Coronary Artery Disease the Elderly CYNTHIA ALEXANDER JACKSONVILLE

Coronary Artery Disease & the Elderly CYNTHIA ALEXANDER JACKSONVILLE STATE UNIVERSITY NU 545

Coronary Artery Disease Coronary artery disease (CAD) develops when the coronary arteries become damaged or diseased. Plaque narrows the arteries and reduces blood flow to the heart muscle. The vessel with plaque ruptures and causes a blood clot to form on the surface of the plaque. (CDC, 2016)

Coronary Artery Disease The clot blocks the blood flow to the heart muscle fed by the artery. Blocked blood flow to the heart muscle causes a myocardial infarction. Coronary artery disease leads to heart failure or stroke depending on the amount of obstruction. (CDC, 2016)

Risk Factors High blood cholesterol levels High blood pressure Family history Diabetes Smoking Age (AHA, 2015)

Statistics Heart disease is the leading cause of death in the United States More than one in three adults (81. 1 million) live with one or more types 42. 2 million are estimated to be greater than 60 years old (Healthy. People. gov, 2016)

Coronary Artery Disease - Elderly Coronary artery disease (CAD) is the most common type of heart disease Coronary artery disease kills over 370, 000 people annually. (NHLBI, 2016)

Coronary Artery Disease - Elderly Currently one third of men and one fourth of women aged 75 years and over are living with CAD. Mortality and morbidity from CAD is strongly associated with age. About 66% of CAD deaths occur in people age 75 and older. (Medscape, 2016)

Issues of Elderly with CAD Lifestyle changes Loss of Independence Finances

Lifestyle Changes Sedentary Lifestyle Unhealthy Eating Smoking

Sedentary Lifestyle Routine physical activity improves physical fitness Reduction in sedentary lifestyle lowers many heart disease risk factors Regular exercise 3 -5 times a week for at least 30 minutes is strongly advised for seniors Walk after meals (AHA, 2015)

Healthy Eating Low sodium, low fat diet Choose a healthy meal and snack. Include plenty of fresh fruit and vegetables. (AHA, 2015)

Smoking Stop smoking Seek support from family and friends. Talk with doctor and pharmacist about Rx and OTC medications Avoid secondhand smoke. Learn new skills and behaviors to replace smoking (NHLBI, 2016)

Loss of Independence 3. 2% (1. 5 million) of the 65+ population in 2014 lived in institutional settings. 1. 2 million lived in nursing homes. Disabled and debilitated as a result of CAD (Ao. A, 2016)

Loss of Independence Heart disease is particularly limiting for older adults. Two out of five people age 70 and older with heart disease need assistance with their activities of daily living (ADLs). Spouses, children, and grandchildren provide 65 percent of the help that is needed. (Ao. A, 2016)

Finances One out of every five elderly Americans live on a limited income. 6 million elderly Americans depend on Medicare for assistance with their medical bills. Medicaid serves as an important complement to Medicare. Medicaid covers prescription drugs and long-term care services not available through Medicare. (AHRQ, 2013)

Finances Elderly persons with heart disease use of health care is intensive. Routine care (physician visits or prescription drugs) require hard choices between basic necessities and needed health care services. Elderly people with functional limitations face non-medical expenses, require additional services, and special transportation arrangements to obtain medical care. Many elderly Americans struggle to pay living expenses (AHRQ, 2013)

Clinician Schedule follow up appointments at the clinic Assess for CAD risk factors such as eating habits, physical activity, smoking Schedule lab work to monitor blood cholesterol and sodium levels Check blood pressure and have patient monitor it weekly (Stanhope & Lancaster, 2012)

Educator Education patient on CAD treatment and prevention Provide education on CAD and the importance of healthy living. Counseling on sedentary lifestyles and smoking cessation. Educate on available resources. Instruct caregivers on meal preparation for low fat, low sodium diet. (Stanhope & Lancaster, 2012)

Administrator Plan a budget and allocate funds for implementation of self management and wellness programs. Provide facilities for health fairs, meetings, and training Delegate tasks for support team members Ensure adequate staff to care for the clinic’s clients (Stanhope & Lancaster, 2012)

Researcher Identify research available on methods to increase nutritional compliance Compare available CAD wellness programs for positive and negative outcomes. Collaborate with other Nurse Practitioners and doctoral prepared nurses to review effectiveness of low salt, low fat, low cholesterol diet in the management of CAD. (Stanhope & Lancaster, 2012)

Consultant Interact with services that provide nutritional support, transportation, and caregiver services to the elderly. Assess family support to ensure assistance is provided with meal preparation, finances, and activities of daily living. Provide consultation with clients/family to help them understand the disease process. Contact local Council on Aging to set up meals on wheels program (Stanhope & Lancaster, 2012)

Self Care Deficit Theory Dorothy Odem’s theory includes self care which is the practice that an individual initiates and performs on his or her own behalf to maintain life, health, and well being. Self care deficits are the result of limitations brought on by illness or the result of deterioration that impedes the patient’s ability or willingness to perform the activities required to care for himself. (Alligood, 2014)

Self Care Deficit Theory Dorothea Orem’s theory accounts for self-care deficit with decline and disease process and provides guidelines to enable nurses to overcome some of the barriers related to caring for a patient with self-care deficits. The theory is a series of actions that, if performed, can help in compensating for the patients limitations while maintaining their autonomy. (Alligood, 2014)

Application Of Theory Dorothea Orem’s theory accounts for self-care deficit with decline and disease process and provides guidelines to enable nurses to overcome some of the barriers related to caring for a patient with self-care deficits. The theory is a series of actions that, if performed, can help in compensating for the patients limitations while maintaining their autonomy.

Application Of Theory Develop a plan that include goals set by the patient and the health care team to overcome limitations of the disease process and maintain independence Assess the nursing care and patient participation by evaluating the results of the goals set.

Application of Theory Ensure the patient is in an environment that facilitates self care but provides assistance as needed. Evaluate resources for availability of funds needed to limit interruptions in delivery of care

References Administration on Aging. (2016). Profile of Older Americans: 2015. Living Arrangements. Retrieved from http: //www. aoa. gov/Aging_Statistics/Profile/2015/6. aspx Agency for Healthcare Research and Quality. (2013). Heart Disease Among Elderly Americans: Estimates for the U. S. Civilian Noninstitutionalized Population, 2010. Retrieved from https: //meps. ahrq. gov/data_files/publications/st 409/stat 409. pdf Alligood, Martha. (2014). Nursing Theorists and their Work. 8 th edition. St. Louis, MS: Elsevier Mosby. American Heart Association. (2015). Coronary Artery Disease-Coronary Heart Disease. Retrieved from http: //www. heart. org/HEARTORG/Conditions/More/My. Heartand. Stroke. News/Coronary. Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article. jsp#. V 3 O 1 c. Y-c. HIV

Reference American Heart Association. (2013). Older Americans and Cardiovascular Diseases. Retrieved from http: //www. heart. org/idc/groups/heartpublic/@wcm/@sop/@smd/documents/downloadable/ucm_319574. pdf Centers for Disease Control and Prevention. (2016). Heart Disease. Retrieved from http: //www. cdc. gov/heartdisease/what_you_can_do. htm Healthy. People. gov (2014). Heart Disease and Stroke. Retrieved from healthypeople. gov

References Medscape. (2016). Importance of Coronary Artery disease in the Elderly. Retrieved from http: //www. medscape. com/viewarticle/748580_2 National Heart, Lung, and Blood Institute. (2016). What Are Coronary Heart Disease Risk Factors? Retrievedfromhttp: //www. nhlbi. nih. gov/health-topics/hd Stanhope, M. and Lancaster, J. (2012). Public Health Nursing. Population-Centered Health Care in the Community. 8 th Edition. Maryland Heights, MO. Elsevier. Mosby. Webster’s Dictionary. (2016). Sedentary Lifestyle. Retrieved from www. websters-onlinedictionary. org