Normal Cardiovascular Aging (Nursing)

by Prof. Lawes

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    00:01 So what does this all mean, how does this play out for Jose? We know that he's had a healthy lifestyle, he stayed active.

    00:08 What are the things going to play out in his normal daily life? Well, he's going to have a reduced exercise tolerance than when he was 20.

    00:16 Remember, he has less cardiac reserve.

    00:19 Now, he's also going to feel a little more tired, he's quicker to be short of breath, and it's going to take him longer to recover from tachycardia.

    00:27 So if he does something that stresses his heart out, and his heart rate goes up faster, then it's going to take him longer to get back to his normal heart rate than when it did when he was 20.

    00:38 The last part is he's going to have a difficulty with hypovolemia, or low volume.

    00:43 Now let's look at maximum heart rate.

    00:46 Take a look at the chart that we have here, you've probably seen something like this at the gym when you've gone to work out.

    00:51 On the left hand side, you see heart rate in beats per minute.

    00:55 It goes from 200, all the way down to 80.

    00:58 Across the bottom, you have ages and you'll see that it goes up to age 60.

    01:04 Now what I want you to do is put your finger on your notes or on the screen on your age and move through all four colors.

    01:12 So find your age and see ,what would be the approximate heart rate for warm up and cooldown? What would be the approximate heart rate for fat burning for you? What about your target heart rate? A nd then what would be the heart rate for high intensity? Now compare your numbers over to what Jose's would be and look at the differences.

    01:37 So you have a decreased maximal attainable heart rate as you age.

    01:42 Normal aging, it's a normal cardiovascular event but when to recognize it as you age, your maximum attainable heart rate will be lower than when you were 20.

    01:55 Here's the NCSBN nursing clinical judgment model.

    01:59 Now why you care about this model is this is the format that the NCLEX is used to write questions.

    02:05 So look at the very bottom, what we're talking about is the importance of how nurses recognize and analyze cues to form hypotheses when you're making clinical judgments.

    02:15 I know that sounds like a lot of words, but really all this model does is break down how excellent nurses think in the clinical setting.

    02:25 So you're always looking for cues, things that you should be on the lookout for and that you should recognize, as in cardiovascular issue in this place.

    02:34 You analyze them, and then you start to form hypothesis.

    02:38 And so let's walk through, how would we apply this to patient care? So I'm going to ask you, what hypothesis can the nurse create from analyzing these cues? So let's pretend we have a patient.

    02:50 Let's say his name is Jose, somebody you know.

    02:53 so what cues will I look for? Well, I know that Jose is 85 years old, that definitely qualifies him to be a geriatric client.

    03:02 Now, when I'm doing his vital signs, I note that his heart rate is 97.

    03:07 Anytime you see a number in practice, or in a test question, you ask yourself, is that high, low or normal? Well, heart rate of 97 is high, even though Jose is 85 years old.

    03:20 So now I have to think, wow, Jose must be experiencing some type of physiological stressor, because his heart rate is high.

    03:30 I know the rationale for my hypothesis is a heart rate greater than 90/minute in older adult indicates some type of physiological stress.

    03:40 So what should I do? In order to refine that hypothesis, I have to figure out what are the cues and assessments I can look at to figure out why Jose is experiencing this.

    03:52 Now it may be something as simple as, he had just run a set of stairs.

    03:57 I don't know why Jose did that but that could be one reason.

    04:00 It might be that he's anxious, he may be in pain but that's my job to figure out, looking at those cues, analyzing those cues, developing a hypothesis and then refining it to help plan care that safe and effective for Jose.

    04:17 So let's take a look at all of these cardiovascular things in a nutshell.

    04:22 When you're listening to heart sounds with Jose, you may expect to hear an s4 sound right before s1 and s2.

    04:29 Remember those changes that are going on in the heart and the valves.

    04:33 Now Jose's gonna have decreased cardiac reserve so he's going to be less able to respond to an increased demand, so if he had just ran those stairs, it's going to take him a while to get back to a normal heart rate.

    04:44 I would also look for dysrhythmias, PACs, PVCs or atrial fibrillation.

    04:51 These are things I'm going to be on the lookout for because he is a geriatric client.

    04:56 Lastly, I know with the baroreceptor reflex response is going to be impaired so I'm going to be very careful in helping Jose go from a sitting to a standing position or a lying to a sitting position.

    05:08 Make sure I allow him time to readjust and stabilize his blood pressure and know that he's at an increased risk for falls.

    05:16 Thank you for watching this video today.

    About the Lecture

    The lecture Normal Cardiovascular Aging (Nursing) by Prof. Lawes is from the course Assessment of the Geriatric Patient: Cardiovascular System (Nursing).

    Included Quiz Questions

    1. Decreased exercise tolerance
    2. Bradypnea
    3. Hypervolemia
    4. Increased maximal attainable heart rate
    1. The 72-year-old client with a heart rate of 93
    2. The 80-year-old client with a heart rate of 97
    3. The 66-year-old client with a heart rate of 80
    4. The 37-year-old client with a heart rate of 95
    5. The 42-year-old client with a heart rate of 85
    1. “120 beats per minute would put you in your target heart rate. Someone your age should aim for around 100 beats per minute to be in the fat-burning zone.”
    2. “Your trainer is correct; the fat-burning zone for someone your age is around 120-130 beats per minute.”
    3. “You should aim for 120 beats per minute during your warm-up and around 150-160 beats per minute to be in the fat-burning zone.”
    4. “120 beats per minute would be considered high intensity for someone your age; you should aim for around 60-70 beats per minute to be in the fat-burning zone.”

    Author of lecture Normal Cardiovascular Aging (Nursing)

     Prof. Lawes

    Prof. Lawes

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