ENSURING QUALITY CARE HEART DISEASE September 2019 Safety, - - PowerPoint PPT Presentation

ENSURING QUALITY CARE

HEART DISEASE

September 2019 Safety, Oversight and Quality Unit

PURPOSE AND KEY TERMS

The purpose is to assist the learner in understanding age related heart changes and what to consider when screening a potential resident. Additionally, it will review accommodations an AFH provider will need to make when providing care for a resident with heart disease.

• Angina
• Blood pressure
• Congestive heart failure (CHF)
• Digitalis toxicity
• Diastolic and systolic blood

pressure

• Myocardial infarction (heart

attack)

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OBJECTIVES

The learner will be able to:

Describe types of age related heart disease List key questions to ask when screening potential residents with a diagnosis

• f heart disease

Describe care guidelines for residents that require routine monitoring related to heart disease Describe associated health problems related to heart disease Describe signs and symptoms of a heart attack or congestive heart failure and the warning signs of digitalis toxicity Explore your own physical and emotional limits regarding the type of care required for residents with heart disease

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INTRODUCTION

The circulatory system is comprised of the heart and blood vessels. The arteries carry blood rich in oxygen and nutrients to the organs and tissues of the body. As the blood flows, it picks up waste products that are filtered through the kidneys and lungs and then eliminated from the body.

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INTRODUCTION CONTINUED

Blood pressure is the force against artery walls that is created when the heart contracts, pumping blood into the arteries.

• The higher the pressure of blood flow, when the heart contracts is called

systolic blood pressure

• The lower the pressure of blood flow, when the muscle rests, is called the

diastolic blood pressure

• Blood pressure is measured in millimeters of mercury (mm Hg)
• The harder the heart has to work to pump blood throughout the body, the

higher the blood pressure readings

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AGE RELATED CHANGES

The heart muscle, like all muscles, weakens with advancing age. The aorta, the large artery that receives blood from the heart, becomes less flexible, decreasing its ability to carry blood throughout the body

• The cardiovascular system is less sensitive to stress - the heart is slower to

respond to sudden demands of activity and takes longer to return to the normal rate after exertion

• Even fit older adults who do not have heart disease have less increase in

heart rate in response to exercise

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COMMON AILMENTS

Heart problems increase with age. However, most problems are due to controllable, preventable diseases, not the aging process itself. Lifestyle plays a very important role in the development of heart problems. The most common heart problems are:

• Myocardial infarction (heart attack)
• Angina
• Congestive heart failure (CHF)
• Digitalis toxicity

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MYOCARDIAL INFARCTION (MI)

A myocardial infarction (heart attack) occurs when the blood supply to the heart is decreased or the artery is blocked. Muscle cells become damaged and die. This condition is called a myocardial infarction (MI). Symptoms of an MI include:

• Chest pain radiating to the neck and down the left arm
• Sweating
• Shortness of breath, difficulty breathing
• Acute mental confusion
• Dizziness (vertigo), faintness and weakness
• Vomiting

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MYOCARDIAL INFARCTION (MI) CONTINUED

A myocardial infarction that occurs without pain is called a “silent heart attack.” It is more common in individuals over 80. Lack of pain may be due to reduced nerve sensation, loss of memory, or the tendency to minimize or ignore new symptoms. Symptoms include:

• Shortness of breath
• Mental confusion
• Vomiting and dizziness
• Faintness or weakness

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MYOCARDIAL INFARCTION (MI) CONTINUED

The major causes of myocardial infarction are:

• Coronary thrombosis caused by blood clots that attach to an artery cutting
• ff the blood supply to the heart, causing damage or death or heart muscle
• Coronary embolus an obstruction in a blood vessel due to a blood clot

blocking blood supply to the heart, causing damage or death of heart muscle tissue

• Spasms of coronary arteries can cause arteries to narrow and reduce or stop

blood flow to heart muscle

• Arrhythmias occur when the electrical impulses in your heart that coordinate

your heartbeats don’t work properly.

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ANGINA

Angina is chest pain or discomfort when the heart muscle doesn’t get enough oxygen-rich blood, and is a common indicator of coronary heart disease. The symptoms are:

• Brief, recurring pain the chest, shoulder and left arm
• Difficulty breathing
• Pallor (paleness in skin color)
• Sweating
• Dizziness, faintness
• Nausea

Common symptom pattern is activity-pain-rest-relief. Pain is usually relieved by rest and medication.

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CONGESTIVE HEART FAILURE (CHF)

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of the heart muscles. It is often referred to as “heart failure” and occurs because of damage to the heart muscle, usually caused by high blood pressure, a heart attack, or hardening of the arteries (arteriosclerosis)

• When a weakened or injured heart lacks the force to pump blood to meet the

body’s needs, it enlarges in an effort to compensate

• Blood circulation is reduced, which decreases the kidney’s ability to eliminate

sodium and water. The blood returning to the heart backs up into the veins, which leads to edema (fluid collection)

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CONGESTIVE HEART FAILURE (CHF) CONTINUED

Symptoms of congestive heart failure differ, depending on whether it is right or left sided heart failure. In general, the symptoms include:

• Sudden and persistent cough, especially at night
• Shortness of breath
• Difficulty breathing when lying flat
• Edema (water retention)
• Fatigue, weakness
• The need to urinate at night, more than once
• Night sweats

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CONGESTIVE HEART FAILURE (CHF) CONTINUED

Treatment for congestive heart failure often includes:

• A salt-restricted diet
• Medication
• Medications are usually prescribed to reduce the heart’s workload by

lowering the blood pressure (anti-hypertensive), removing surplus sodium and fluids (diuretics); and opening up peripheral arteries and veins (vasodilators)

• Altered daily activities
• Rest

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DIGITALIS TOXICITY

• Digitalis is widely used to treat heart disease. It is eliminated more

slowly in order people, increasing the risk of toxicity, known as digitalis toxicity. Toxic symptoms that may look similar to the flu include:

• Loss of appetite, nausea
• Diarrhea
• Fatigue
• Pulse rate below 60 and “fluttering” heartbeat or unusually irregular

heartbeat

• Vision changes such as yellow-green halos around objects or blurred vision

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DIGITALIS TOXICITY

CONTINUED

If the symptoms of digitalis toxicity are present, immediately notify the physician or nurse practitioner. The treatment usually includes withholding the digitalis and prescribing medication to correct the irregular heartbeat; however, treatment may require hospitalization.

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GUIDELINES FOR CARE

Residents who have heart disease can have cognitive and emotional needs that require your reassurance and support. For example, a resident may experience:

• Feeling hopelessly crippled and as though life is over
• Fear and worry about further pain and death
• Anger, bitterness and resentment
• Depression
• Confusion and reduced processing capacity

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GUIDELINES FOR CARE CONTINUED

As a provider, you should:

• Monitor the resident’s progress
• Encourage rest to decrease the workload of the heart
• Support the resident physically and emotionally

Your specific responsibilities are to:

• Monitor drug therapy as directed by the health care professional

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GUIDELINES FOR CARE CONTINUED

• Weigh the individual as ordered by the doctor
• Encourage exercise as ordered - muscles regain strength only through

exercise

• Promote rest to decrease the demand on the heart - include how

much rest is needed in the resident’s care plan

• Report unusual episodes of fatigue or mental confusion to the resident’s care

team.

• Follow any special diet plans - the resident may need to restrict salt

and fluids

• Encourage recovery and independence

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SPECIAL CAREGIVING CONCERNS

Angina - care goals are to relieve and prevent acute angina attacks:

• Remind the resident to stop all activity - they should sit or lie down as

soon as an attack begins, and remain quiet until the pain subsides

• Dispense nitroglycerin as soon as the pain begins if the resident has a

medical order for nitroglycerin

• Be prepared for side-effects including burning sensation on the tongue,

throbbing sensation in the head, low blood pressure, palpitations, and flushing of the skin.

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SPECIAL CAREGIVING CONCERNS CONTINUED

Anticoagulants - a resident who takes anticoagulants (blood thinners) requires special attention:

• Ask about non-prescription/ over-the-counter drugs such as aspirin, cold
• r allergy medications, sleeping pills or vitamin supplements
• Plan for blood tests - taking anticoagulants requires regular laboratory

testing to monitor the drug level

You should notify the physician or nurse practitioner if the following symptoms occur:

• Signs or symptoms of bleeding or unusually severe or prolonged headache
• r abdominal pain

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SPECIAL CAREGIVING CONCERNS CONTINUED

Notifying the physician or nurse practitioner cont…

• Resident becomes ill (e.g., develops diarrhea, feels weak, faint or dizzy)
• Resident has bruises or is injured. If the individual is involved in an

accident or receives a blow or other injury, notify the health care practitioner, regardless of whether there are any visible signs of bleeding

• In an emergency, be prepared to provide the name of the anticoagulant the

resident is taking and the name, address and telephone number of the prescribing practitioner

• The resident should wear a medical alert identification that gives this

information, as well as the individual’s name, address and telephone number

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SPECIAL CAREGIVING CONCERNS CONTINUED

Pacemakers are surgically implanted and powered by batteries. To monitor the pacemaker, you must take the individual’s pulse for one full minute daily or as ordered by the doctor. Signs that a battery is low appear very slowly, usually over a period of months, and include:

• Pulse rate below preset rate
• Dizziness
• Shortness of breath
• Extreme fatigue
• Some pacemakers have devices that allow the individual’s physician
• r clinic to monitor directly by telephone.

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SPECIAL CAREGIVING CONCERNS CONTINUED

Pacemakers are designed to work on demand, or when needed, to stimulate a heartbeat. They are set based on the needs of the individual:

• Ask the doctor or nurse practitioner what the standard heart rate should be

for the resident

• The resident should wear a medical alert identification that gives this

information as well as the individual’s name, address and telephone number

• Check with the resident’s health care practitioner for guidance if the

resident’s pacemaker if affected by microwaves or electric shavers

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SPECIAL CAREGIVING CONCERNS CONTINUED

Cardiac arrest is the abrupt loss of heart function. It can come on suddenly, or in the wake of symptoms. Signs of cardiac arrest include:

• Sudden and complete unconsciousness
• Absence of breathing or gasping respiration
• Absence of heartbeat or pulse

Prepare yourself and staff by following these guidelines:

• Know signs of cardiac arrest
• Know how to give cardiopulmonary resuscitation (CPR)
• Develop an emergency plan for each resident
• Make sure all staff and substitute caregivers are aware of these plans

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SPECIAL CAREGIVING CONCERNS CONTINUED

In an emergency:

• Call 911 immediately:
• Follow any directions the 911 operator gives - even though the operator is

still on the phone, emergency personnel have been dispatched

• Start CPR:
• If you are alone, call for help and then begin CPR; if someone else can call,

begin CPR at once

• Notify the resident’s health care practitioners and others after you’ve secured

emergency assistance

• Follow each resident’s emergency plan. This includes having any of the

following documents the resident has available for emergency personnel: advanced care directive, Physician Orders for Life-Sustaining Treatment (POLST), letters of conservatorship and guardianship.

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SPECIAL CAREGIVING CONCERNS CONTINUED

Document what happened. Note the time. Describe what happened, what measures were taken and by whom, how the resident responded, and if, when, how and where the resident was transferred.

CPR does not always succeed in reviving the resident. If a resident has a heart attack or cardiac arrest, you may feel frightened or guilty. The following advice may help you work through questions and issues:

• Accept your limitations - unsuccessful efforts to revive an individual do not mean

you did something wrong

• Discuss your feeling with others
• Be prepared to assist the family - listen and try to avoid feeling defensive; refer

relatives to the resident’s health care professional for questions you cannot answer

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DISCUSSION/QUESTIONS

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