Topic 9: Ch 20 CV subjective data

smoking, diet, alcohol use, exercise patterns, stress

what lifestyle factors influence the development of CV disease

systolic HTN

increase in systolic BP that occurs with aging, caused by thickening and stiffening of the large arteries (arteriosclerosis), creates an increase in pulse wave velocity because arteries cannot store the volume ejected

overall size does not change but left ventricular wall thickness increases to accommodate vascular stiffening leading to increased workload on the heart

how does the size of the heart change with age

decreases; increasing pulse pressure with rise in systolic

what occurs to diastolic BP after the 5th decade

no change

what occur to resting HR and cardiac output with age

decreased ability to augment cardiac output decreased max HR and diminished sympathetic response

what cardiac changes occur during exercise with age

increased presence of supraventricular and ventricular dysrhythmias, ectopic beats are common, tachydysrhythmias are not well tolerated due to thicker and less compliant myocardium and impaired early diastolic filling at rest causes shorted diastole and further compromised heart

what changes occur with dysrhythmias with aging

• prolonged PR interval (First degree AV block) and prolonged QT interval

• QRS interval is unchanged

• Left axis deviation from age-related mild LV hypertrophy and fibrosis in left bundle branch

• increased incidence of bundle branch block

what age related ECG changes occur as a result of histologic changes in the conduction system

cardiovascular disease (CVD)

the leading cause of death in those aged 65 and older, and chances increase with age

smoking, chronic alcohol use, obesity, lack of exercise, diet, lack of exercise, genetics, untreated HTN, type 2 DM, high levels of LDL, sex (women are higher risk)

what affects chances of CVD

HTN

if left untreated, direct damage to the arterial system occurs and accelerates the process of atherosclerosis, increasing workload of the heart, increases oxygen demand of the heart; most common in Black Americans

smoking/tobacco use

increases the risk of CVD by increasing oxygen demand on the heart while causing a concomitant decrease in oxygen supply, by activation of platelets and fibrinogen, and by an adverse change in lipid profile; increases HR and BP

elevated cholesterol

high levels of LDL add to the lipid core of plaque formation in coronary and carotid arteries, resulting in MI and stroke

symptoms of SOB, nausea, fatigue, chest discomfort; blockages in smaller coronary arteries; less likely to undergo invasive testing and Tx; after MI have higher mortality, bleeding risk, new-onset HF, and reduced quality of life

how is CVD different in women than men

1. chest pain

2. dyspnea

3. orthopnea

4. cough

5. fatigue

6. cyanosis/pallor

7. edema

8. nocturia

9. past cardiac hx

10. family cardiac hx

11. patient-centered care (cardiac RF)

what is subjective data about the heart

• any chest pain or tightness

• onset: when did it start, how long have you had it this time, have you had this pain before, how often

• location: where did the pain start, does it radiate to any other spots

• character: how would you describe it (crushing, stabbing, burning, viselike, aching, heaviness)

• what aggravates pain (activity, rest, emotional upset, after eating, during sex, with cold weather)

• any associated symptoms (sweating, ashen gray/pale skin, heart skips a beat, SOB, N/V, racing of heart)

• is pain relieved by nitro/how many tablets

what are questions a nurse should ask about chest pain in a client

• any SOB

• what activity brings this on

• onset: does it come on unexpectedly

• duration: constant or comes and goes

• affected by positioning, lying down

• awaken you from sleep at night

• does it interfere with ADLs

what are questions a nurse should ask about dyspnea in a client

SOB that awakes you at night occurs with heart failure, typically awakens after 2 hours of sleep with the perception of needing fresh air because lying down increases the volume of intrathoracic blood and the weakened heart cannot accommodate the increased load

paroxysmal nocturnal dyspnea (PND)

• how many pillows do you use when sleeping or lying down

what are questions a nurse should ask about orthopnea in a client

orthopnea

the need to be more upright to breath

• do you have a cough

• how long have you had it

• is it related to time of day

• Type: dry, hacking, barking, hoarse, congested

• mucus: color, odor, blood, consistency

• associated with activity, position (lying down), anxiety or talking

• does activity make it better or worse

• relieved by activity or rest

what are questions a nurse should ask about cough in a client

• do you tire easily

• able to keep up with fam and coworkers

• when did it started, sudden/gradual, any recent change occurred in energy level

• related to time of date

  • fatigue from anxiety/depression occurs all day or is worse in the morning

  • fatigue from decreased cardiac output is worse in the evening

what are questions a nurse should ask about fatigue in a client

unusual fatigue

a top prodromal MI symptom for women

cyanosis/pallor

occurs with MI or low cardiac output states as a result of decreased tissue perfusion; presents as blue/ashen skin

edema

dependent when caused by HF

• any swelling of feet and lets

• when did it start

• any recent change

• what time of day does occur, do shoes feel tight at end of day

  • Cardiac edema is worse at evening and better in morning after elevating legs all night

• how much swelling, equal B/L

  • cardiac edema is B/L

  • U/L swelling has a local vein cause

• does it go away with rest, elevation, sleep

• any SOB, does it occur before leg swelling or after

what are questions a nurse should ask about edema in a client

Hx of HTN, elevated cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever or unexplained joint pains as a child or youth, recurrent tonsillitis, anemia, heart disease, lasst ECG, stress ECG, serum cholesterol measurement, and other heart tests, previous heart medication, procedure, or surgery

what are questions a nurse should ask about past cardiac history in a client