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.
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.
Remember, he has less cardiac reserve.
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.
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.
The last part is he's going to have a
difficulty with hypovolemia, or low volume.
Now let's look at maximum heart rate.
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.
On the left hand side, you see
heart rate in beats per minute.
It goes from 200, all the way down to 80.
Across the bottom, you have ages and
you'll see that it goes up to age 60.
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.
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.
So you have a decreased maximal
attainable heart rate as you age.
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.
Here's the NCSBN nursing clinical judgment model.
Now why you care about this model is this is the
format that the NCLEX is used to write questions.
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.
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.
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.
You analyze them, and then
you start to form hypothesis.
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.
Let's say his name is Jose, somebody you know.
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.
Now, when I'm doing his vital signs,
I note that his heart rate is 97.
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.
So now I have to think, wow, Jose must be
experiencing some type of physiological stressor,
because his heart rate is high.
I know the rationale for my hypothesis is a
heart rate greater than 90/minute in older adult
indicates some type of physiological stress.
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.
Now it may be something as simple
as, he had just run a set of stairs.
I don't know why Jose did that
but that could be one reason.
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.
So let's take a look at all of these
cardiovascular things in a nutshell.
When you're listening to heart sounds with Jose, you
may expect to hear an s4 sound right before s1 and s2.
Remember those changes that are
going on in the heart and the valves.
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.
I would also look for dysrhythmias,
PACs, PVCs or atrial fibrillation.
These are things I'm going to be on the
lookout for because he is a geriatric client.
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.
Make sure I allow him time to readjust
and stabilize his blood pressure
and know that he's at an increased risk for falls.
Thank you for watching this video today.