Cardiovascular Risk Factors Evaluation in the Medical-Surgical Unit of MountainView Hospital
Risk Factors and Rationales
Assessment of the cardiovascular system includes modifiable and nonmodifiable risk factors. Modifiable factors are personal lifestyle habits the patient can control such as tobacco use, diet, and exercise. Non modifiable factors are uncontrollable such as age, sex, ethnicity, and family history (Ignatavicius, 2016).
Tobacco Use
Cigarette smoking is a major modifiable risk factor for coronary artery disease (CAD) and peripheral vascular disease (PVD) (Ignatavicius, 2016). Tar, nicotine, and carbon monoxide are three compounds linked to development of CAD (Ignatavicius, 2016). Second-hand smoke reduces blood flow in coronary arteries and the risk for dying increases if exposed (American Heart Association [AHA], 2019). Smoking damages the endothelium of blood vessels, increases fatty deposits in arteries, increases clotting, raises low-density lipoprotein (LDL) cholesterol and reduces high-density lipoprotein (HDL) (Ignatavicius, 2016). Nicotine is addictive and accelerates the heart rate and raises blood pressure (World Heart Federation [WHF], 2017).
Diet
The role of diet is another modifiable factor that is crucial in the development of cardiovascular disease (CVD).
Fat
Abnormal blood lipid levels have a strong correlation with the risk of CAD, heart attack and coronary death (WHF, 2017). Saturated and trans fats are hard and semi-hard fats found in animal products or manufactured that can lead to atherosclerosis (WHF, 2017).
Sodium
Excess sodium consumption can lead to high blood pressure (hypertension) which is a major risk factor for CVD. Sodium in the bloodstream causes the body to hold onto fluid, increasing the total volume of blood, therefore increasing the pressure (AHA, 2019).
Physical Inactivity
A sedentary lifestyle is also a major modifiable risk factor for heart disease (Ignatavicius, 2016). Physical inactivity leads to being overweight or obesity. Physical activity protects you by regulating your weight and improving your body’s use of insulin (WHF, 2017). Being active is beneficial for your blood pressure, blood lipid levels, blood glucose levels, blood clotting factors, the health of your blood vessels and inflammation, which is powerful promoter of cardiovascular disease (WHF, 2017).
Cholesterol
Cholesterol is carried through our blood by particles called lipoproteins: low-density lipoprotein (LDL) and high-density lipoprotein (HDL) (WHF, 2017).. High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream (WHF, 2017).
Hypertension
Hypertension is defined a systolic blood pressure level of 140 and above. This is a risk factor for coronary heart disease and the single most important risk factor for stroke (WHF, 2017). It causes about 50% of ischemic strokes and increases the risk of hemorrhagic stroke (WHF, 2017). Hypertension stresses your body’s blood vessels, causing them to clog or weaken(WHF, 2017). Hypertension can lead to atherosclerosis and narrowing of the blood vessels making them more likely to block from blood clots or bits of fatty material breaking off from the lining of the blood vessel wall (WHF, 2017). Damage to the arteries can also create weak places that rupture easily or thin spots that balloon out the artery wall resulting in an aneurism (WHF, 2017).
Stress/Coping Strategies
Stress is a modifiable psychological risk factor that makes people more vulnerable to the development of heart disease (Ignatavicius, 2016). Chronic anger and hostility are associated with CVD. The constant arousal of the sympathetic nervous system as a result of anger may influence blood pressure (Ignatavicius, 2016).
Alcohol
Harmful uses of alcohol has been shown to damage heart muscle and increase the risk of stroke and cardiac arrhythmia (CDC, 2015). Excessive drinking is defined as 8 or more drinks per week for women and 15 or more drinks per week for men (CDC, 2015). Consuming too much alcohol can cause problems such as increase blood pressure, acute myocardial infarction, and cardiomyopathy.
Caffeine
Caffeine has metabolic effects such at stimulating the central nervous system, release free fatty acids from adipose tissue, and is a diuretic which can lead to dehydration (AHA, 2014).
Illicit Drugs
Cocaine causes aortic stiffening, higher systolic blood pressure, and increases stiffness of the heart’s left ventricle wall (AHA, 2015).
Diabetes
People with diabetes is at increased risk for CVD because of hypertension, high triglycerides, obesity, physical inactivity, poorly controlled blood sugars, smoking (AHA, 2015).
Age
Age is a nonmodifiable risk factor for cardiovascular disease. Risk for developing CVD increase in people over 50.
Sex
Men are more likely to develop CVD than women. In females, estrogen raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women (WHF, 2017). Women who smoke are at a higher risk of heart attack than men who smoke. A man would have to smoke six to nine cigarettes a day to double his risk (WHF, 2017).
Ethnicity
In the United States, heart disease is the leading cause of death for African Americans, Hispanics, and whites (AHA, 2019).
Family History
The chance of having a heart attack increases if first-degree relatives have had them. Another inherited factor is high cholesterol level. Diabetes also has a genetic component (WHF, 2017).
Health Habits and Rationales
Tobacco Cessation
Three to four years after a patient has stopped smoking, his or her CVD risk appears to be similar to that of a person who has never smoked (Ignatavicius, 2016). Quitting is the best thing one can do for one’s health and according to the literature, it is not “too late”; stopping cigarette use can effectively reduce the risk of developing CVD. The AHA outlines a detailed strategy that people can use to assist with their effort to stop smoking that includes educating yourself and making a plan to quit. Creating a plan that fits one’s lifestyle consists of setting a quit date, choosing a method (cold turkey or gradually), deciding if you need help such as a nicotine replacement, preparing for your quit day by planning how to deal with cravings and urges, and making a commitment to quitting on your quit day (WHF, 2017).
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Diet
Diet can also play a key role in preventing CVD as much as it is in developing it. The AHA suggests a few principles to help guide people to eat better; make better food choices, limit or avoid processed foods and drinks, and cook at home to take control of the nutritional content of your food. Fruits, vegetables, fish, and whole grains are examples of key components of a heart healthy diet (WHF, 2017).
Fat
Unsaturated fats are beneficial for heart health. They are present in fish, nuts, seeds and vegetables. Another measure of healthy fats are essential fatty acids omega-3 and omega-6 which are found in oily fish, nuts and seeds. They are essential because our bodies cannot make these acids and they need to be consumed in order to gain their benefits. It is important for the patient to know which fats are healthy, and which to stay away from. For instance, one should avoid shop-bought cakes, biscuits, and stock cubes. Total fat intake should not exceed 37% of total calories consumed in a day, even if that fat is unsaturated. In addition, high-risk groups should not exceed 10% of total energy in fats, and total fat intake for people with diabetes should be 7% or less (WHF, 2017).
Sodium
Reduction in dietary intake of sodium by 1 gram a day would lead to a 50% reduction in the number of people needing treatment for hypertension (AHA, 2019). Foods to avoid due to high salt content are breads, pizza, cold cuts/cured meats, soups, burritos and tacos (AHA, 2019).
Physical Activity
Regular physical activity promotes cardiovascular fitness and produces beneficial changes in blood pressure and levels of blood lipids (Ignatavicius, 2016). The recommended exercise guidelines are 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week plus muscle-strengthening exercise at least twice per week (Ignatavicius, 2016). To keep things simple, even walking at least two hours a week reduced the incidence of premature death from cardiovascular disease by 50% (WHF, 2017).
Cholesterol
Optimal values for total cholesterol is 5.1 mmol/l; LDL cholesterol is 2.6 mmol/l or less; HDL cholesterol is more than 1.0 mmol/l; and triglycerides is 1.7 mmol/l or less.
Hypertension
Dietary salt is a significant factor in raising blood pressure in people with hypertension and in some people with normal blood pressure. If you are already overweight then a high intake of salt increases your risk of cardiovascular disease (WHF, 2017).
Stress/Coping Strategies
There are two ways you can deal with the role stress plays in one’s life. Reduction of stress and coping with stress. The elimination of stress is not practical; however, one can reduce the amount of stress in one’s life by disallowing certain uncontrollable factors to escalate into anger and hostility. Guided imagery is strategy that can be helpful in dealing with stressors that cannot be avoided, which is a visualization technique that focuses on images to help connect with your inner resources for improving health.
Alcohol
The Dietary Guidelines for Americans defines moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men (CDC, 2015).
Caffeine
Caffeine is not only in coffee or tea, but also soft drinks and chocolate (AHA, 2014). These items should be consumed in moderation. The FDA defined moderate caffeine intake as 400 mg per day, or four to five cups of coffee.
Illicit Drugs
People should find alternative ways to cope than to do so with controlled substances. Substance Abuse and Mental Health Services Administration provides a national helpline that is free, confidential, and 365/24/7 to those facing substance use disorders.
Diabetes
People with diabetes is at increased risk for CVD because of hypertension, high triglycerides, obesity, physical inactivity, poorly controlled blood sugars, smoking (AHA, 2015).
Nonmodifiable Factors
Age, sex, ethnicity, and family history are nonmodifiable risk factors, therefore there are no behaviors that reduce the risk for CVD or rationales other than providing patient education on the risk factors that are modifiable and encouraging healthier habits in those areas.
References
- American Heart Association. (2019). Understand your risks to prevent a heart attack. Retrieved from https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
- American Heart Association. (2019). How to quit tobacco. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7/ls7-quit-smoking-infographic
- American Heart Association. (2019). How to eat better. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7/lifes-simple-7-eat-better-infographic
- American Heart Association. (2019). Get the scoop on sodium and salt. Retrieved from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sodium-and-salt
- American Heart Association. (2014). Caffeine and heart disease. Retrieved from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/caffeine-and-heart-disease
- American Heart Association. (2015). Illegal drugs and heart disease. Retrieved from https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/illegal-drugs-and-heart-disease
- American Heart Association. (2015). Cardiovascular disease and diabetes. Retrieved from https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease--diabetes
- Centers for Disease Control and Prevention. (2015). Heart disease risk factors. Retrieved from https://www.cdc.gov/heartdisease/risk_factors.htm
- Centers for Disease Control and Prevention. (2015). Alcohol fact sheet. Retrieved from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
- Ignatavicius, D. D., Workman, M. L., Rebar, C. (2016). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier, Inc.
- Substance Abuse and Mental Health Services Administration. (2019). National Helpline. Retrieved from https://www.samhsa.gov/find-help/national-helpline
- United States Food and Drug Administration. (2018). Spilling the beans: How much caffeine is too much? Retrieved from https://www.fda.gov/consumers/consumer-updates/spilling-beans-how-much-caffeine-too-much
- World Heart Federation. (2017). Fact sheets: Cardiovascular disease. Retrieved from https://www.world-heart-federation.org/resources/risk-factors/
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