Question 2

Hypertension

Answer 2

• is the most common chronic risk factor for CVD.
• is diagnosed whenever the diastolic blood pressure (BP) is consistently
  ≥90 mm Hg or the systolic BP is consistently ≥140 mm Hg
• Older adults often have isolated systolic HTN, unlike younger people, who
  are more likely to have an elevation of just the diastolic BP or elevation
  indicated by both systolic and diastolic BP readings.
• Blood pressure is a proxy outcome for reducing adverse health outcomes:
  The goals of therapy for HTN are to treat modifiable risk factors for persons
  with diabetes and other chronic diseases and to maintain a systolic BP <140
  mm Hg and a diastolic BP <90 mm Hg and reduce CVD risk.

Question 3

CAD

Answer 3

Coronary arteries are unable to send enough blood to heart muscle
* Usually caused by cholesterol deposits (atherosclerosis)
* Symptoms can be “silent” for a long time; usually include: Angina, shortness
of breath, fatigue.
* Atherosclerosis can lead to MI or CVA (silent MI for older people)

Question 4

Heart Valve disease

Answer 4

Disruption of blood flow through valves
* Signs and symptoms: heart murmur, chest pain, abdominal swelling, fatigue,
SOB, swelling of feet/ ankles, dizziness and fainting, cardiac dysrhythmias

Question 5

Heart Failure / CHF

Answer 5

Most frequent cause for hospitalization of older adults
- Progressive condition, around 50% of people diagnosed with HF will die
within 5 years of diagnosis
- Affects other organs through fluid build up: kidneys, lungs, and extremities

Right sided HF
The heart’s right ventricle is too weak to pump enough blood to the lungs. As
blood builds up in the veins, fluid gets pushed out into the tissues in the body.

Left sided HF
The left ventricle of the heart no longer pumps enough blood around the body.
As a result, blood builds up in the pulmonary veins (the blood vessels that carry
blood away from the lungs)

Question 6

What are the main risk factors for cardiovascular diseases?

Answer 6

• Age >55 for men, >65 for women
• Family history of CVD
• Microalbuminuria
• Hypertension
• Smoking
• Central obesity
• Physical inactivity
• Dyslipidemia
• Diabetes, impaired glucose tolerance/ impaired fasting glucose
• Metabolic syndrome

Question 7

Climate change and impact on older people

Answer 7

Both low and high temperatures are associated with cardiovascular and respiratory
disease mortality rates
* During the past 20 years, there has been a 53·7% increase in heat-related mortality in
people older than 65 years
* Climate change affects the most vulnerable populations the most, including older
people (>65 yrs), locally and worldwide
* Index for heat vulnerability
* Food insecurity will change nutrition and may increase cardiovascular disease (eg
lack of omega 3 for prevention of CVD) eg, 1·4 million deaths due to cardiovascular
disease in 2017 were attributed to diets low in seafood omega-3 fatty acids
* Increased pollution increases exacerbations of cardiovascular and respiratory
disease

Question 8

Living with Cardiovascular Disease / HF
Patient Perspective

Answer 8

• Disruptions and distress
• Sense of loss of power
• Role dysfunction
• Beliefs about disease progression
• Coping strategies
• Adjustment of living with CHF

Question 9

Nurses Role

Answer 9

Focus on support systems
* Providing “hope” in managing (even if not halting) disease progression
* Further understanding for cultural differences in adjustment process

Question 10

What does 50% stenosis of the circumflex artery mean?
what is orthostatic hypotension?
what is cardiomegaly?
sinus tachycardia with left bundle branch block on ECG?

Answer 10

• 50% : moderate blockage
• Also called postural hypotension: dizziness/ fainting → fall risk for older people
• enlarged heart
• Problem with conduction system
• Wide QRS intervals, dominant s wave in V1

Question 11

FANCAPES
Fluids

Answer 11

How much do you drink daily? Have you gained weight/ urinary output decreased? → Fluid retention

Question 12

FANCAPES
Aeration

Answer 12

do you have a cough? Is it productive? If so, describe sputum. What happens when you wake up
gasping for breath? How often does this happen? How many pillows do you use? Do you/ did you smoke?

Question 13

FANCAPES
Nutrition

Answer 13

What are your favourite foods? What did you eat in the last 48 hours? Explain the main “problem”
re salty foods. Try understand onset of symptoms with possible food intake

Question 14

FANCAPES
Communication

Answer 14

Do speak the same language? Any auditory/ visual problems that might affect
communication?

Question 15

FANCAPES
Activity

Answer 15

What makes you tired? Are there activities that affect your breathing? Sleep problems?

Question 16

FANCAPEs
Pain

Answer 16

Are you experiencing chest pain/ discomfort/ numbness in shoulders/ arms/ hands/ neck/ jaw? How
does it feel? Any other cardiac sensations?

Question 17

FANCAPES
Elimination

Answer 17

urinary output (see fluids)

Question 18

FANCAPES
Socialisation / Support

Answer 18

What support do you have at home? Does it feel adequate? How often do you
leave the house?

Question 19

Probable Causes of HF?

Answer 19

Hypertension: Heart is having to pump hard against the resistance in the
vessels → cardiac muscle hypertrophy → cardiomegaly
Coronary Artery Disease: Ischaemic myocardium is not able to produce
adequate stroke levels
Anaemia: decreases oxygen availability to all body tissues → heart
responds by increasing blood flow → increasing oxygen demand of the
heath → myocardial ischaemia. Low Hct due to hemodilution

Question 20

Physical Assessment
What is LS HF?

Answer 20

The left ventricle of the heart no longer pumps enough blood around the body. As a
result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the
lungs)
Weakness, hacking cough/ worse at night, exertional dyspnea, S3/S4 gallop, crackles/wheezes
in the lungs

Question 21

Physical Assessment
What is RS HF?

Answer 21

The heart’s right ventricle is too weak to pump enough blood to the lungs. As blood
builds up in the veins, fluid gets pushed out into the tissues in the body.
Jugular neck distention, dependent oedema, enlarged liver and spleen, distended abdomen,
weight gain

Question 22

Medications

Answer 22

Enalapril: ACE inhibitor to decrease blood volume and blood return to heart →
decrease workload of the heart
Furosemide: Loop diuretic → decrease fluid volume
Carvedilol: Non-specific beta blocker → decrease heart rate
Digoxin: decreases myocardial contractility → enhanced cardiac efficiency and
output
Potassium Chloride: electrolyte → replace potassium that may be lost with
diuretic therapy
Will you give Carvedilol CR? No, it is controlled release
How many tablets of digoxin? 2

Question 23

What do you need to monitor in view of new medication orders?

Answer 23

Potassium levels:
Diuretic causes K to be secreted hence K supplement but ACE inhibitors
causes retention of K; also affects digoxin toxicity susceptibility
Digoxin:
Monitor K levels: hypokalaemia can increase susceptibility to digoxin
toxicity;
Digoxin toxicity can emerge during long-term therapy as well as after an
overdose. It can occur even when the serum digoxin concentration is within
the therapeutic range. Toxicity causes anorexia, nausea, vomiting and
neurological symptoms. It can also trigger fatal arrhythmias

Question 24

Education, Lifestyle Modifications and reducing risk factors

Answer 24

Gradually increase activity levels
- Minimise stress if possible
- Avoid hot or cold environments → context of climate change
- Learn to take your pulse: call your provider is pulse is < 50 bpm or
>100 bpm or very irregular → can exacerbate HF
- Weigh daily to monitor fluid retention report a 2-5 lb (1-2.25kg) weight
gain over 1-4 days
- Carefully follow salt restricted diet
- Limit fluid intake to 2 l daily
- Ensure you take medication as prescribed – do not suddenly stop
medication without speaking to health care provider
- If you experience any sudden changes in symptoms (new or
worsening of existing symptoms) call your health care provider
immediately

Question 25

What foods high in sodium and must be avoided?

Answer 25

Canned soups, Cheddar cheese, Processed meats

Question 26

Digoxin Toxicity

Answer 26

Signs and symptoms include: Diarrhoea, visual changes, loss of
appetite or nausea
Most common cause for digoxin toxicity?
Hypokalaemia → think diuretic therapy
For older people specifically: lower body mass (esp muscle) and
decreased glomerular filtration rate