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Facilitating

Cardiovascular health

Hypertension

Hypertension

Hypertension has been termed the silent killer

Common complications include stroke, end-stage renal failure, and heart failure
(Miller, 1999)

Adoption of a healthier lifestyle, starting in childhood and youth, can prevent and
reverse abnormal blood pressure patterns

Blood pressure and pulse pressure increase progressively with age. According to
Famingham data, adults at age 55 with normal blood pressure have an estimated 90%
lifetime risk for developing hypertension. (Vasan et al, 2002)

Blood pressure screening must be done during every health care encounter with an
older adult to detect hypertension and prevent its complications

Hypertension (cont.)

The addition of risk factors such as smoking, glucose intolerance,


hypercholesterolemia, and left ventricular hypertrophy significantly elevates
risk.
Classifications of Blood Pressure

CATEGORY

SYSTOLIC (mm Hg)

DIASTOLIC (mm Hg)

Normal

<120

And

<80

Prehypertension

120-139

or

80-89

Stage 1 hypertension

140-159

Or

90-99

Stage 2 hypertension

160

Or

100

Stage 3

180

Or

110

The phenomenon of pseudohypertension falsely elevated blood pressure is


found in the older adult population.

Pseudohypertension is a result of the calcification and thickening pf the arterial


wall. Rigidity in the brachial artery leads to ineffective compression of the
brachial artery with a sphygmomanometer.

Oslers maneuver

Primary hypertension: The most common form, exact cause is unknown (family
history, age, race, diet (foods high in saturated fats and saturated salt;
decreased potassium, magnesium, and calcium intake, smoking, stress, alcohol
and drug consumption, physical activity, and hormonal intake))

Secondary hypertension: elevated blood pressure caused by underlying disease


such as renal artery disease, renal parenchymal disorders, endocrine and
metabolic disorders, and central nervous system disorders

All prescription and over-the-counter-medications need to be assessed for


possible cause o elevated bloodpressure (amphetamines, glucocorticoids,
Decongestants, phenobarbital, rifampin, and NSAIDS)

One of the most important


considerations in drug therapy in older
adults is that blood pressure should be
lowered gradually, beginning with low
doses of a single agent

Pharmacological
Treatment

Pharmacological Treatment

Use non-pharmacologic interventions and lifestyle modification

Select an appropriate agent with consideration for comorbidity (Diuretics and


beta-blockers)

Increase the dose of the first drug, and then add a second drug of a different
class or substitute a drug from another class.

Continue adding agents from other classes. Consider referral to a


hypertensive specialist.

Diuretics

Thiazide diuretic, hydrochlorothiazide


and chlorthalidone are the most
commonly prescribed for older adults.
Initial dosage should be 12.5 to 25
mg/day.
Furosemide should not be used unless the
client has renal impairment
Concern: Hypotension or hypokalemia

Beta-Blockers

Beta Blockers are effective in lowering


morbidity and mortality in older adults.
(Atenolol and metoprolol are beta-blockers
that are cardioselective)

Angiotensin-Converting Enzyme Inhibitors

Inhibits the converting enzyme that is


responsible for the formation of
angiotensin II a potent vasoconstrictor that
stimulates the release of aldosterone

Calcium Channel Blockers

Inhibits the inward movement of calcium


across the cell membrane of the vascular,
which results in vasodilation of peripheral,
coronary, and renal arteries

Coronary Artery
Disease

Coronary Artery Disease

CAD, or ischemic heart disease, refers to a broad group of conditions that


partially or completely obstruct blood flow to the heart muscle.

Atherosclerosis

Although the development of atherosclerosis appears to be a normal process of


aging, the severity of this process can be accelerated with the adverse lifestyle
of smoking, physical inactivity, and obesity, as well as elevated serum
cholesterol levels, hypertension, and diabetes milletus.

Promoting health lifestyles in younger and older individuals is an important


aspect of care in the prevention of CAD.

CAD is the major cause of morbidity, disability and mortality in the adult
population

Angina

Diagnostic
Tests and
Procedures

Diagnostic Tests and Procedures

Serum cardiac enzymes of creatinine phosphokinase

Cardiac troponin levels

ECG

Complete blood count

Serum electrolytes, particularly sodium, potassium, and calcium

Chest-x-ray examination

Myocardial imaging

Cardiac catheterization

Stress test

Holter monitor or echocardiogram

Pharmacological
Treatment
Treatment is directed toward restoring the balance between
myocardial oxygen demand and oxygen supply for the prevention of
CAD

Nitrates

Nitrates are used for the prevention and


termination of angina attacks and for reducing the
pain associated with myocardial ischemia

Beta-Blockers

Beta-Blockers are used to prevent attacks in


clients with stable angina or to reduce the size of
infarction and complications of MI.

Calcium Channel Blockers

Calcium Channel Blockers are used to treat stable


and variant angina and to increase coronary
perfusion

Verapamil and diltiazem (not recommended)


Amlodipine (recommended)
Fibrinolytics, Anticoagulants, Antiplatelets
Heparin and warfarin
Antihyperlipidemics

These agents are used to prevent, reduce, and


dissolve thrombi around atherosclerotic plaques
by altering blood-clotting mechanisms
Are used to lower serum lipid levels by preventing
absorption of cholesterol and promoting its
secretion.

Nonpharmacologic
Treatment

Nonpharmacologic Treatment
Invasive

and Surgical Procedures: Older


adults who are healthy are candidates for
invasive treatment.

Percutaneous

Transluminal Coronary
Angioplasty (PTCA)

Stents
Coronary

Artery Bypass Graft (CABG)

Arrhythmia

Arrhythmia

An abnormal heart rate or rhythm caused by a disturbance in automaticity, conductivity, or


both.

Can originate in the atria, ventricles, or artiroventricular junctions, and can result in
decreased cardiac output and impaired perfusion of coronary arteries.

Older adults can develop any type of arrhythmia; however atrial fibrillation, sick sinus
syndrome, and heart block occur more often in the older population.

The incidence of atrial fibrillation increases with age and is the most common contributing
factor for ischemic stroke in older adults

Atrial fibrillation can occur during intense emotional stress, exercise, or alcohol intoxication

Symptoms of Arrhythmia are weakness, fatigue, forgetfulness palpitations, dizziness,


hypotension, bradycardia, and syncope, all of which predispose older clients to falls and
injuries

Treatment
Treatment should be limited to symptomatic clients
with significant arrhythmias Antiarrhythmic
medications should be avoided when possible

Treatment

Atrial Fibrillation: The treatment of atrial fibrillation has two objectives: 1.


control rate with maintenance anticoagulant therapy and 2. convert the
rhythm to a normal sinus rhythm (beta-blockers atenolol and metoprolol)

Sick Sinus Syndrome: Treatment may include the administration of vagolytic


agents such as atropine to block vagal impulses, resulting in an increased
heart rate. (vagolytic agents)

Heart Block: Treatment for first degree heart block includes observation to
prevent deterioration into severe heart block. 2nd and 3rd degree block,
vagolytic and sympathomimetic agents are usually employed.

Orthostatic Hypotension

Orthostatic Hypotension

Is a major risk factor for syncope and falls In older adults.

Orthostatic hypotension is defined as a drop in blood pressure of 10-20 mm Hg


with upright posture.

It is even more common among persons with certain risk factors such as
authonmic dysfunction, low cardiac output, and hypovolemia

The use of certain medications, such as sedatives, antihypertensive,


vasodilators, and antidepressants.

Consideration for hypertension

Health teaching, explain the procedures to be done (anxiety)

Includes signs and symptoms , treatment, regimen and medications.

Low sodium, low fat, reduce calorie diet

Weight loss, preparation and label reading

exercise

Consideration for CAD

Relieving pain, improving myocardial blood flow, decrease myocardial


workload, educating client

Nurse should be sensitive to the needs and initiate discussion with the client,
family, and physician

Exercise should be gradually increased in recovery like walking

Thermoregultion

Activities that build endurance like swimming and water aerobics

With unstable angina no exercise

Sexual activity should be discussed with older adults. Safe :4-6 wks after MI

Health teaching

Consideration for arrhythmias

Vital signs monitoring

Encourage to report symptoms like weakness, dizziness, and palpitations

Nurse should prepare to administer CPR

physiologic responses to activity is monitored

Place pt. at a higher risk for fainting and falls especially those who are
experiencing tachycardia, bradycardia and long sinus pause

Anticipate difficulty with home recovery

Older clients taking anticoagulants should be taught ways on how to prevent


injury

Consideration for orthostatic


hypertension

Teach to move into a recumbent position to a sitting position

Exercise lower legs and ankles for venous return

High salt diet increase blood volume

Encourage to limit alcohol intake, avoid large meals, and monitor, and control
diabetis mellitus

Envt safety remains important: grab bars

Postfall syndrome produces fear teaching of client of proper technique of


standing

Encourage support

Heart failure

Assess BP, apical pulse, heart rate, heart and lung sounds, and peripheral
edema, to detect early s/sx of cardiac output

I and O should be monitored and recorded

Increase clients activity according to tolerance and provide time to rest

Should maintain in fowlers position

One pillow at night to sleep with

Diuretics in the morning so that sleep Is not disturbed

Dyspnea- take slow deep breaths and maintain calm environment

Restrict sodium and fluid intake

Avoid processed, canned, and frozen foods

Electrolyte levels should be monitored

anemia

Focus in dietary management

Balance ofrest and activity

Health education

Ental safety

Appropriate food selection

Foods high in iron, folic acid

1.

what is known to be termed as the


silent killer

2-3.

give the 2 types of hypertension

4.

give 1diagnostic test and procedure for


CAD

5.

common arrhythmias in older adults

6-10.

give 5 modifiable factors that affects


the cardiovascular condition of the elderly