Outcomes: By the end of this session the student will be able to:

Discuss the cardiovascular system Identify the normal changes that occur with

ageing Explain the nurses role in the care of

residents with cardiovascular disease

The cardiovascular system comprises the heart, the blood vessels and the blood.

The function:* transport of oxygen, waste, hormones and

nutrients to and from various parts of the body.

The function of blood is to: Carry oxygen (O²) from lungs to cells. Carry carbon dioxide (CO²) from cells to the

lungs. Absorb nutrients (from food) from the

duodenum (in the digestive system) and transports them to cells.

Carry waste products from the cells to the kidneys to be eliminated as urine.

Carry hormones from the endocrine system to receptors in various cells.

Red cells (erythrocytes) which contain haemoglobin. *Haemoglobin carries the oxygen (O²) in the blood.

White cells (leukocytes) which fight infection by destroying bacteria/virus/etc and help to repair tissues.

Plasma, which is the liquid portion of blood and contains protein and salts.

Platelets (thrombocytes) which are important for clotting.

Consist of arteries, arterioles (which carry oxygen rich blood to cells), veins, venules (which carry blood rich in CO² away from cells) and capillaries.

Blood pressure is the pressure of the blood against the walls of an artery as the heart contracts (called systole) and;relaxes between contractions (called diastole); specifically, the period when the two ventricles are dilated by the blood flowing into them.

Dilation and contraction of the blood vessels helps the body regulate temperature.

Blood vessels reach every organ of the body, including the heart itself.

The heart is a hollow organ about the size of a fist and is composed of special muscle tissue. (cardiac muscle).

It lies under the breast bone (sternum) in the centre of the cardiothoracic cavity.

The heart has of 3 layers – pericardium (outer layer), myocardium (the muscle layer) endocardium (the inside layer).

There are four chambers within the heart: Two atria above Two ventricles below.

The septum divides the right atria and the right ventricle from the left atria and the left ventricle.

Valves, control the blood flow between the chambers of the heart

There are four valves within the heart:

Tricuspid Valve

Pulmonary Valve

Mitral (Bicuspid) Valve

Aortic Valve

The heart is supplied by its own arteries and veins.

The “conduction system” of the heart is a system of nerve cells and fibres that determine its beat, which averages at 72 beats per minute.

Increase in size of heart.

Impaired response to exercise.

Decrease in cardiac output due to loss of heart muscle elasticity.

Decrease in blood flow to organs.

Increase in blood pressure.

Artery walls thicken.

Changes occur in veins and valves.

The interior of vessels roughens.

Cardiovascular adjustments to changes in position decrease.

Arteriosclerotic changes to the vessels occur, causing narrowing.

CCF is the inability of the heart to maintain circulation sufficient to meet the bodies needs.

Signs & Symptoms:• Breathlessness • abnormal retention of water and sodium

leading to oedema (fluid retention) with congestion of the lungs or the peripheral circulation or both

Oedema

Dyspnoea

Ascites

Care is concerned with alleviating the presentingproblems:

Fluid balance chart- fluid restriction

Oxygen therapy as required - very important for the nursing assistant NOT to initiate oxygen therapy.

Special diet - low sodium

Report any consistent, hacking cough

Observe for cool, pale skin

Observe for oedema, dyspnoea

Assist with activities of daily living as required.

A conduction disorder is an abnormalelectrical conduction of the heart resulting in an abnormal rate or rhythmof the heart.

These depend upon the location in the heart ofthe disorder but generally there is :

An irregular pulse.

A feeling of general malaise.

Maybe breathlessness.

Palpitations.

Report any symptoms or change in resident to registered nurse.

Rest

Assist with ADL’s.

Oxygen therapy as required (NOT initiated by nursing assistant).

Angina

Angina is chest pain due to inadequate oxygen supply to cardiac muscle.

Chest pain, often bought about by exercise or stress.

“Tightness” in chest.

Report any episodes of angina to registered nurse.

Discuss with resident lifestyle choices, which impact on the disease i.e. Smoking, diet, and obesity.

A myocardial infarction or “heart attack”

is an area of necrotic myocardium due to

a lack of oxygenated blood

Acute, crushing retro-sternal chest pain, radiating down left arm and into the jaw

Nausea, sweating.

Shortness of breath.

Desire to open bowels.

Do not ignore ℅ pain in chest, jaw or (L) arm

Assist resident to a comfortable position

Do not leave the resident

Notify the RN

Be prepared to assist with whatever is required. Know where all emergency equipment is stored.

Hypertension is defined as sustained,

elevated BP i.e. >140/90

(65yrs+ = >160/95)

:

Headache, tinnitus, blurred vision.

Successive raised blood pressure.

Also depends on underlying cause i.e. vascular problems, renal disease.

Encourage resident in lifestyle related decisions that affect hypertension: diet (low sodium, low caffeine), exercise, no smoking

Report any acute change in condition of resident that reflects above symptoms.

Postural hypotension is low blood pressure associated with change in the residents position.

Pallor, sweating

Nausea, dizziness, fainting.

Observe resident.

Instruct and assist resident to sit up slowly.

Do not leave resident during episode.

A cerebral vascular accident is a disruption of blood supply to the brain resulting in loss of brain function.

Aneurysm.

Arteriosclerosis.

Hypertension.

Haemorrhage.

PLAQUE BUILDUP IN AN ARTERY

The presenting problems of a CVA reflect the location and severity of the CVA in the brain

Dizziness, headache, poor concentration, “pins and needles”.

Noticeable droop on one side of the face.

Change in level of consciousness, weakness.

Speech, sensory, motor deficits.

Paralysis.

Incontinence.

Changes in behaviour and/or personality.

Personal care and assistance with activities of daily living.

Work with other members of the health care team - Physiotherapist, Occupational Therapist/Diversional Therapist, Dietitian, and Speech Therapist.

Rehabilitation.

Encourage as much independence as possible to promote dignity and self-esteem.

Unfortunately, many people adopt changes to their lifestyle after they develop the symptoms of heart disease. Lifestyle changes are vital in the ongoing management and prevention of heart disease.

Eating – low fat, low sodium, low animal products and high carbohydrate.

A reduction of caffeine and alcohol

Stress management and relaxation

Exercise

Education about risk factors, eg smoking.Nepean Hospital Outpatient Program – Healthy Heart.

As a person ages they experience changesIn circulation, as their heart cannot function as it once did. These changesmay include:

Cold hands and feet

Ulceration, especially on the feet and lower legs

Easily bruised

Peripheral oedema

Ascities

Cyanosis – especially the extremities

Poor pulse

Dyspnoea

Postural Hypotension

Anderson et al 1996