Galen - NUR 257 - Chronic - Chp 22 - Cardiovascular and Respiratory Disorders With 100% correct answers 2025-2026 already graded A+

Modifiable Factors to Minimize Risk for Heart Disease

- control BP

- maintain healthy trigs and lipid levels

- prevent/control DM

- cease/never use tobacco products

- reduce exposure to pollutants

- healthy diet and maintain acceptable weight

- regular exercise

- control alcohol intake 1/day women, 2/day men

- reduce stress

- treat depression

Benefits of Reducing BP by 5%

34% fewer strokes

21% less ischemic heart disease

Home Measurement of BP (Tips for Best Practice)

- Observe the technique uses, in both arms, using personal device

- duplicate the measurement with same device, but with the nurse

- measure BP with a reliable device / manual method

- if discrepancy, teach correct technique or replace device

Signs of Potential Exacerbation of Illness in an Older Adult with Coronary Heart Disease

- light headedness/dizziness

- gait/balance disturbance

- loss of appetite or weight

- inability to concentrate / short attention span

- changes in personality or mood

- unusual patterns in urination / defecation

- vague pain/discomfort

- frequent bouts of anxiety

- excessive fatigue

- withdrawal from sources of pleasure

Chest Pain (Gender Differences)

Instead of typical s/s of CP, women will experience

s/s:

- SOA

- weakness

- fatigue

- indigestion

- sense of dread

Risk factors:

- life stressors / events

- sense of loss of control

- illness/death of significant others

Classification of Heart Failure

Class I: Asymptomatic (no limitations on phys. activity)

Class II: Mild Heart Failure

- slight limitations of phys. activity

- comfortable at rest

- An increase in activity may cause fatigue, palpitations, dyspnea, or angina

Class III: Moderate Heart Failure

- marked limitation in phys. activity

- comfortable at rest

- ordinary walking/climbing of stairs can quickly trigger s/s of fatigue, palpitations, dyspnea, or angina

- substantial periods of bedrest required

Class IV: Severe Heart Failure

- almost permanently confined to bed

- inability to carry out any phys. activity w/o discomfort, or severe s/s

- some s/s occur at rest

- chronic SOA common

Cardiovascular Health - Healthy People 2020

Emerging issues in cardiovascular health include:

- defining, measuring overall cardiovascular health

- assessing, communicating lifetime risk for cardiovascular disease

- addressing depression as a risk factor for and assoc. conditions of heart disease, stroke

- examining cognitive impairment due to vascular disease

QSEN - Cardiac Conditions v. Chronic Problems

when cardiac s/s occur, they can be rapid and require acute hospitalization

often requires intensive treatment followed by rehab

many other chronic conditions can be treated at home

Skills Required for Promoting Healthy Aging in the Person w/ Cardiovascular Disease

- correct technique for BP

- monitor response to prescribed exercise

- admin meds and eval SEs

- monitor s/s of changes in cardiovascular condition

- monitoring diet, I+O

- monitor weight (daily, biweekly, weekly)

- auscultate heart, lung sounds

- monitor lab values

- educate pt/family on all of the above

- provide palliative care

Several Factors Increasing Risk for Pneumonia - Evidence-Based Practice

- worsening of another health condition at the same time

- RR > 30/min

- Systolic BP < 70

- HR > 125/min

- temp < 95º

- current heart disease

- altered mental status

- age > 50 years

- male gender

- living in LTC

Respiratory Assessment

Hx:

-family

-PMHx

-S/S

Phys Assessment:

-overall body configuration (e.g. posture, chest symmetry, shape)

-respirations (ease, use of accessory)

-detailed description of level of dyspnea per activity

-oxygenation (SaO2, skin color, capillary refill, pallor)

-sputum (coca)

-palpation, percussion, and auscultation

-functional status

-cognitive status

-mood

-discussion of wishes for treatment, advance planning

-presence/absence of living will/health care surrogate

Instructions for Persons with COPD (Nutrition)

- eat small, freq. meals w/ high protein and prescribed caloric content

- select foods that do not req. a lot of chewing or cut food in bite-size pieces to conserve energy

- 2-3L of fluids daily

- weigh self twice weekly, report changes

Instructions for Persons with COPD (Activity Pacing to Conserve Energy)

- Plan exertion during best periods of day

- arrange regular rest periods

- allow plenty of time to complete activities

- schedule sexual activity around best breathing time of day

- use prescribed bronchodilators 20-30 min before sex

- choose sexual positions that avoid pressure on chest or support arms

Instructions for Persons with COPD (General Instructions)

- participate in regular exercise

- select clothes/footwear that are easy to put on/remove

- avoid indoor/outdoor pollutants

- avoid exposure to others with illness

- obtain annual flu shot

- obtain pneumococcal and streptococcal immunizations as appropriate

- notify PCP of temp elevation, change in sputum color/amount, increased SOA

Healthy People 2020 (Goals for Those with COPD)

- Reduce COPD-related limitations in persons ≥ 45 yrs (from 23.3% in 2008 to 18.7 in 2020)

- Reduce # of COPD-related deaths in persons ≥ 45 yrs (from 113.9 per 100000 to 102.6 per 100000)

- Reduce COPD-related hospitalizations in persons ≥ 45 yrs (from 56 per 100000 to 50.1)

Cardiovascular Disease (Major ones)

HTN

CHD (including MI and angina)

HF

#1 cause of death for caucasians and African American

Cardiovascular Disease (HTN)

most common chronic cardiovascular disease for GERI

>140/90 (>150/90 if ≥ 65 yrs, unless w/ DM)

BP normally increases slightly w/ age

Diastolic levels or decreases > 60 yrs (isolated systolic HTN)

90% of normotensive at 50 yrs will be HTN later

Often discovered during screenings or when complications (end-organ damage) have occurred

Those with HTN at higher risk for CHD, A-Fib, HF, acute infarctions (heart, brain)

Poorly controlled leads to chronic renal insufficiency, ESRD, and PVD

Rec for GERI = 3 separate readings to Dx, 1 in home setting

> 40 and high-risk (smokers, obese, Afr. Amer) should be screen annually

Cardiovascular Disease (Heart Disease / CHD or CAD)

Causes = atheriosclerosis (hardening of arteries) or plaques or uncontrolled HTN

atheriosclerosis and plaques limit blood and O2 through heart vessels (poor O2 = pain)

High-risks = smokers, exposure to pollutants, uncontrolled HTN, comorbid DM or family Hx of DM

angina = sudden, short lived ischemia to heart vessel

AMI = men pain rads from chest to shoulder, women pain mild localized to back or abd or just nausea, heartburn

Frail may have "silent MI" = no visible s/s except after death or EKG for another reason

Death from CVD, esp. AMI, more common in women for yrs but improving b/c inc. awareness of s/s

Cardiovascular Disease (A-Fib)

rapid, irregular HR (some pattern or random)

occurs once, intermittent, or persistent

May be asymptomatic

s/s (vague) = fatigue, palpitations, intermittent SOA, or CP (esp. if intermittent)

about 30 M in US, avg Dx 67 yrs for men, 75 yrs for women

Often attributed to exacerbated HF or old age

Causes: HF, DM, ETOH abuse, CHD, HTN, Thyroid disease

Increases risk for dementia and stroke-related mortality

blood pooling in heart chambers inc. risk for emboli which inc. risk for stroke

Rx = anticoags (ASA, clopidogrel, warfarin, Pradaxa, Eliquis)

Remember Anticoag teaching

Cardiovascular Disease (HF)

heart muscle damaged and malfunctions

can no longer pump blood effectively

Causes: HTN, fever, hypoxia, anemia, metabolic disease, infection

High-risk: smokers, unhealthy diet, lack of exercise, family Hx

no cure (management of s/s)

left/right s/s but both later in life

S/S: SOA w/ exertion, unable to lie flat w/o SOA, waking at night gasping for air, weight gain, swelling in LEs, may have cough which tends to be worse at night

Dyspnea can occur at rest, exertion, or at night (paroxysmal nocturnal dyspnea)

Often relieved by sleeping on mult. pillows or elev. HOB

GERI atypical s/s: confusion/delirium, falling, dizzy, fainting; c/c of insomnia, nocturia, or the "droops" (malaise, dec. in activity)

Implications for GERI nursing (CVD Assessment)

Hx (self report or proxy): events leading to c/c, presentation of s/s

LTC: recurrent monitoring VS and kidney function important b/c comorbid risk factors, esp. DM

Caution auscultory gap in BP reading (long pause in heart sounds)

Implications for GERI nursing (CVD Interventions)

Teach warning s/s of MI and use of AED

Teach 9-1-1

Teach quality goals

Teach healthy eating, exercise e.g. "mall walking", rest/activity balance

Exercise Cautions: Patients post MI experience exercise-related orthostatic hypotension (b/c dec. in baroreceptor responsiveness)

Exercise Caution: dec. thermoregulation means exercise intensity should decrease in hot/humid settings

Teach correct/safe O2 use

Risk reduction programs should be mindful of difficulty in changing unhealthy behaviors; instead, RN should use LEARN communication model

When treatment no longer effective, then palliative care considered

If frail, SEs of Meds may outweigh benefits, consider quality over curative measures

Potential for disability progresses rapidly after acute event/illness (esp. if person thinks activity will exacerbate) so teach cardiac exercise rehab (progressive exertion under supervision)

ID energy conserving measures for ADLs

Respiratory Disorders (General)

normal aging changes inc. risk for resp. problems

GERI higher risk of death from resp. problems

Identified as obstructive (preventing airflow out) or restrictive (dec. lung capacity)

Almost all caused by tobacco or pollutant exposure

Goals: maintain function, quality of life, monitor early s/s of infection (which become more atypical)

COPD and Pneumonia exemplars

Respiratory Disorders (COPD)

catch-all term for d/o affecting airflow: asthma, bronchitis, emphysema

third leading cause of death for older pop

emphysema: little sputum and pink appearance b/c actually get O2 in lungs

chronic bronchitis: chronic sputum/cough and pale/cyanotic appearance b/c diff. getting O2 in lungs

RN: watch for s/s of (worsening) infection, aggravation of underlying heart disease, changes in cognition/function

Acute episodes (bronchitis/emphysema): worsened SOA, inc. volume, change in sputum color

Acute Asthma: SOA and wheezing

Triggers: infections, pollutants, environmental exposure, weather

GERI with COPD: periods of worse s/s and periods of control, during illness: med changes may be needed, hospitalization may be required for infections

Respiratory Disorders (Pneumonia)

lower resp tract infection causing inflammation of lung tissue

4th-7th (w/ flu) leading cause of death for GERI

risks: normal aging, comorbidities e.g. ETOH, COPD, heart disease, communal/homeless settings, dental caries/periodontal disease

Prevention and dec. lethality by 2 PNA immunizations and flu shot

Community Acquired Disease or Hospital Acquired Condition (nosocomial)

LTC: common cause aspiration of colonized oral secretions or reflux of stomach contents

s/s: cough, fatgiue, SOA

GERI atypical s/s: falling, MS changes, confusion, general deterioration, weakness, anorexia

often incorrectly attrib. to geriatric syndrome

Dx: abnormal CXR, fever, inc. WBC (delayed in GERI)

If waiting for Dx s/s in GERI, may be too late (sepsis)

If frail: be prompt to treat if infection reasonable explanation of sudden change in status

Implications for GERI nursing (Respiratory Disorders: Interventions)

many cannot be cured so palliative and controlling disease process

Goals: reduce risk of exacerbations/hospitalizations, maximum function, preventing premature disability

Teaching (e.g. smoking, breathing, O2, ID infection) very important

Treatment can occur in home settings in most cases

Implications for GERI nursing (Respiratory Disorders: Teaching Interventions)

smoking cessation,

secretion clearance techniques,

identification/mgmt of exacerbations,

breathing retraining,

mgmt of depression/anxiety,

nutritional support,

proper med admin, (including inhaler, nebulizer)

peak flow meter

cleaning equipment

importance of good oral care after inhalation treatments

proper O2 use

coping strategies

maintaining sexual activity

Implications for GERI nursing (Respiratory Disorders: Multidisciplinary Care - GOALS)

- Inc. independence

- improve function

- dec. hospitalizations

- inc. exercise toleraqnce

- inc. self-esteem/self-care skills

- improve quality of life and comfort

Implications for GERI nursing (Respiratory Disorders: Multidisciplinary Care - Dietary Education)

address reasons for weight monitoring

s/s of malnutrition

weight loss can be rapid b/c energy for breathing while eating

early satiation (fullness) caused by congested abd

anorexia occurs b/c sputum production, gastric irritation from bronchodilators/steroids

monitor for fluid overload in HF pts

Implications for GERI nursing (Respiratory Disorders: Multidisciplinary Care - Activity/Exercise Tolerance)

Assessed by RT and OT

activities prescribed to inc. endurance and improve resp status

may be done w/ or w/o O2 supp

referral should be done as soon as condition allows

teach sexual activity still possible

Implications for GERI nursing (Respiratory Disorders: Multidisciplinary Care - Medications)

primarily to treat infection and control SOA/sputum production

inhalers can be difficult with dexterity issues/strength (e.g. arthritis) - special adaptive devices available

consider economic concerns, know options

consider transport/limited income

Medicare coverage for O2 and nebulizers determined by need (< 88% sat improved by O2)

Supplemental oxygen NEVER covered by insurance when comfort measures

income can cause anxiety and a focus on most basic phys needs

Implications for GERI nursing (Respiratory Disorders: Multidisciplinary Care - Prevention)

Pneumococcal vaccine (Pneumovax) - ≥65 yrs - usually a one-time dose but sometimes second dose recommended by PCP

streptococcal vaccine (Prevnar) - ≥ 65 yrs - one-time dose and outside of 1 year before or after Pneumovax in order to be covered by Medicare

Streptococcal pneumonia most lethal form

Annual flu immunizations each fall, additional may be recommended by public health