NCOA Module 4 (3)

Chapter 21: Cardiovascular Function

  • Age-Related Physiological Changes in the Cardiovascular System
        - Myocardium: Experiences slight atrophy and enlargement, leading to less effective contractions.
        - Pacemaker Cells: There is a decreased number of pacemaker cells, specifically in the Sinoatrial (SA) node.
        - Structural Deposits: Increased deposits of fat, collagen, and elastic fibers occur around the SA node.
        - Arteries: Degenerative changes in the arterial walls increase the risk for fatty plaque formation.
        - Veins: Become thicker, more dilated, and lose elasticity.
        - Leg Veins: Become less efficient at returning blood back to the heart.

  • Cardiovascular Disease (CVD) Scope and Diagnoses
        - CVD encompasses all pathological processes affecting the heart and the circulatory system.
        - Common diagnoses includes:
            - Coronary Artery Disease (CAD).
            - Arrhythmias (e.g., PVCs).
            - Atherosclerosis.
            - Heart Failure.
            - Myocardial Infarction (MI).
            - Deep Vein Thrombosis (DVT).
            - Stroke.
            - Transient Ischemic Attacks (TIAs).

  • Risk Factors for Cardiovascular Disease
        - Nonmodifiable Risk Factors: Age, race, gender, and ethnicity.
        - Modifiable Risk Factors:
            - High Blood Pressure.
            - High Cholesterol.
            - Diabetes.
            - Obesity (defined as a BMI of 30 kg/m230\text{ kg/m}^2 or higher).
            - Smoking.
            - Lack of physical activity.

  • Atherosclerosis
        - Defined as the buildup of fatty plaques in the arteries.
        - Significant clinical concern when it occurs in the coronary arteries.
        - Progression involves formation of plaque, growth of the lesion, and potential rupture leading to a blood clot.

  • Metabolic Syndrome Diagnostic Criteria
        - Diagnosis requires 3 or more of the following conditions:
            - Abdominal Obesity: Waist circumference ≥40 inches\ge 40\text{ inches} (102 cm102\text{ cm}) in men or ≥35 inches\ge 35\text{ inches} (88 cm88\text{ cm}) in women.
            - Blood Pressure: Equal to or higher than 130/85 mm Hg130/85\text{ mm Hg}.
            - HDL Cholesterol: Less than 40 mg/dL40\text{ mg/dL} in men or equal to/lower than 50 mg/dL50\text{ mg/dL} in women (or current drug treatment for lipid disorder).
            - Triglycerides: 150 mg/dL150\text{ mg/dL} or more (or specific treatment for hypertriglyceridemia).
            - Fingers Fasting Blood Glucose: 100 mg/dL100\text{ mg/dL} or more (or drug treatment for increased glucose levels).

  • Pathological Conditions Affecting Cardiovascular Wellness
        - Orthostatic Hypotension:
            - Defined as a reduction in systolic blood pressure of at least 20 mm Hg20\text{ mm Hg} or diastolic blood pressure of at least 10 mm Hg10\text{ mm Hg} within 22 to 3 minutes3\text{ minutes} of standing after being recumbent for at least 5 minutes5\text{ minutes}.
            - Symptoms: Fatigue, dizziness, and syncope.
        - Postprandial Hypotension:
            - Defined as a systolic blood pressure reduction of 20 mm Hg20\text{ mm Hg} or more within 2 hours2\text{ hours} after eating a meal.
            - Common in older adults.
            - Key risk factors: Constipation, Type 2 Diabetes Mellitus (DM2), and Parkinson Disease.

  • Nursing Interventions for Cardiovascular Health
        - Primary Prevention: Actions taken before the disease occurs to reduce risk.
            - Management of medical conditions (HTN, high cholesterol, diabetes).
            - Smoking cessation and avoiding secondhand smoke/air pollutants.
            - Engaging in moderate physical activity for 30 minutes30\text{ minutes} at least 5 days5\text{ days} a week.
            - Stress management (yoga, meditation).
            - Maintaining weight within normal limits.
        - Secondary Prevention: Early detection, treatment, and prevention of worsening condition.
            - Cardiac Rehab: Education regarding disease, treatment, dietary patterns, activity, and smoking cessation.

  • Heart-Healthy Eating Pattern Recommendations
        - Fruits: 33 to 55 servings daily (especially deeply colored).
        - Vegetables: 33 to 55 servings daily (especially deeply colored).
        - Dairy: 22 to 33 servings of low-fat or nonfat products.
        - Carbohydrates/Fiber: Whole-grain products (rye, barley, oats, whole wheat).
        - Fiber Goal: At least 25 g25\text{ g} daily.
        - Protein: Leanest meats, poultry, fish, and shellfish.
        - Restrictions: Avoid high-calorie foods, trans fats, and refined sugars.

  • Guidelines for Nursing Management of Hypertension
        - Lifestyle Modifications:
            - Weight reduction if weight is more than 110%110\% of ideal weight.
            - 3030 to 45 minutes45\text{ minutes} of exercise (e.g., brisk walking) at least 5 times5\text{ times} weekly.
            - Alcohol limitation: 1 drink1\text{ drink} per day (defined as 2 ounces2\text{ ounces} of 100-proof whiskey, 8 ounces8\text{ ounces} of wine, or 24 ounces24\text{ ounces} of beer).
        - Nutritional Interventions:
            - Sodium intake limited to 1.5 g1.5\text{ g} daily.
            - Avoidance of processed foods.
            - Grains: 77 to 88 servings daily.
            - Fruits and Vegetables: 88 to 1010 servings daily.

  • Education for Orthostatic and Postprandial Hypotension
        - Fluid Intake: Maintain 8 glasses of noncaffeinated beverages daily.
        - Meal Pattern: Eat 55 or 66 smaller meals daily instead of large meals; choose low-carbohydrate meals.
        - Positioning: Change positions slowly. Sit at the bedside for several minutes after rising from lying down before standing. Sleep with the head of the bed elevated on blocks.
        - Postprandial Precautions: Take antihypertensive medications 1 hour1\text{ hour} after meals rather than before. Avoid strenuous exercise for $$2