CARDIOVASCULAR

HEALTH PROMOTION
FOR OLDER ADULTS
Mark Ebony Sumalinog, RN MSN
EFFECTS OF AGING ON
CARDIOVASCULAR SYSTEM
• Heart valves increase in thickness and rigidity due to sclerosis and
fibrosis

• Aorta becomes dilated, a slight ventricular hypertrophy develops, and

thickening of the left ventricular wall

• Myocardial muscle is less efficient and loses some of its contractile

strength, causing reduction in cardiac output when the demands on the
heart is increased
EFFECTS OF AGING ON
CARDIOVASCULAR SYSTEM
• More time is required for the cycle of diastolic filling and
systolic emptying to be completed

• Calcification and reduced elasticity of vessels occur

• Older hearts are less sensitive to baroreceptor regulation of

blood pressure
 NURSING DIAGNOSIS:
AGING AND RISK TO ADEQUATE CIRCULATION

Causes and Contributing Factors Nursing Diagnosis

Decreased elasticity of the heart Ineffective Peripheral Tissue Perfusion

Increased resistance of peripheral vessels Activity Intolerance

Decreased coronary blood flow Decreased Cardiac Tissue Perfusion

Reduced proportion of oxygen extracted from Risk of Decreased Tissue Perfusion

arterial blood by tissues

Reduced cardiovascular responsiveness to Activity Intolerance

adrenergic stimulation
Good tissue health depends on adequate tissue
perfusion. To ensure good tissue perfusion, arterial
blood pressure must remain within normal range.
Unfortunately, older adults are more likely to suffer
from conditions that can alter tissue perfusion, such as
the ff.:
• Cardiovascular disease: arteriosclerotic heart disease,
hypertension, CHF and varicosities
• Diabetes mellitus, cancer, and renal failure
• Blood dyscrasias: anemia, thrombus and transfusion
reactions
• Hypotension: arising from anaphylactic shock,
hypovolemia, hypoglycemia, hyperglycemia and orthostatic
hypotension
• Medications: anti-hypertensives, vasodilators, diuretics
and antipsychotics
• Other conditions: edema, inflammation, prolonged
immobility, hypothermia and malnutrition
CARDIOVASCULAR HEALTH
PROMOTION
• Proper Nutrition
• Adequate Exercise
• Cigarette Smoke Avoidance
• Stress Management
• Proactive Interventions
A. Proper Nutrition
A diet that provides all daily requirements,
maintaining weight within ideal range
for height and age, and controls
cholesterol intake is beneficial.
Dietary Guidelines for Reducing
the Risk of Cardiovascular Disease
• Reduce the intake of fried foods, animal fats, and partially hydrogenated
fats. BEWARE OF FAST FOODS, which tend to be high in fat and
calories

• Increase the intake of complex carbohydrates and fiber. Use

unrefined whole grain products such as whole wheat, oats and oatmeal,
rye, barley, corn, popcorn, brown rice, buckwheat, millet, quinoa and
sorghum

• Maintain caloric intake between ideal range (Haris Benedict)

Dietary Guidelines for Reducing
the Risk of Cardiovascular Disease
• Use monosaturated oils: canola oil, cold pressed olive oil,
and omega-6 oils

• Eat fish rich in omega 3 fatty acids (salmon, trout and

herring) at least twice weekly

• Reduce intake of red meat, sugar and highly processed foods

• Limit alcoholic beverages

Nutritional Supplements for
Cardiovascular Health
• Vitamin B6: effective in preventing homocysteine-induced oxidation
of cholesterol, which can aid in preventing heart attacks and strokes

• Vitamin B12: decrease homocysteine level

• Folic Acid: for proper metabolism of homocysteine

• Vitamin C: prevents formation of oxysterols, maintains integrity of

arterial walls
Nutritional Supplements for
Cardiovascular Health
• Selenium: reduces platelet aggregation

• Magnesium: dilates arteries and facilitates circulation, prevents

calcification of vessels, lowers total cholesterol, raises HDL, inhibits
platelet aggregation

• Calcium: decrease total cholesterol and inhibit platelet aggregation

• Chromium: lowers total cholesterol and triglycerides (particularly

combined with niacin), raises HDL
Nutritional Supplements for
Cardiovascular Health
• Potassium: can aid in reducing reliance on anti-hypertensives
and diuretics

• Fish Oil: reduces death from CAD, lowers blood pressure

Note: It is preferable to get necessary vitamins and

minerals from the diet, not through supplements
 The Reversal Diet
Diet that has been proven effective not only in
preventing but also in reversing heart disease
The Reversal Diet consists of the following:
• Less than 10% of calories from fat and very little of
those from saturated fat
• High fiber intake
• Exclusion of all oils and animal products,
except nonfat milk and yogurt
• Exclusion of caffeine and other stimulants
• Allows, but does not encourage, less than 2 oz. of
alcohol per day
• No calorie restriction
Ornish Prevention Diet. It is intended for
persons with cholesterol level less than 150 or a
ratio of total cholesterol to high density lipoprotein
(HDL) of less than 3 who have no cardiac disease

• It is similar to the Reversal Diet, with the

exception that as much as 20% of calories can
come from fat
• Advocates moderate exercise, increased intimacy,
stress reduction and other healthy practices
B. Adequate Exercise

• A sensible distribution of exercise throughout the week is more

beneficial to cardiovascular function than are periodic spurt of
activity

• The lack of physical activity, known as physical deconditioning,

can heighten many age-related functional declines that aging
people can experience
• Nurses can encourage persons who dislike scheduled exercise
programs to maximize opportunities for exercise during their
routine activities

• 30 minutes of moderate physical activity at least 5 days per

week OR 20 minutes of vigorous exercise at least 3 days per
week
C. Cigarette Smoke Avoidance

• Smoking cessation programs (acupuncture)

• Even if the patient had repeated failures in attempting to quit,

the next try could be successful and should be encouraged.
(breaking the habit is quite difficult)

• Limit exposure to the cigarette smoke produced by others (2nd

and 3rd hand smoking)
D. Stress Management

• Effective management of stress

• Relaxation exercises, yoga, meditation, and other stress-

reducing activities

• It is much easier and more useful to establish good

healthier practices early in life than to change them
or deal with their outcomes in old age
D. Proactive Interventions

• A daily aspirin dose at 75 to 81 mg is sufficient to provide heart disease

prevention benefits

• Light drinking could be beneficial (consume alcohol at least 3 or 4 days

per week showed a reduction in the risk of myocardial infarction)

• Daily multivitamin supplements

• Undergoing C-Reactive Protein screening

• Comprehensive assessment of the cardiovascular system is useful

Nursing Diagnosis Related to
Cardiovascular Problem
Nursing Diagnosis Related to
Cardiovascular Problem
Nursing Diagnosis Related to
Cardiovascular Problem
 CARDIOVASCULAR
DISEASE AND WOMEN

• 1/3 of women aging 45-54 years

• 70% of women aging 65 years and older

• CVD kills 12 times the number of women yearly as breast cancer

• Often women miss signs of CVD because of symptoms are less

evident than in men
 SELECTED
CARDIOVASCULAR
CONDITIONS
A. Hypertension

• Incidence increase with advancing age

• Most prevalent cardiovascular disease

• Vasoconstriction associated with aging, which

produces peripheral resistance

• SBP of > 140 and DBP of >90

• Assess in standing, sitting, and prone positions

• Check for anxiety, stress or activity before the

blood pressure check

• Symptoms: awakening with a dull headache,

epistaxis, disorientation, confusion, impaired
memory and slow tremor
• Advised to rest, reduce sodium intake, reduce their weight

• Aggressive antihypertensive therapy is discouraged because

of the risk of sudden dangerous decrease in blood pressure

• Signs of hypotension: dizziness, confusion, syncope,

restlessness and drowsiness; elevated BUN

• Diuretics, beta blockers, calcium channel blockers, ACE

inhibitors
• The use of non-pharmacologic measures since
anti-hypertensives can cause adverse reactions (Fish-oil
supplements, whole grain intake, garlic, hawthorn
berries, periwinkle)

• Ginseng and licorice can cause a rise in blood pressure

B. Hypotension
• A decline in SBP of 20 mmHg or more after rising and standing
for 1 minute is postural hypotension

• A reduction within 1 hour of eating is postprandial hypotension

• Due to increased intake of vasoactive medications and concomitant

decrease in physiologic function, such as baroreceptor sensitivity

• Priority: SAFETY
C. Congestive Heart Failure
• Increases with age

• Complication of having an arteriosclerotic heart disease, treatment of MI with

thrombolytic agents

• CAD is responsible for most cases of CHF, followed by

hypertension

• Other factors: DM, dyslipidemia, sleep-disordered breathing, albuminuria,

anemia, CKD, use of illicit drugs, sedentary lifestyle and psychological stress
• Symptoms: dyspnea on exertion (the most common finding),
confusion, insomnia, wandering during night, agitation,
depression, anorexia, nausea, weakness, SOB, orthopnea,
wheezing, weight gain and bilateral ankle edema
• Symptoms: dyspnea on exertion (the most common finding),
confusion, insomnia, wandering during night, agitation,
depression, anorexia, nausea, weakness, SOB, orthopnea,
wheezing, weight gain and bilateral ankle edema

• Auscultation: moist crackles are heard

4 categories of CHF according to
the New York Heart Association
Class 1: Cardiac disease without physical limitation

Class 2: Symptoms experienced with ordinary physical activity; slight

limitations may be evident

Class 3: Symptoms experienced with less than ordinary activities; physical

activity significantly limited

Class 4: Symptoms experienced with any activity and during rest; bed
rest may be required
Management
• Bed rest, ACE inhibitors, beta blockers, digitalis, diuretics and
reduction in sodium intake

• Sit in a chair beside the bed (CBR is discouraged to avoid thrombosis

and pulmonary congestion)- observe for fatigue, dyspnea and changes
in skin color and pulse

• Presence of edema and poor nutrition of the tissues associated with the
disease, along with the fragile skin of the aged, predispose to skin
breakdown
• Regular skin care and frequent changes of positioning
D. Pulmonary Emboli
• High in older persons
• Risk: fractured hips, CHF, arrhythmias, and history of
thrombosis; immobilization and malnourishment
• Symptoms: confusion, apprehension, increasing
dyspnea, slight temperature elevation, pneumonitis and
elevated sedimentation rate
• Atypical: may not experience pain due to altered pain
sensation
• Diagnosis: lung scan or angiography
Ventilation–perfusion (VQ) scan 

Uses radioactive material to examine airflow

(ventilation) and blood flow (perfusion) in the lungs. 
E. Coronary Artery Disease (CAD)/
Ischemic Heart Disease

• Angina
• Myocardial Infarction
Angina
• Detection is difficult because of its atypical
pattern in older adults
• The first indication: vague discomfort under
the sternum (after exertion or large meal)
• May be attributed to indigestion
• Progress to precordial pain radiating down the
left arm
• Other symptoms: coughing, sweating with
exertion, syncope, episode of confusion
• Formation of small areas of myocardial necrosis
and fibrosis (diffuse) leading to myocardial
weakness and the potential risk of CHF
Management

• Nitroglycerin for angina attacks (lower doses may be

indicated because of its potential risk of hypotension)
• Sit or lie down after taking the tablet to prevent falls
• Sublingual administration (do not swallow)
• Usual number of tablets to alleviate the attack
Management
• Avoid factors that aggravate
angina syndromes:
• Cold wind • Acupuncture
• Emotional stress • If pain not reduced by
• Strenuous activity nitroglycerin, suspect for
myocardial infarction
• Anemia
• Tachycardia
• Arrhythmias
• Hyperthyroidism
Myocardial Infarction

• Most common in men with history of hypertension and arteriosclerosis

• Atypical: absence of pain (diagnosis is missed or delayed)

• Symptoms: if pain is present (pattern: left arm radiating to the

entire chest, the neck, jaw, and the abdomen); numbness in arms,
neck or back; confusion; moist, pale skin; decreased blood pressure;
syncope; SOB; cough; low grade fever; elevated sedimentation rate
• Monitor for anuria
• Arrhythmias may occur leading fibrillation and to death, if
untreated
Management

• Replace CBR with allowing the patient to sit in an armchair next

to the bed (patient should be assisted into the chair with
minimal exertion by him or her)

• Prevent the complications of immobility and prevents pooling of

the blood in the pulmonary vessels, thereby decreasing the work
of the heart
Management

• Early ambulation following an MI is encouraged

• Using of bedpan puts more work on the heart than using a

commode

• Thrombolytic (watch for cerebral and intestinal bleeding)

• Watch for complications: CHF and pulmonary edema

 F. Hyperlipidemia

• Increased LDL puts an elderly at risk of CAD associated with

total cholesterol

• Other cause: uncontrolled diabetes, hypothyroidism, uremia,

and nephrotic syndrome

• Drugs that may cause hyperlipidemia: corticosteroids, thiazide

diuretics
• Diagnosis: LIPID PROFILE
• let patient fast for 12 hours prior the testing (triglycerides are sensitive
to food)
• triglycerides > 200 mg/dl is borderline; if more than 240 mg/dl, high
• LDL less than 100 mg/dl is recommended for people with CHD or
diabetes

• If none (no CHD or diabetes) but with two coronary risk factors, 130
mg/dl is advised

• If none (no CHD or diabetes) but with one or no risk factors, 160
mg/dl
Management

Dietary changes and exercise

Guidelines:
• Reduced intake of egg yolk and organ meats

• Increase consumption of soluble fibers (oats)

• Reduced red meat intake and substitute with fish, chicken
• Use skim milk and non fat cottage cheese
• Substitute olive oil for vegetable oils

• Fresh fruits and vegetables

• Reduce weight and limit alcohol intake

• Medications:
 DOC: HMG-CoA or 3-hydroxy-3-methylglutaryl-coenzyme
reductase inhibitors
 Atorvastatin, fluvastatin, lovastatin, rosuvastatin and simvastatin

 Effective in lowering LDL

 Omega 3 (fish oil)

 Garlic supplements, green tea and antioxidants (vitamin A, C and E and

beta-carotene)
G. Arrhythmias

• Factors: digitalis toxicity (most common), hypokalemia, acute

infections, hemorrhage, angina syndrome, coronary
insufficiency

• Symptoms: weakness, fatigue, palpitations, confusion, dizziness,

hypotension, bradycardia, syncope
• Medications:
• Tranquilizers (Valium)

• Anti-arrhythmic drugs (Amiodarone, beta blockers, CCB)

• Digitalis (watch for digitalis toxicity: effect can be evident even 2 weeks after
the drug has been discontinued)

• Potassium supplements

• Cardioversion
Management

• Patient education on:

• diet modification
• smoking
• drinking
• activity
H. Peripheral Vascular Disease
• Arteriosclerosis
• Special Problems associated with Diabetes
• Aneurysm
• Varicose Vein
• Venous Thromboembolism
Arteriosclerosis
• Common among elderly with diabetes
• Affects smaller vessels farthest from the heart
• Diagnosis: Arteriography and radiography
• Oscillometric testing to assess arterial pulse at
different levels
• Keep the patient in a warm, stable room
temperature for at least 1 hour before testing
• TTT: bedrest, Buerger-Allen exercise and
vasodilators
Buerger-Allen Exercise
• Improve circulation of feet
and legs

• Contraindication:
recent thrombosis or
embolus

• Termination: stop if
pain and cramping of the
calf leg occurs
Proper Foot Care
• Persons with PVD must pay close attention to foot care
• Inspect daily (foot and nails)
• A simple fungal infection of the nails can lead to gangrene
• Avoid walking bare feet
• Check for discoloration or foot lesion and report immediately to the
physician
• Place cotton in between toes and frequent removal of shoes to keep
feet dry
• Shoes should be large enough to avoid any pressure and safe
enough to prevent injuries
• Laces should not be tied tightly to avoid pressure on the feet
• Colored socks may contain irritating dyes
• Change socks regularly
• Feet should be kept warm; BUT, the direct application of heat
on the feet (heating pads, hot water bottles, and soaks) can
increase the metabolism and circulatory demand, thereby
compounding the existing problem
Special Problems Associated
with Diabetes
• Diabetes associated neuropathies and infection that affects the
vessels throughout the entire body
• Arterial insufficiency is present
• Resting pain due to intermittent claudication
• Arterial pulses are hard to find or totally absent
• Skin discolorations and ulcer; gangrene may be present
• Diagnostics:
• Oscillometry
• Elevation-dependency tests
• Palpation of pulses and skin temperature at different sites
• Arteriography (if surgery is possible) to identify exact
location

• TTT:
• Walking to promote collateral circulation (sufficient mgmt.
for intermittent claudication)
• Analgesics for resting pain
Aneurysm
• Advanced arteriosclerosis is responsible for
most aneurysm
• Assessment: some aneurysms can be seen
through naked eye and are palpated as a
pulsating mass; others can be detected by
radiography
• Complication: thrombosis can develop
leading to arterial occlusion or rupture (most
serious)
• Aneurysm of the abdominal aorta (most frequent in
elderly)
• History of arteriosclerotic lesions, angina pectoris,
MI, CHF
• Pulsating mass, sometimes painful, in the
umbilical region
• Prompt correction: Abdominal Aortic Aneurysm
Repair / Endovascular Aneurysm Repair (EVAR)
• Post-op complications: hemorrhage, MI, CVA,
acute renal insufficiency
• Aneurysm can also occur in the peripheral
arteries (most common: femoral and popliteal)
• Complication: loss of limb due to formation of
thrombus that occludes the vessel
• Resection of the lesion and then replaced with a
prosthetic material

• Lumbar sympathectomy
• An injection procedure performed to block the
sympathetic nerves and increase the blood supply to
the skin in the leg.
Varicose Veins
Cause: lack of exercise, prolonged standing, aging process (loss of
elasticity and strength)

Dilated, tortuous nature of the vein, especially in the lower extremities

Dull pain and cramping of the legs, sometimes severe that it interferes
with sleep

Dizziness may occur as patient arise from lying position

• Varicosities makes the skin more
susceptible to trauma and infection,
promoting to development of ulcerative
lesions
Management
• Aimed in preventing venous stasis
• Elevate and rest affected limb
• Exercise, particularly walking
• Elastic stockings properly used
• Patient education of risk factors
• Venous Ligation and Stripping
Topics To Include In Teaching
The Patient With A Leg Ulcer
• Use gravity to promote circulation and reduce edema by elevating
the lower extremity when sitting and by avoiding prolonged
standing, sitting and crossing legs
• Use an overbed cradle to keep linens from touching ulcer
• Prevent constriction by avoiding tight socks or garters
• Control pain by analgesics
• Change the dressing as described (ask caregiver if difficulty is
noted)
• Promote circulation by exercising (walking, swimming, dorsiflexion
of the feet)
Venous Thromboembolism
• Risk: prolonged bed rest; recent surgery; and fractures or lower
extremity
• Symptoms depend on the vessel involved:
• Be alert of edema (veins of the calf muscle)
 Discoloration and pain are often absent in aged person
• Warmth of affected area
• Pain in the sole of the foot

• Inferior vena cava: bilateral swelling, aching and cyanosis of the

lower extremities, engorgement of the superficial veins, tenderness of
the femoral vein
Management
• Treatment (depend on the location)
• Elastic stockings or bandages
• Rest
• Elevation of affected limb

• Analgesics to relieve pain

• Anticoagulants
Preventing complications
• Documentation of fluid balance (encourage fluid intake within
prescribed fluid restriction to prevent dehydration)
• IVF must be monitored closely to prevent excessive fluid
infusion (hypervolemia)
• Vital signs monitored closely with attention to changes (inc.
temperature can reflect infection or MI)
• Tachycardia could indicate hypoxia caused by obstructed airway
• Bradycardia may be associated with digitalis toxicity
Preventing complications
• Oxygen therapy
• Elderly may not manifest cyanosis as initial sign of hypoxia
• Instead, restless, irritable and dyspneic
• ABG levels
• Address nutritional needs if anorexic (cardiovascular disease)
• Small frequent feedings
• Constipation must be avoided, enemas, and removal of fecal
impaction cause vagal stimulation (dangerous for patient with
CVD)
Integrating CAM
• Hawthorn berry: dilates blood vessels and improve circulation to
the heart, relieve spasms of the arterial wall and produce
hypotensive effect
• Garlic: contains antioxidant sulfur compounds that dissolves clots
• Ginger: lower cholesterol
• Meditation increases blood flow and oxygen consumption
• Biofeedback, guided imagery, tai chi, and yoga lowers blood
pressure and heart rate
• Acupuncture: lowers blood pressure
• Yoga (various asanas or posture) increases circulation because
of the effects on the endocrine glands and nerve plexuses

• Acupressure massage techniques: rubbing, kneading,

percussion, and vibration to improve circulation

• Gingko biloba effective in improving cerebral and peripheral

blood flow
 CARDIOVASCULAR
HEALTH PROMOTION
FOR OLDER ADULTS