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June 2012 DHS – Office of Licensing and Regulatory Oversight 1

HEART DISEASE


PURPOSE & 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 pressure Myocardial

infarction


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 with heart

disease routine monitoring, and associated health problems related to heart disease;

Describe signs and symptoms of a heart attack or congestive heart failure and warning signs of digitalis toxicity;

Explore your own physical and emotional limits regarding the type of care required for residents with heart disease.


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 eliminated from the body.


INTRODUCTION CONTINUED

Blood pressure is the force against artery walls created when the heart contracts, pumping blood into the arteries: The higher pressure of blood flow, when the heart

contracts is called systolic pressure; The lower pressure of blood flow, when the heart

muscle rests, is called the diastolic 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 pressure readings.


AGE RELATED CHANGES

The heart muscle, like all muscle, weakens with advancing age. The aorta, the large artery that receives blood from the heart, becomes less flexible, decreasing its ability to carry blood through 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 normal rate after exertion;

Even fit elderly people who do not have heart disease have less increase in heart rate in response to exercise.


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: Heart attack; Angina; Congestive heart failure; and Digitalis toxicity.


MYOCARDIAL INFARCTION (MI)

A heart attack occurs when the blood supply to the heart is decreased or the artery is blocked. Muscle cells are damaged and die. This condition is called a myocardial infarct. Symptoms of a 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.


MYOCARDIAL INFARCTION (MI) CONTINUED

A heart attack that occurs without pain is called a “silent heart attack.” It is more common in persons over 80. Lack of pain may be due to reduced nerve sensation, loss of memory or the tendency to minimize or ignore a new symptom. Symptoms include: Shortness of breath; Mental confusion; Vomiting and dizziness; Faintness or weakness.


MYOCARDIAL INFARCTION (MI) CONTINUED

The major causes of heart attack are: Coronary thrombosis is caused by blood clots that

attaches to an artery cutting off blood supply to the heart, causing damage or death of heart muscle;

Coronary embolus is 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 the 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.


ANGINA

Angina is a common indicator of coronary heart disease. The symptoms are: Brief, recurring pain in 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 relieved by rest and medication.


CONGESTIVE HEART FAILURE

Congestive heart failure 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).


CONGESTIVE HEART FAILURE CONTINUED

Symptoms of congestive heart failure differ depending on whether it is right or left sided heart failure. In general, they include: Sudden and persistent cough, especially at night; Shortness of breath; Difficulty breathing when lying flat; Edema (water retention); Fatigue, weakness; Need to urinate during night, more than once; Night sweats.


CONGESTIVE HEART FAILURE 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; and Rest.


DIGITALIS TOXICITY

Digitalis is widely used to treat heart disease. It is eliminated more slowly in older people; increasing the risk of toxicity. Toxic symptoms that may look similar to the flu: Loss of appetite, nausea; Diarrhea; Fatigue; Pulse rate below 60 and “fluttering” of heartbeat or

unusually irregular heartbeat; Vision changes such as yellow-green halos around

objects or blurred vision.


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.


GUIDELINES FOR CARE

Residents who have heart disease experience cognitive and emotional problems that require your reassurance and support. For example, a resident may suffer from: Feeling hopelessly crippled and that life is over; Fear and worry about further pain and death; Anger, bitterness and resentment; Depression; Mental confusion and impaired thinking.


GUIDELINES FOR CARE CONTINUED

As a care team member, you should: Monitor the resident’s progress. Encourage rest to decrease the workload of the

heart. Support the resident physically and emotionally. Prevent complications.

Your specific responsibilities are to: Monitor drug therapy as directed by the health

care professional;


GUIDELINES FOR CARE CONTINUED

Weigh the person as ordered by the doctor; Encourage exercise as ordered. Muscles regain

strength only through exercise; Promote rest to decrease the hearts’ workload.

Include how much rest is needed in the care plan: Report unusual episodes of fatigue or mental

confusion to the resident’s care team. Follow special diet plan. The resident may need to

restrict salt and fluids; Encourage recovery and independence.


SPECIAL CAREGIVING CONCERNS

Angina The 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 pain beings if they 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;


SPECIAL CAREGIVING CONCERNS CONTINUED

Anticoagulants: The resident who takes anticoagulants (blood

thinners) requires special attention: Ask about nonprescription drugs/over-the-counter drugs

such as aspirin, cold or 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 doctor or nurse practitioner if the following conditions occur: Signs or symptoms of bleeding or unusually severe or

prolonged headache or abdominal pain;



Resident becomes ill (e.g., develops diarrhea, feels weak, faint or dizzy). Resident has bruises or is injured. If the person 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 doctor. The resident should wear a medical alert identification

that gives this information, as well as the person’s name, address and telephone number.



Pacemakers are designed to work on demand, or when needed to stimulate a heartbeat and 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 person’s name, address and telephone number;

Check with the resident’s health care practitioner for guidance if the resident’s pacemaker is affected by microwaves or electric shavers.



Pacemakers are surgically implanted and powered by batteries. To monitor the pacemaker, you must take the 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 person’s physician or clinic to monitor directly by telephone.



Cardiac Arrest: You must be prepared for a complication such as

a cardiac arrest. 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 care providers are aware of these plans.



In an emergency: Call 9-1-1 immediately:

Follow any directions the 9-1-1 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 available for the responding emergency personnel any of the following documents the resident has: advanced care directive, POLST, letters of conservatorship and guardianship;



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 and guilty. The following advice may help you work through questions and issues: Accept your limitations. Unsuccessful efforts to revive a

person do not mean you did something wrong; Discuss your feelings 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.


DISCUSSION/QUESTIONS

heart disease - oregon.gov home page · pdf filethe aorta, the large artery that receives...

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