Types of dietary fat: Saturated - use sparingly Animal fat (bacon, lard, egg yolk, dairy) Butter, cream cheese, sour cream Monounsaturated - good Oils- fish, canola, peanut, olive Avocado, nuts (almond, peanuts, pecans), olives Polyunsaturated - use sparingly Vegetable oils (safflower, corn, soybean, cottonseed, flaxseed) Some fish oil and shellfish Seeds (pumpkin, sunflower) Margarine Cholesterol-lowering drug therapy: o Drugs that restrict lipoprotein production - statins (Lipitor, Zocor, Niacin) stabilize plaque o Drugs that increase lipoprotein removal - bile acid sequestrants (Questran) o Drugs that decrease cholesterol absorption - Zetia Anti-platelet therapy: low-dose aspirin or Plavix Use statins to prevent plaque rupture (thromboembolism Gerontologic considerations: o Greater incidence and cause of death o Diligent management of HTN and hyperlipidemia will help to stabilize plaques in coronary arteries o Same health promotion strategies, with modifications - longer warm up, longer periods of lower level activity, longer rest periods o Avoid exercise in environmental extremes as older adults have less efficient sweating & may develop heat intolerance
o Assess readiness for education b. Angina pectoris i. Insufficient blood flow, leading to anaerobic metabolism and lactate within 10 seconds of coronary occlusion ii. when artery is narrowed and obstructed by at least 75%: stenosis iii. Assessment Signs/Symptoms: o Pain: usually lasts less than 15 mins Varies in intensity—“crushing” Felt deep in the chest; retrosternal, substernal May radiate to jaw, shoulder, back Decreased or absent in diabetics and elderly May be absent in women o Weakness or numbness in arms, wrists, and hands o Shortness of breath o Prodromal symptoms: (under-diagnosed; may present with unstable angina before CAD is diagnosed; fatigues occurs in many illnesses) Fatigue, SOB, indigestion, anxiety o Precipitating factors: Physical exertion Exposure to cold Eating a heavy meal Stress or any emotion-provoking situation Smoking iv. Management Relieve chest pain, decrease myocardial O2 demand o MONA : morphine, oxygen, nitroglycerin, aspirin Aspirin thins the blood and protects the heart Nitroglycerin dilates blood vessels, making it easier for blood to flow through o Pharmacologic therapy: thrombolytic therapy within 1-3 hours of symptoms or 30 mins in ED (“door to needle time”), i.e. t-PA, Activase = tissue plasminogen activator dissolves all clots o Heparin infusion prevents future clots o 12-lead EKG, blood work o Increase oxygen supply: ACE-inhibitors, Beta-blockers o Promote adequate tissue perfusion o Reduce anxiety o Monitor and manage complications o Patient teaching v. STEMI: Transmural infarction of the myocardium (the myocardium has undergone necrosis resulting in ST elevation. Usually due to occlusive thrombus) Requires thrombolytics like Streptokinase to lyse the thrombus Give TPA infuse in blood vessels or heart to diffuse the clot vi. NSTEMI A partial dynamic block to coronary arteries (non-occlusive thrombus) no ST elevation of Q waves on ECG
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- Spring '14