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Cardiovascular Problems in the Elderly

Cardiovascular Problems in the Elderly

Sample Answer 

Cardiovascular Problems in the Elderly

Pertinent Positives.

The patient is a 66-year-old male who presents with a one-month history of fatigue in his legs. He has noticed his legs appearing pale and cool to the touch. Has numbness and tingling. Has pain and cramping with activity relieved by rest. He’s on lisinopril. Takes caffeinated coffee daily. Has xanthelasma on bilateral eyelids. Minimal hair growth is also noted in the lower extremities. His vitals are within the normal range. Lower extremities have a +1 pulse bilaterally and a capillary refill of less than 3 seconds. His sensation is intact, and he has normal breath sounds

Pertinent Negatives

Doesn’t smoke or drink. No new onset of shortness of breath, cough, difficulty in breathing, or wheezing. No headaches or weakness. No chest pain, palpitations, dyspnea, or orthopnea. No swelling, joint pains, difficulty in a range of motion, or varicosities. No back pain and stiffness. No history of anemia or thyroid problems. No cyanosis or clubbing. No murmurs

Missing Information

No information on signs of fluid retention, such as edema and ascites.

List of Differential Diagnosis and Actual Diagnosis

  1. Fatigue
  2. Activity intolerance
  • Ineffective tissue perfusion
  1. Decreased cardiac output
  2. Acute pain

Plan for the Priority Diagnosis

Diagnosis: Fatigue related to an imbalance between oxygen supply and demand, as evidenced by easy fatiguability in his legs when walking.

Goals: Attaining and maintaining adequate tissue perfusion and decreased fatigue.

Outcomes: The patient will verbalize and confirm the reduction of fatigue, as evidenced by the ability to perform desired activities and increased energy.

Nursing intervention:


1.      Assess for and document other causes of fatigue, such as medication.



2.      Document the cardiopulmonary response to activity.





3.      Implement graded cardiac rehabilitation program






4.      Provide supplemental oxygen as indicated




1.      Fatigue can be a side effect of some medications, e.g., ACE inhibitors and beta-blockers (Jaarsma, 2006).


2.      Compromised cardiac output during activity may cause an increase in heart rate and oxygen demands, thereby aggravating fatigue (Jaarsma, 2006).



3.      It improves and strengthens cardiac function, especially under stress. A gradual increase in activity avoids excessive oxygen consumption by the myocardial cells by reducing stress. (Gulanick, 2016).


4.      The presence of hypoxemia reduces oxygen available for muscle cells resulting in pain, cramping, and fatigue (Gulanick, 2016).






The patient is assessed for recovery according to the set goals and outcomes. Evaluate for the ability to conduct activities of daily life with ease. Evaluate for verbal confirmation of improved sense of energy (Gulanick, 2016).


Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.

Jaarsma, T., Strömberg, A., De Geest, S., Fridlund, B., Heikkila, J., Mårtensson, J., … & Thompson, D. R. (2006). Heart failure management programmes in Europe. European Journal of Cardiovascular Nursing, 5(3), 197-205


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Cardiovascular Problems in the Elderly

NU 627 DT 11 Instructions

Unit 11 Discussion – CAD, Atrial Fibrillation, Congestive Heart Failure Peripheral Vascular Disease, TIA’s and Stroke


It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Cardiovascular Problems in the Elderly

Cardiovascular Problems in the Elderly

Discussion Prompt

This week you are learning quite a bit regarding the older adults’ experience with cardiovascular, pulmonary and neurological problems.  According to the CDC, 60% of older adults are living with two or more chronic conditions.  This starts to become a challenge as you manage and educate multiple conditions and let’s not forget the polypharmacy involved (NIA, n.d.).

National Institute on Aging. (n.d.).  Supporting older patients with chronic conditions.  U.S. Department of Health and Human Services.  Retrieved from older-patients-chronic-conditions

Initial Post Instructions: 

  • Please critically evaluate the subjective and objective information provided to you in the attached file below.
    The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
  • Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
    Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
  • Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.

NU 627 Week 11 Case Study CC “My legs feel tired when I walk.” HPI: H.H. 66 y.o. M presents with a one-month history of fatigue in legs. Patient states that he first noticed this pain over one month ago when he was walking at the grocery market. He describes the pain as legs being tired. He has noticed legs appearing pale and cooler at times, no open areas. Patient reports cramping lower extremities with activity which is relieved with rest. At times will have some numbness and tingling. He has not tried anything because wasn’t sure what to do. Mr. H.H. denies CP, SOB, palpitations. PMH: HTN, pre-DM (A1c 6.1, last Summer) Surgeries Tonsillectomy at age 5. Health Maintenance: Flu and pneumonia vaccination 2 years ago. Medication: Lisinopril 10 mg PO daily. Ibuprofen 200 mg orally every 6 to 8 hours as needed for pain. Allergies: Penicillin causes rash Family History: Mother (deceased) had a history of hypertension. Father had no health problems and died at the age of 71 due to natural causes. Sister, 70 years old, with asthma and uses an Albuterol inhaler. Social History: Lives at home with his wife of 40 years. Drinks 1-2 cups of caffeinated coffee a day. Denies drinking alcohol, smoking, or using illicit drugs. ROS: General: Denies any weight loss or gain, weakness, fever, or chills. Describes overall health as good. Skin: Denies rashes, lumps, lesions, itching. Reports at times feet pale and cool to touch. Respiratory: Denies new onset of shortness of breath, cough, and wheezing. Cardiovascular: Denies any chest pain, palpitation, dyspnea, or orthopnea. Peripheral Vascular: Denies phlebitis, varicose veins, or swelling in calves. Reporting legs feeling tired with activity for 1 month now. Reports cool and pale feet at times. At times will have numbness and tingling in his feet. Currently denies pain but will have cramping with activity that is relieved with rest. Musculoskeletal: No joint pain, stiffness, swelling, redness, or difficulty in range of motion in uninjured extremities. Denies history of previous ankle injury. Denies back pain and stiffness. Neurologic: Denies headaches, visual changes, weakness in strength and confusion. Denies memory, cognition, attention or speech problems. Denies tremors. Psychiatric: Denies depression, sadness, or anxiety. Hematologic/Endocrine: Denies history of bleeding, easily bruising, and anemia. Denies history of diabetes, increase thirst/urination, thyroid problem, excessive sweating, or intolerance to heat or cold. Objective: VS 129/76 HR 62 RR 19 98% RA Wt.: 176 lbs., Ht 70” General: Alert, oriented, and cooperative 66 years old male who appears to be in a good health. He is well groomed and is dressed appropriately for the situation. Xanthelasma bilateral eyelids. Skin: Skin pink, warm, dry, and intact without any lumps or lesions. Minimal hair growth noted to lower extremities. Nail beds pink and no cyanosis or clubbing noted. Lymph Nodes: Lymph nodes non-palpable in neck, groin, and popliteal fossa. Thorax and Lungs: Thorax symmetric bilaterally with expansion with good excursion. No abnormal curvature. Lungs resonant. Breath sound equal and clear bilaterally. Cardiovascular: Heart rate and rhythm regular. No abnormal pulsation, lifts, or jugular vein distention. Normal S1 and S2 heart sound with no S3, S4, murmurs, gallops, or rubs. Peripheral Vascular: No varicosities, ulcers, and edema noted in bilateral lower extremities. Lower extremities cap refill less than 3 seconds, uneven distribution of hair. Popliteal, posterior tibial, and dorsalis pedis pulses intact and +1 bilaterally. No redness, warmth, edema, and tenderness noted on bilateral calves or other uninjured extremities. Musculoskeletal: No joint deformities, joint instability, uneven alignment and symmetry, or complete loss of function noted in bilateral lower extremities. Full active range of motion on bilateral upper and left lower extremities. Neurological: Alert, cooperative, and oriented to person, place, and time. Muscle strength 5/5 in all extremities. Able to walk without issues. Cerebellar function intact with rapid alternating movement and point-to-point movement. Sensation intact to pinprick, light touch, position sense, and vibration. Romberg negative. Reflexes +2 in bilateral biceps, triceps, patellar, Achilles, and planter region.

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