Credit Hours: 2

Many clients we serve live with chronic cardiac conditions that require close attention. This in-service will review several of the most common conditions and outline interventions you can take to keep clients safe. You must also be prepared to act quickly if a client experiences an acute cardiac crisis.

Heart Attack (Myocardial Infarction)
Signs and Symptoms
• Crushing or squeezing chest pain Pain not relieved by nitroglycerin (in angina patients)
• Pain not relieved by rest
• Pain radiating down the left arm (most common)
• Pain radiating to the back, shoulder, neck, or jaw
• Changes in heart rate, blood pressure, or respiratory rate
• Sweating, clammy or pale skin
• Shortness of breath
• Anxiety, confusion, restlessness
• Fainting
• Extreme weakness or tiredness
• Heartburn or upset stomach

Silent Heart Attacks
• Women: vague complaints (gas, unusual fatigue).
• Elderly: low blood pressure, low body temperature, vague discomfort, perspiration, dizziness.

Emergency Actions
If you suspect a heart attack:
• Call 911 (unless the client is on hospice—then call hospice).
• Sit or prop the client up with pillows.
• Administer oxygen if available.
• Be prepared to begin CPR if the heart stops.
• Sponge with cool water if hot and sweaty.
• Remain calm and reassure the client.
• Follow EMS operator instructions until help arrives.
• After EMS leaves, call the office and report.

⚠️ Always know the exact address and phone number of the client’s home before calling for help.

Congestive Heart Failure (CHF)
Signs and Symptoms
• Swelling/edema of feet and ankles
• Loss of appetite, nausea
• Prominent neck veins
• Frequent nighttime urination
• Cough
• Shortness of breath, especially when lying down
• Inability to sleep
• Restlessness
• Rapid pulse
• Weakness and fatigue

Treatment
• Oxygen therapy
• Elevating head and/or feet
• Low-sodium diet, restricted fluids (if ordered)
• Heart medications, diuretics (water pills)

Caregiver Interventions
• Weigh client frequently; report gains of 2–3 lbs.
• Ensure low-sodium diet (avoid added salt).
• Elevate head and support arms with pillows for easier breathing.
• Report swelling in feet/ankles.
• Provide safe bathroom access (night light, clear path).
• Assist with incontinence care if needed.
• Request equipment as appropriate (shower chair, bedside commode, hospital bed).
• Clean and maintain oxygen concentrator if present.
• Reposition every 2 hours to prevent pneumonia and bedsores.
• Record and report vital sign changes, appetite loss, or new abdominal symptoms.

Acute Pulmonary Edema
Signs and Symptoms
• Severe shortness of breath
• Noisy, congested breathing
• Cough
• Can only breathe sitting upright
• Anxiety, panic
• Rapid pulse
• Distended neck veins (JVD)
• Cyanosis (blue skin)
• Profuse sweating
• Inability to sleep

Emergency Actions
• Report immediately.
• If severe distress, call 911 (hospice: call hospice).
• Keep the client sitting up with the head elevated.
• Apply cool sponges while waiting for help.

Blood Clotting Disorders
Key Points
• Many cardiac patients take blood thinners: Heparin, Coumadin, Warfarin, Lovenox.
• Require frequent blood tests.
• Never handle or recap needles. Report unsafe disposal.
• Avoid OTC meds, herbs, or supplements without doctor approval.
• Avoid spinach, leafy greens, tomatoes, liver, fish, and green tea (interfere with medications).

Watch For (Report Immediately)
• Blood in urine or stool (dark/tarry stools)
• Unusual bruising
• Nosebleeds, bleeding gums
• Vomiting blood, severe stomach pain
• Coughing up blood

Caregiver Interventions
• Use caution with transfers; even light touch may bruise.
• Inspect skin during bathing; apply lotion gently.
• Ensure slippers/shoes are worn to protect feet.
• Inform dentist/physicians about blood thinner use.
• Report dizziness, weakness, or fainting.
• Never allow client to double up on missed doses.

Phlebitis & Deep Vein Thrombosis (DVT)
Signs and Symptoms
• Red or blue skin color over vein
• Warm, hard, or swollen area (often calf)
• Tight, stretched skin
• Pain in calf
• One calf larger than the other

Causes
• Prolonged bedrest or sitting
• Injury, fracture, or surgery
• Obesity, cancer, smoking
• Sedentary lifestyle

⚠️ Report suspected DVT immediately. Do not attempt to treat yourself.

Prevention
• Turn/reposition client frequently
• Support legs with pillows
• Encourage fluids, walking, ROM exercises
• Avoid leg crossing and “hyperflexion” positions
• Apply elastic stockings (if ordered)

Chronic Venous Insufficiency
Signs and Symptoms
• Lower leg discoloration (red, purple, or blackish)
• Swelling of legs/ankles
• Severe varicose veins

Prevention
• Stop smoking
• Elevate legs
• Use elastic stockings
• Encourage walking, exercise
• Avoid leg crossing
• Weight management

Complications
• Cellulitis
• DVT
• Stasis ulcers

Caregiver Role
• Apply elastic stockings as ordered
• Remind client to elevate legs
• Encourage exercise
• Report skin ulcers immediately

High Blood Pressure (Hypertension)
Definition: Blood pressure consistently above 140/90 on multiple readings. If untreated, can cause stroke.

Causes of High Blood Pressure (Hypertension)
• High salt intake
• Family history
• Diabetes, kidney disease
• Obesity, heart disease
• Sleep apnea, aging

Lifestyle Treatment
Stop smoking
Weight loss
Reduce salt, caffeine, and alcohol
Exercise (walking)
Heart-healthy diet (fruits, vegetables, low-fat, high-fiber)

Caregiver Role
Assist with BP monitoring (only if trained/checked off).
Have client sit at edge of bed before standing to prevent dizziness.
Encourage diet and exercise plan.
Report unusual BP readings.

Stroke (Cerebrovascular Accident)
Signs and Symptoms
• Sudden severe headache
• Numbness/weakness on one side of body
• Difficulty swallowing or speaking
• Vision problems (loss or double vision)
• Loss of motor ability on one side

FAST Test
Face: Ask client to smile.
Arms: Ask client to raise both arms.
Speech: Ask client to say a simple sentence.
Time: Call 911 immediately.

Problems After Stroke
• Paralysis or weakness on one side
• Aphasia (inability to speak)
• Swallowing problems → pneumonia risk
• Depression, incontinence
• Difficulty following instructions

Caregiver Role
• Follow dietary restrictions
• Monitor swallowing (prevent pocketing food/aspiration)
• Keep client upright during meals and 30 min after
• Perform range of motion exercises
• Learn therapy exercises to assist client
• Communicate with patience; explore alternatives (writing, gestures)
• Encourage participation in self-care