Question

GERONTOLOGICAL NURSING

TOPIC: CARDIO

1. Identify non-modifiable and modifiable risk factors for hypertension.

2. What are the major sign and symptoms of congestive heart failure? Give nursing interventions for each sign and symptoms.

3. How will you decrease the workload of the heart of the patient with heart disease?

4. Make a drug study of common medication use for heart disease.

Answer 1

1. Hypertension or high blood pressure is a chronic medical condition in which the blood pressure in the arteries is elevated, requiring the heart to work harder than normal to circulate blood through the blood vessels. It has been described as the “silent killer” because initially the disease presents no apparent symptoms, and hence an individual can have hypertension without realizing it. Blood pressure is regarded as normal, if the level is 120/80 mmHg or less. Blood pressure between 120/80 mmHg and 138/89 mmHg is regarded as pre-hypertension, which denotes increased risk of hypertension, whereas a blood pressure of 140/90 mmHg and above is considered to be hypertension. factors are conditions that increase your risk of developing a disease.

Risk factors are either modifiable, meaning you can take measures to change them, or non-modifiable, which means they cannot be changed. Factors associated with the development of hypertension can be categorized into modifiable and non-modifiable risk factors. The modifiable risk factors include obesity, physical inactivity, high salt diet, smoking alcohol consumption and others.Non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease.

2. Heart failure, known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.

Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).

Heart failure signs and symptoms may include:

• Shortness of breath (dyspnea) when you exert yourself or when you lie down

To prevent exacerbations, teach the patient and family to monitor for an increase in shortness of breath or edema. Tell the patient to restrict fluid intake to 2 to 2.5 L per day and restrict sodium intake as prescribed. Teach the patient to monitor daily weights and report weight gain of more than 4 pounds in 2 days.

• Fatigue and weakness

Nursing interventions include complete bed rest by promoting low level activity and reducing fatigue to relieve the symptoms of fluid overload.

• Swelling (edema) in your legs, ankles and feet

Maintain strict fluid intake and output measurements.
Monitor daily weights.
Assess for edema and severe diaphoresis.
Monitor electrolyte values and hematocrit level.
Maintain strict fluid restrictions as prescribed.

• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)

Take diuretics as prescribed. Diuretics aids in the excretion of excess body fluids. Elevate edematous extremities, and handle with care. Elevation increases venous return to the heart

• Very rapid weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain if your heart failure is caused by a heart attack

monitoring of vital signs, modification of patient's life styles, diet modification for the patient, administration of medications and oxygen therapy.

3. Increased SV = increase stretch of heart muscle which increases contractility or how hard the heart muscle contracts = increased workload = increased oxygen demand. Increased diastolic BP = increased workload to open the aortic valve = increased oxygen demand.

The different methods to decrease the cardiac workload

Decrease your cardiac workload by making sure you're doing everything you can to make your heart's job a little easier.

Step 1
Lose weight if you're overweight. Even 10 extra pounds on your body makes your heart work harder to provide your body with the blood it needs. By dropping unnecessary pounds through a combination of a sensible diet and daily exercise, you reduce your heart's workload and your overall blood pressure, which is an accurate measurement of how hard your heart is working.

Step 2
Exercise 30 to 60 minutes each day. Not only will exercise help you manage your weight more effectively, but it'll also help to strengthen your heart's natural processes. Cardiovascular activity is especially effective for improving heart function, which means jogging, walking, biking, aerobics, dancing and even water aerobics can help you build a healthier heart.

Step 3
Consume less sodium in your diet. Sodium is known for raising blood pressure and including your cardiac workload, particularly when it comes to increasing your risk for heart attack and heart disease. Sodium can be hidden in a number of prepackaged, processed foods, so stick to homemade or low-sodium versions of the foods you love. In general, you shouldn't consume more than 2,000 mg of sodium per day.

Step 4
Quit bad behaviors that make your heart work harder. Smoking and drinking alcohol can both contribute to an overworked heart. While a small amount of alcohol is usually fine, drinking to excess or on a regular basis increases your risk for heart disease. When it comes to smoking, it can increase your risk for plaque in the arteries, making it harder for your heart to effectively pump blood. Cut back or skip these habits altogether.

Step 5
Schedule regular screenings and checkups with your doctor. Some people are simply more prone to high blood pressure than others. If you fall into that category, your doctor may be able to reduce your cardiac workload through a combination of lifestyle changes and prescription medications, which is why it pays to have your blood pressure checked a couple of times each year.

4. Drug study in heart diseases

1. Statins — to lower LDL cholesterol
Statins were first introduced in 1987 and doctors now have seven different medications from which to choose depending on a patient’s need. They lower the “bad” LDL cholesterol levels by 20 to 60 percent and also reduce inflammation. Most people who have had a heart attack or stroke, bypass surgery, stents, or diabetes should be taking statins. Some patients with a high LDL level, but without heart disease, should also take statins.

2. Aspirin — to prevent blood clots

Aspirin has been around for a long time and was first discovered to have cardiovascular benefits in the 1960s. Aspirin can help to keep arteries open because of its anti-clotting and anti-platelet effects. A standard dosage for heart patients is 81 mg a day, which is one baby aspirin. Aspirin makes sense for people who already have heart disease, but not necessarily for people who just have risk factors.

3. Clopidogrel — to prevent blood clots
This drug is considered a “super-aspirin” because of its effectiveness in preventing platelet clumping and it is often used in combination with aspirin. For some patients there is an increased risk of bleeding and doctors will weigh the benefits versus the risks of this drug. However, for patients with stents, the combination of aspirin and clopidogrel is essential to preventing clotting. It is also often used for patients with worsening angina.

4. Warfarin — to prevent blood clots
This drug is a stronger anti-clotting agent than aspirin and clopidogrel. It works as an anticoagulant – or blood thinner. Warfarin is widely used to prevent the formation of clots for patients with atrial fibrillation, those with artificial heart valves and those who have formed blood clots in veins of the legs. Because it interacts with other medications and diet, it requires close monitoring by a physician.

5. Beta-blockers — to treat heart attack and heart failure and sometimes used to lower blood pressure
Beta-blockers block the effects of adrenaline, which comes on in response to stressful situations. Beta-blockers are prescribed in the treatment of these four conditions—angina, heart attack, congestive heart failure and abnormal heart rhythms. Dosage must be adjusted for the desired response and doctors will monitor for dizziness (due to low heart rate), and kidney and liver problems.

6. ACE inhibitors — to treat heart failure and lower blood pressure
ACE (angiotensin-converting enzyme) inhibitors prevent the body from producing the artery-constricting hormone angiotensin. Arteries relax with ACE inhibitors and this lowers blood pressure. They are prescribed for patients with congestive heart failure, a recent heart attack, and those with hypertension.

Drugs used for congestive heart failure mainly

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Medicines for congestive heart failure
Some medicines for heart failure improve how well your heart pumps. Others help remove excess fluid from your body or dilate blood vessels so blood can flow more easily so your heart doesn't have to work as hard. A combination of medicines is often used to manage your condition and help you feel better.

Heart failure is an ongoing health condition. To stay as healthy as possible, you might need to take medicine for the rest of your life. It's important that you take your medicines as your doctor prescribed and not miss any doses. Make sure to have prescriptions for these medicines refilled before you run out.

Don't take any over-the-counter medicines until you talk to your doctor to see if they are safe. Don't use nonsteroidal pain relievers (such as ibuprofen, Advil, Motrin, Aleve, and Nuprin), cold and flu remedies (especially those containing pseudoephedrine), and medicines that contain sodium, such as Alka-Seltzer.

Call your doctor right away if you have problems or side effects from your medicine. Do not stop taking your medicine without talking with your doctor or nurse.

The following medicines are frequently used to treat heart failure.

Beta blockers (carvedilol, metoprolol, bisoprilol)
These medicines lower heart rate and blood pressure, and protect your heart from certain substances that can damage your heart. Beta blockers are often started at a very low dose and then are increased until a dose is reached that works best.

Common side effects of beta blockers:

Dizziness
Feeling tired
Worsening of usual symptoms (this might improve over time without changing medicines)
Stopping beta blockers suddenly can cause your symptoms to get worse. Don't stop taking your medicine without talking to your doctor or nurse.

Call your doctor if you feel faint, pass out, have increased shortness of breath or wheezing, or have other symptoms that bother you.

ACE inhibitors (lisinopril, captopril)
Angiotensin converting enzyme (ACE) inhibitors reduce the amount of heart-damaging hormones your body produces. They also dilate blood vessels and lower blood pressure to lessen the workload of your heart.

Common side effects of ACE inhibitors:

Dizziness
Changes in kidney function
Dry cough that often improves with time
Increased potassium levels
You will have regular blood tests to check kidney function and potassium levels while taking this medicine.

Get medical help right away if you have swelling of your mouth, lips, or tongue. This could be an allergic reaction that can be life-threatening.

Angiotensin receptor blockers (losartan)
Angiotensin receptor blockers are similar to ACE inhibitors, but they don't cause the cough that some people have when taking ACE inhibitors.

Common side effects of angiotensin receptor blockers:

Dizziness
Changes in kidney function
Increased potassium levels
You will have regular blood tests to check kidney function and potassium levels while taking this medicine.

Get medical help right away if you have swelling of your mouth, lips, or tongue. This could be an allergic reaction that can be life-threatening.

Combination medicines (Entresto, or sacubitril/valsartan)
Entresto is a medicine that combines the angiotensin receptor blocker (ARB) valsartan with a substance known as sacubitril that causes the heart to squeeze harder and can help your body eliminate excess fluid. The effect of this combination can be more powerful than either drug alone. Entresto is usually started after a person has been able to tolerate target doses of either an angiotension converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB), so this is not usually the first medicine used to treat heart failure. It is currently only used if other medicines have not improved the heart’s ability to pump effectively. If you are taking an ACEI (such as lisinopril or enalapril) you will need to stop that medication for 36 hours before starting Entresto. This is very important; not doing so could result in a serious reaction.

Common side effects:

Dizziness
Changes in kidney function
Increased potassium levels
Get medical help right away if you have swelling of your mouth, lips, or tongue. This could be an allergic reaction that can be life-threatening.

Call your doctor if you have rapid weight loss soon after starting Entresto.

Aldosterone antagonist (spironolactone, eplerenone)
These medicines prevent your body from producing too much of the hormone aldosterone that can damage your heart.

Common side effects of aldosterone antagonists:

Changes in kidney function
Increased potassium levels
Swelling or tenderness in the breasts (in both men and women)
You will have regular blood tests to check kidney function and potassium levels while taking this medicine.

Digoxin (Lanoxin)
This medicine slows heart rate and might improve the pumping ability of your heart. You'll get a blood test to make sure the dose you're taking is right for you.

Common side effects of digoxin:

Nausea
Poor appetite
Digestive problems
Call your doctor if you are nauseated, or notice a yellow tinge or "halos" in your vision.

Hydralazine and nitrates (Apresoline, Nitrobid, Imdur, Isordil)
Hydralazine and nitrates are often used together to treat heart failure. They dilate blood vessels so it's easier for your heart to receive and pump blood.

Common side effects of hydralazine and nitrates:

Dizziness
Headache
Swelling of the hands, arms, feet, or legs
Diuretics: furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex), metolazone (Zaroxolyn)
These medicines are called water pills because they remove excess fluid from the body to help you breathe easier and feel better.

If you take a diuretic once a day, take it in the morning. If you take it twice a day, try to take the second dose no later than 4 p.m. to lessen the urge of going to the bathroom during the night.

If you take metolazone plus another diuretic, take metolazone first, about 30 minutes before the other diuretic.

Diuretics (especially metolazone) can cause you to lose potassium, so your doctor might prescribe a potassium supplement. Not everyone taking diuretic medicine needs extra potassium, so ask your doctor if you have any questions.

If your diuretic dose is changed, you will need lab tests to monitor kidney function.

Common side effects of diuretics:

Increased urination
Dizziness
Dehydration
Changes in kidney function
Ringing or buzzing in the ears
Skin rash or hives
Itching
Increased blood sugar levels
Gout (painful inflammation of the joints)