Common problems in
elderly.
BHARATHY.R
Overall objective
• Students are able to understand and give holistic care
using nursing process on patients with cardiac and
respiratory illness.
Cardiovascular system
• Heart does not atrophy with ageing
• Heart muscle mass increase, wall thickens
• Heart valve –calcification-regurgitation
• loss of elasticity
• Fibrous and sclerotic
• Decreased venous return
• Less effective pumping
• Varicosities-rectal veins
Physiologic changes and their
results
Physiologic changes Results.
• Decreased cardiac • Decreased tissue
muscle tone oxygenation
• Decreased cardiac out • Increased rate of heart
put failure, peripheral
circulation failure
• Decreased elasticity • Decreased venous return,
dependent
edema,varicosities
• Increased blood pressure
• Increased
atherosclerosis
Common conditions
• CAD
• Myocardial infarction
• Coronary valve disease
• Cardiac arrhythmias
• CCF
• Cardiomyopathy
• Peripheral vascular disease
• Aneurysms
• Varicosities
• Hypertension
Myocardial infarction
• Acute
• Reduced \loss of blood supply
• Irreversible myocardial cell death
• High mortality -
• Silent MI (elderly)
Causes &predisposing factors
• Occlusion of vessels • Ageing, DM,
• Atherosclerosis • Hyperlipidemia
• Thrombosis • Hypertension,
• CAD • Obesity
• Coronary artery spasm • Positive family history
• Sedentary lifestyle
• Menopause
• smoking and stress
Patho physiology
• Three zones
• Zone of ischemia-
• Zone of injury
• Zone of infarction
Assessment findings
• Elderly usually don’t report
• Persistent crushing substernal pain
• No pain
• Indigestion
• Dysnea
• In CAD-angina, fatigue,vomiting,shortness of breath
• Sudden death
INSPECTION
• Anxious ,confused
• Jugular vein distension
• Palpitations
• Worsening heart failure
• Stroke
• Syncope
• Dizziness, abdominal symptoms
• Falls,tingling extremities,ARF
AUSCULTATION
• S4 & S3 paradoxical splitting of S2
• Decreased heart sound
• Systolic murmur
• Pericardial friction
• Fever
Diagnostic tests
• ECG-Abnormal or normal
• St segment depression-subendocardial MI
• ST segment elevation and Q waves in necrosis
• Serum creatine kinase elevated-confusing LBM
• CKMB
• Troponin T and Troponin I
• Myoglobin elevated
• ECHO-ventricular wall dyskinesia
Treatment
• Goal –relieve pain,stabilise heart rhythm, reduce
cardiac workload
• Revascularization(CVA,GI bleed,HTN)
• Antiarrhythmics
• Pacemaker
• Cardioversion
• Morphine
• Beta blockers
• ACE inhibitors
Drugs
• Nitroglycerin
• Calcium channel blockers
• Lidocaine
• Oxygen
• Intra Aortic balloon pump
• Cardiac catheterization
• CABG(coronary artery bypass graft surgery)
• PTCA(percutaneous transluminal coronary angioplasty)
THROMBOLYTIC THERAPY
• Within 6 hours
• Streptokinase and Tissue plasminogen activator
• Streptokinase –elderly use- unlikely to cause stroke and
cerebral hemorrhage
Complications
• Arrhythmias
• Cardiogenic shock
• Pericarditis
• Heart failure
• Rupture of arterioventricular septum
• Fear and anxiety of death
• Personality change
NURSING CARE
• Monitor
• Assess pain
• Auscultate
• Organize patient activities
• Stool softeners
• ROM exercise
• Antiembolic stockings
• Emotional support
Patient teaching
• Medications
• Exercises
• Resuming ADL
• Dietary restrictions
• Cardiac rehabilitation
• Sexual activity
Respiratory system
• Degraded structure and function
• Greater risk in elderly
• Exposure to air pollution, cigarette
• Lung damage.
Changes
Physiologic changes Results
• Decreased body fluids • Decreased ability to
• Decreased number of cilia humidify air
• Decreased tissue • Decreased ability to trap
elasticity debris
• Decreased capillaries • Decreased gas exchange,
pooling of secretions
• Increased calcification of
cartilage • Increased residual volume
• Rigidity of ribs, decreased
lung capacity.
Common problems
• COPD
• Pneumonia
• Influenza
• TB
• Lung cancer
• ARDS
PNEUMONIA
• Acute inflammation of lung parenchyma by viral,
bacterial ,fungal, chemical and mechanical agents
• Broncho pnuemonia
• Lobar pneumonia
• Lobular pneumonia
• Primary/secondary
• Aspiration pneumonia
• Community acquired pneumonia
• Hospital acquired
causes
• Chronic debilitation
• Cancer
• Abdominal /thoracic surgery
• Atelectasis
• Chronic respiratory disease
• Aspiration
• Immunosuppressant state
Assessment
• Fatigue, cough
• Plueritic pain
• Cerebral hypoxia
• Tachypnea (increased respiratory rate)
• Fever
• Shaking with chills
• Creamy yellow sputum
• Jelly sputum
• Clear sputum
• Dullness
• Crackles
• Decreased breath sounds and vocal resonance
Tests
• Chest x ray
• Sputum examination
• Blood cultures
• ABG
• Bronchoscopy
• Pleural tapping
Treatment
• Antimicrobials
• Oxygen
• Bronchodilators
• Antitussives
• Mechanical ventilation-high PEEP(positive end
expiratory pressure)
• Sedation and narcotics used with caution in elderly
complications
• Atelectasis
• Pleural effusion
• Pleurisy
• Septic shock, meningitis
• Hypoxemia, bacteremia, endocarditis,pericarditis
• ARDS, empyema lung abscess
• Respiratory failure
Prevention
• Stop smoking
• Rest
• Exercise
• No URI
• Avoid crowds,swimming pool
• Healthy diet,
• Plenty of fluids
• Pneumovaccine annually
COPD
hronic airflow limitation
•C
characterized by reduced
airway lumen from mucosal
thickening and increased
airway compliance from
destruction
•Chronic bronchitis,
asthma and emphysema
in elderly
• Chronic bronchitis-excessive production of mucus-
hypertrophy & hyperplasia
• Increased goblet cells , ciliary damage
• Squamous metaplasia
• Chronic leucocytic and lymphocytic infiltration
• Airway narrowing
• resistance to air
• severe ventilation perfusion mismatch
• Causes-smoking , alpha 1 antitrypsin deficiency
• Proteolytic enzyme secretion
• Genetic
• Heavy pollution
• Drugs
• Chemicals
Assessment
•Cardiac symptoms
• Nausea
•General malaise
•Cough
Inspection
•Barrel chest
•Pursed lip breathing
•Cyanosis
•Clubbed fingers
•Nasal flaring
•Over aeration of lungs
• Large retro sternal airspace
•X-ray chest
•Blood tests-RBC , Hb
increased
•WBC,TC DC increased
Tests
• PFT-reduced pao2,
• ABG
• ECG-p waves , signs of right ventricular failure,
hypertrophy
• Sinus tachycardia
• Signs of corpulmonale
c
• Decreased tactile fremitus
• Chest expansion restricted
• Pedal edema
• Neck vein distension
• Vocal fremitus, hyperesonance
• Grunting respiration
Treatment
• Stop smoking
• Avoid pollutants
• Antibiotics
• Bronchodilators
• Steroids-use in caution
• Fluids 2 liters
• Chest physiotherapy
Complications
• Recurrent infection
• Corpulmonale
• Respiratory failure
• Right ventricular hypertrophy
• Pneumothorax
• Status asthmatics
