Page 83 Complete Your CE Test Online - Click Here abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation” [49]. Causes can be cardiac or non-cardiac in nature [50]: ● ● Cardiac causes include cardiac surgery, cardiomyopathy, congestive heart failure (CHF), hypertensive heart disease, ischemic disease, pericarditis, and or valvular disease. ● ● Noncardiac causes include alcoholism, chronic pulmonary disease, pulmonary emboli, or thyrotoxicosis. Symptoms are variable but the most common are palpitations and shortness of breath. The majority of the patients may be asymptomatic. During your assessment you may find your patient to have an irregular pulse that is tachycardic, typically in the 110- to 140-range. This may be the only abnormality that you will find [49]. Myocardial infarction (heart attack) Most nurses are aware of the signs and symptoms of heart attack. Many patients are aware of them as well. Most clinicians and even laypersons regard: crushing; substernal chest pain; jaw pain; pain that radiates to the left arm, neck, jaw or shoulder; sweating, nausea, vomiting; and some respiratory discomfort as typical presenting symptoms [13]. However, older adults are less likely to complain of chest pain, and will usually present with vague symptoms, such as fatigue or nausea. Shortness of breath is the most common symptom observed in older adults. Women often present with atypical symptoms [9]. Women and heart attack After a woman experiences menopause, she is at as much risk for heart attack as men. Women are typically older than men when they present with symptoms of cardiovascular disease. This is because, prior to menopause, estrogen seems to offer some protection against cardiovascular disease. Therefore, the earliest presenting age of symptoms is generally older, but this depends on the age of the woman when she experienced menopause [9,13,14]. Important statistics pertaining to women and heart disease include [51]: ● ● One in four women die of heart disease in the U.S. ● ● Only 54% of women know that heart disease is the number one cause of death for women. ● ● Heart disease is the leading cause of death for African-American and white women in the U.S. and the second leading cause of death (cancer is first) in American Indian or Alaska Native, and Asian or Pacific Islander women. ● ● About 64% of women who die suddenly of coronary heart disease have no previous symptoms. These statistics show how important it is for all women to be assessed for heart disease. Part of this assessment is to identify atypical symptoms of heart disease in women [13,51,52,53]: ● ● Abdominal pain or heartburn. ● ● Complaints of indigestion or gas-like pain. ● ● Feelings of “tightness” in chest. ● ● Fullness, discomfort, or pressure in the chest. ● ● Discomfort in the back, neck, stomach, or jaw. ● ● Dizziness/lightheadedness. ● ● Shortness of breath. ● ● Nausea. ● ● Cold sweats. ● ● Unexplained feelings of weakness and extreme fatigue. ● ● Pain or discomfort between the shoulder blades. ● ● Sense of impending doom. Women may also experience the “typical” symptoms, but their “atypical” symptoms are just as significant as those experienced by men. It is imperative that nurses teach female patients about both the typical and atypical symptoms women are likely to experience with a heart attack. If they do not recognize these signs and symptoms, they may delay or refuse to seek help. In fact, findings from recent research show that women wait an average of 22 minutes longer than men to seek help when having a heart attack [9,13,50,51]. This delay can cause serious complications, including death. The sooner treatment is initiated, the better the chances of reducing damage to the heart and resulting complications. However, heart health can be achieved/maintained by following common sense guidelines such as eating a low-salt, low fat diet, eating adequate amounts of fiber, fruits, and vegetables, getting sufficient exercise, reducing stress, and following any treatment plans designed in conjunction with healthcare providers. Leading a “heart-healthy” life can promote cardiac wellness throughout the lifespan. Nursing consideration: Heart disease is not an “inevitable” part of aging. Encourage patients to follow heart healthy guidelines throughout life. Heart failure and congestive heart failure About 5.1 million people in the U.S. have heart failure and about half of those individuals die within five years of diagnosis [50]. Heart failure is defined by the American Heart Association and the American College of Cardiology as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood” [50]. Common clinical history and assessment findings include: decreased exercise tolerance; shortness of breath/ dyspnea; fatigue; a third heart sound; and signs of volume overload (i.e. fluid retention which manifests as peripheral or abdominal swelling/edema and rales upon auscultation of the lungs). Many conditions, such as coronary artery disease, hypertension, valvular heart disease, and diabetes mellitus, can cause or lead to heart failure. Diagnosis is made with a combination of procedures which include: laboratory studies (especially a B-type Natriuretic Peptide (BNP) Blood Test); chest X-ray; and echocardiogram (ECG). Treatments usually include lifestyle changes, limiting sodium intake, medicines, and ongoing care (especially weight monitoring). The respiratory system Sometimes it can be difficult to distinguish normal age-related changes from pathology in the older person’s respiratory system. The following changes in lung physiology and structure occur with normal aging and can influence the effectiveness of respirations [9,13,14]: ● ● Decrease in lung elasticity, reducing the ability of the lungs to recoil. ● ● Decreased airway clearance, cough reflex, and laryngeal reflex. ● ● Decreased alveolar surface area available for gas exchange, leading to an increase in dead space, and a decrease in ventilation/perfusion. ● ● Chest muscles decrease in strength and the chest wall stiffens. ● ● Stiffening of the diaphragm. ● ● Ciliary action decreases (decreasing the mucociliary clearance), which increases the risk of respiratory infection as well as aspiration. ● ● Decreased cough and gag reflex due to changes in the musculoskeletal structures leading to an inability to mobilize mucous from the lungs and increase risk of aspiration. ● ● Immune system antibody production decreases thus increasing susceptibility to lung infections. Nursing consideration: The physiological impacts of age-related respiratory system changes include residual volume increases, vital capacity decreases, ventilation and perfusion mismatches increase, and arterial oxygen levels decrease [9]. This does not mean that lung disease is inevitable. It means that nurses must be aware of such changes and promote healthy lifestyle actions such as proper diet, adequate exercise, and smoking cessation, if applicable. Patients who are immobile after surgery, have limited mobility due to physical deterioration, or who lead sedentary lifestyles are at risk for lung disease. Encourage patients to change position, become and stay ambulatory, and take frequent deep breaths. As always, help patients access smoking cessation programs if they smoke! Nursing consideration: A word about influenza. Encourage older adults to be vaccinated against the “flu” annually. They may think that it is not a serious illness, but it can be a fatal illness, especially in those of advanced age!