ENSURING QUALITY CARE
HEART DISEASE September 2019 Safety, Oversight and Quality Unit
PURPOSE AND KEY TERMS • Angina The purpose is to assist the learner in understanding age • Blood pressure related heart changes and what to • Congestive heart failure (CHF) consider when screening a • Digitalis toxicity potential resident. Additionally, it will review accommodations an • Diastolic and systolic blood AFH provider will need to make pressure when providing care for a resident • Myocardial infarction (heart with heart disease. attack) September 2019 Safety, Oversight and Quality Unit 2
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 of 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 September 2019 Safety, Oversight and Quality Unit 3
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. September 2019 Safety, Oversight and Quality Unit 4
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 September 2019 Safety, Oversight and Quality Unit 5
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 September 2019 Safety, Oversight and Quality Unit 6
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 September 2019 Safety, Oversight and Quality Unit 7
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 September 2019 Safety, Oversight and Quality Unit 8
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 September 2019 Safety, Oversight and Quality Unit 9
MYOCARDIAL INFARCTION (MI) CONTINUED The major causes of myocardial infarction are: • Coronary thrombosis caused by blood clots that attach to an artery cutting off 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. September 2019 Safety, Oversight and Quality Unit 10
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. September 2019 Safety, Oversight and Quality Unit 11
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) September 2019 Safety, Oversight and Quality Unit 12
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 September 2019 Safety, Oversight and Quality Unit 13
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 September 2019 Safety, Oversight and Quality Unit 14
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 September 2019 Safety, Oversight and Quality Unit 15
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. September 2019 Safety, Oversight and Quality Unit 16
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 September 2019 Safety, Oversight and Quality Unit 17
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 September 2019 Safety, Oversight and Quality Unit 18
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 September 2019 Safety, Oversight and Quality Unit 19
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