BACHELOR OF SCIENCE IN NURSING:

NCMB 314 –CARE OF THE OLDER ADULT

RLE MODULE RLE UNIT WEEK

2 8 9

CARDIOVASCULAR CHANGES
  Read course and laboratory unit objectives
 Read study guide prior to class attendance
 Read required learning resources
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Describe age-related changes in cardiovascular system.

3. To promote lifestyle modification for elderly to reduce heart failure.

3. To describe factors contributed to heart disease in older adults.

Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones &

Bartlett Publishers.610.7365 G31 2010

Eliopoulos (2018). Gerontological Nursing 9 thEdition.Wolters Kluwer

Meiner (2019). Gerontologic Nursing 6th Edition. ELS

Cuison,Roy. Handbook of Lectures on Geriatric Medicine

Cardiovascular System

Some cardiovascular changes commonly attributed to age actually result from pathological
conditions. Heart size does not change significantly due to age; rather, enlarged hearts are associated
with cardiac disease, and marked inactivity can cause cardiac atrophy. There is a slight left ventricular
atrophy with age and the aorta becomes dilated and elongated. Atrioventricular valves become thick
and rigid as a result of sclerosis and fibrosis, compounding the dysfunction associated with any cardiac
disease that may be present. There may be incomplete valve closure resulting in systolic murmurs.
Extra systolic sinus bradycardia and sinus arrthymia can occur in relation to irritability of the
myocardium.

Age -related physiologic changes in the cardiovascular system appear in a variety of ways.
Throughout the adult years, the heart muscle loses its efficiency and contractile strength, resulting in
reduced cardiac output under conditions of physiologic stress. Pacemaker cells become increasingly
irregular and decrease in number, and the shell surrounding the sinus node thickens. The isometric
contraction phase and relaxation time of the left ventricle are prolonged; the cycle of diastolic filling and
systolic emptying requires more time to be completed.

Usually, adults adjust to changes in the cardiovascular system quite well; they learn that it is easier
and more comfortable for them to take an elevator rather than the stairs, to drive instead of walking a
long distance, and to pace their activities. When unusual demands are placed on the heart (e.g.,
shoveling snow for the first time of the season, receiving bad news, and running to catch a bus), the
person feels the effects. The same holds true for older individuals who are not severely affected by
less cardiac efficiently under non-stressful conditions. When older persons are faced with n added
demand on their hearts, however, they note the difference. Although the peak rate of the stressed
heart may not reach the levels experienced by younger persons, tachycardia in older people will last fo
a longer time. Stroke volume may increase to compensate for this situation, which results in elevated
blood pressure, although the blood pressure can remain stable as tachycardia progresses to heart
failure in older adults. The resting heart rate unchanged.

Maximum exercise capacity and maximum oxygen consumption vary among older people. Older
adults in good physical condition have comparable cardiac function to younger persons who are in
poor condition.

Blood vessels consist of three layers, each of which is affected differently by the aging process.
The tunica intima, the innermost layer, experiences the most direct changes, including fibrosis, calcium
and lipid accumulation, and cellular proliferation. These changes contribute to the development of
atherosclerosis. The middle layer, the tunica media, undergoes a thinning and calcification of elastin
fibers and an increase in collagen, which cause a stiffening of the vessels. Impaired baroreceptor
function and increased peripheral resistance occur, which can lead to rise in systolic blood pressure.
The outermost layer, the tunica adventitia, is not affected by the aging process. Decrease elasticity of
the arteries is responsible for vascular changes to the heart, kidney, and pituitary gland. Reduced
sensitivity of the blood pressure-regulating baroreceptors increases problems with postural
hypotension and postprandial hypotension (blood pressure reduction of at least 20 mmHg within 1 hour
of eating). The reduced elasticity of the vessels, coupled with thinner skin and less subcutaneous fat,
causes the vessels in the head, neck, and extremities to become more prominent.
Case Scenario: Mr. H, an 82-year-old man who is widened and lives alone, arrives in the emergency
room complaining he has had difficulty breathing, especially at night, associated with nausea, for the
past week. He states that he must sleep with two pillows to breathe more easily at night and still does
not get a good night’s rest. He also complains of cough that is worse at night and relieved by nothing.
Mr. H has pneumonia. Assessment of Mr. H reveals the following;

Vital signs: temperature, 98F; apical heart rate 86 beat s/min and irregular, respiratory rate, 36
breaths/min and labored; and blood pressure, 170/96 mmHg

Skin – pale, cool, and diaphoresis

Inspiratory bibasilar crackles that do not clear with coughing

S3, heart sound on auscultation

Visible jugular vein distention

3+ bilateral pedal edema

A 12-lead ECG and a chest x-ray examination are ordered. An intravenous line is started at a “keep
vein oven” (KVO) rate. Oxygen via mask is admitted with a diagnosis of CHF.

1. What are the signs and symptoms of heart failure?

2. Give 7 lifestyle modifications to teach older adults with heart failure and discuss briefly.
3. Make a drug study on Digoxin including the nursing consideration.
4. Give 6 objectives with interventions (for each objective) in the management of CHF.

Date Completed:

Date Submitted:

Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones &

Bartlett Publishers.610.7365 G31 2010

Eliopoulos (2018). Gerontological Nursing 9 thEdition.Wolters Kluwer

Meiner (2019). Gerontologic Nursing 6th Edition. ELS

Cuison,Roy. Handbook of Lectures on Geriatric Medicine