Question

Answer the questions below

1)What are normal vital signs for an elderly client? 2)What are normal heart sounds? 3)Where do you listen for heart sounds? 4)Where would you listen for an apical heart rate and why would you listen for an apical heart rate? 5)What nursing interventions may be used to correct fever in the elderly client? 6)What can a client have while on a 2-gram sodium, low-cholesterol diet? Develop a meal plan: breakfast, lunch, and dinner with snacks and beverages.

Answer 1

1)What are normal vital signs for an elderly client?

Answer:

Normal vital signs in an elderly client are the physical signs which are examined to ensure the normal functioning of their body and detect the presence/absence of disease. Some of the diseases which are the common in the elderly clients  like hypertension and heart disease can be picked up by vital signs monitoring of the elderly clients.

The vital signs normally measured are temperature ,pulse and respiration .Blood pressure and pain are additional vital signs for elderly client while pupillary status,blood oxygenation and blood glucose examination are vital to the elderly unconciousness/trauma clients..

The normal vital signs for an elderly client are described below:

1 Normal body temperature:

The body temperature of a person depends on the gender, age, hormonal status(in females)his or her activity level,and kind of  food consumed. Normal body temperature for an elderly person varies from 97.8 degree Fahrenheit [or 36.5 degrees celsius] to 99 degree Fahrenheit [or 37.2 degrees celsius]

2 pulse

The pulse rate is the measurement of rate of the cardiac contraction/ heartbeat and it gives an idea about the circulatory system and cardiac funtion status, Abnormal rhythm indicates the presence of arrhythmia The blood pressure changes and the perfusion status can be inferred by the strength of the pulse. The normal pulse rate for an elderly client  is 60 to 100 beats per minute, regular rhythm .good strength.Any bradycardia[less than 60} or tachycardia[more than 100} must be promptly investigated.

3.Respiratory rate :

The normal respiratory rate in an elderly client is 12 to 18 beats per minute without audible foreign sounds and use of accessory muscles of respiration.The respiratory rate does not change with age but the vital capacity of the lungs decreases with aging  

4.Blood pressure:

This may/may not be considered as a vital sign by all but has to be generally measured along with the temperature, pulse ,respiration as it is an essential parameter for elderly client. Elderly clients have a higher risk of hypertension and also are more susceptible to low blood pressure states /hypotension.

.Blood pressure is the measurement of the pressure within the blood vessels and is an indicator of the effective circulatory system and cardiac function status.The normal blood pressure for the elderly individuals is 120/ 80 millimetres of mercury.The upper limit of the reading indicate the systolic pressure of the heart and the lower limit of the reading indicates the diastolic pressure of the heart. If the systolic blood pressure is in the range of 121- 130 millimetres mercury . it is defined as pre hypertensive state and anything above that is diagnosed as hypertension. Blood pressure reading less than 60/ 90 millimetres mercury is considered as hypotension.

5.Pain

Additionally in elderly clients, pain is often considered as an additional vital sign as there are complaints of chronic pain with ageing related musculoskeletal degeneration and age related osteoporosis.

The pain is measured on a scale of 0 to 10 and is often recorded as a part of the vitals and general examination in the elderly.  

6.Additionally,pupillary examination is included in the vital signs by the members of the emergency response team as a part of the client examination as also blood glucose and blood oxygenation measured by pulse oximetry in cases of elderly unconsciousness/elderly trauma.

2)What are normal heart sounds?

Answer:

The normal heart sounds are audible noises /sounds are produced by the closure of the various valves that are present in the heart. Abnormal turbulence of the blood flow in the cardiac chambers can also give rise to some abnormal heart sounds and murmurs

There are four heart sounds S1 S2 S3 and S4 described which can be heard on auscultation of the different areas of the precordium and these vary in the character of the sound ,its intensity, nature and duration.

Of these, S1 S2 are normal heart sounds and often heard as lub dub on auscultation S1 is the first heart sound .It is low pitched sound and occurs due to the closure of the atrioventricular valves signifying the end of the the atrial systole and the beginning of the ventricular systole.It has two components a M1 and T1 which signify the mitral valve closure and the tricuspid valve closure respectively. M1 is heard before T1.

The S2 is  the second heart sound.It is a high pitched sound that  occurs as a result of the closure of the semilunar valves signifying the end of the ventricular systole and the beginning of the ventricular relaxation. it has two components the A2 and P2 which are the aortic valve closure and the pulmonary valve closure respectively .Normally A2 is heard before P2. It is during deep inspiration, a split of the S2 sound into A2 and P2 can be appreciated.

S3 heart sound can be physiological or pathological ,S3 is a third heart sound that can be heard just after the S2 heart sound and contributes to the gallop rhythm .It is normal in case of trained athletes but otherwise it signifies dilated congestive heart failure/ heart pathology. This sound is caused by the turbulence of the blood back and forth within the lumen of the dilated ventricles as the blood from the atrium flows into the ventricles .This is seen typically in cases of impaired cardiac contractility and cardiac failures states.

S4 heart sound is an abnormal heart sound which is indicator of cardiac pathology.This is typically heard in case of hypertrophic left ventricular pathological states  such as in chronic hypertension,hypertrophic cardiomyopathy,aortic valvular disease /stenosis. it is a caused due to the resistance offered to the blood flow by the hypertrophic /inelastic less distensible left ventricle muscle wall.

Heart Murmurs are  blood flow sounds which can be heard in physiological or pathological states. These are caused due to the turbulent flow of the blood across damaged valves/dilated chambers of the heart. Pathologically the murmurs can be heard in valvular heart diseases,valvular stenosis or regurgitation where.the turbulence is generated by the damaged valves.

summary: S1 and S2 and physiological murmurs are the normal heart sounds. S3 heart sound may be seen in some physiological states like athletes and also in pathological states like congestive cardiac failure causing the gallop rhythm.S4 heart sounds, pathological murmurs and pericardial rub [which is a friction sound of the pericardium seen in case of pericarditis] are pathological heart sounds.

3)Where do you listen for heart sounds?

Answer: Heart sounds are heard at the four specific areas of the precordium which are the aortic area pulmonary area. mitral area and tricuspid area .

The auscultation can be  done with both the diaphragm or the bell of the stethoscope in these four areas to understand the heart sounds and the cardiac rhythm.

The aortic area is located in the right second intercostal space against the right upper sternal border.Tricuspid  area is located in the right 4th/5th intercostal space just against the right lower sternal border.The pulmonary area is located in the left second intercostal space against the left upper sternal border. Mitral area is located in the left fifth intercostal space just medial to the left midclavicular line. The specific locations of the valves with respect to the chest wall in this particular areas account for the prominence of the heart sounds being heard more over the other.

S1 is best heard in the mitral area and the tricuspid area while S2 heart sounds are better heard in the aortic area and the pulmonary area. The mitral area is also called as the apex of the heart  or the area of the apical impulse of the heart.The third left intercostal space on the left sternal border has also known as as Erb's point.This is an area where the S2 heart sound can be appreciated nicely.

4)Where would you listen for an apical heart rate and why would you listen for an apical heart rate?Answer:

Apical heart rate is heard in the mitral area which is present in the left fifth intercostal space just medial to the left fifth midclavicular line. it is the point where the maximum intensity of the heart sound is heard as it represents the area of the chest wall where the contracting cardiac muscle abuts onto the ribs/chest wall creating highest intensity heart sound. It directly corresponds to the ventricular contraction.

It is important to listen for an apical heart rate as it serves as a guide to the normal physiology and physiological functioning of the heart and directly corresponds to ventricular contraction.

It is also important to listen for apicalheart rate in order to understand the cardiac contractility and cardiac function status in the person.The apical area of the heart is the area where the the force of the ventricular contraction is directly conducted and is the most representative area of the cardiac contraction..

.Any abnormal deviation in the apical pulse rate indicates cardiac pathology.The normal apical heart rate is 60 to 100 beats per minute/good intensity and volume indicating normal cardiac contractility.

In certain pathological conditions, there may be apex  pulse deficit . The pulse may not correspond to the apical heart rate in these conditions.These include conditions of premature ventricular contractions,atrial fibrillation and certain cardiac arrhythmias

Decrease in the intensity of the apical heart rate points towards underlying pericardial effusion, ventricular dilatation, ventricular aneurysm with the poor cardiac contractility and increase in the intensity may indicate the presence of ventricular hypertrophy.

Apical heart rate directly signifies the cardiac function and cardiac contractility and hence is an important parameter in the auscultation of the heart.