10.1 Cardiovascular and Respiratory Conditions

Hypertension: The Silent Condition

Hypertension (high blood pressure) is persistently elevated pressure of blood against the artery walls. It is called the silent killer because most people feel completely fine while it quietly damages the heart, brain, kidneys, and blood vessels over years. A resident cannot tell you their blood pressure is high — only measurement can. That is why routine vital signs matter so much, and why you report readings outside the parameters the nurse gives you.

Your role in hypertension care includes:

• Measuring blood pressure accurately and on schedule, using the correct cuff size and the arm the care plan specifies (never an arm with a dialysis fistula or on the side of a mastectomy)
• Reporting readings above or below the facility's reportable parameters right away
• Supporting lifestyle measures in the care plan: encouraging the prescribed diet (often low-sodium), fluid orders, and activity
• Observing for headache, dizziness, blurred vision, or nosebleed and reporting them
• Encouraging medication adherence by reminding residents that pills are due — but never giving or withholding medication yourself, which is outside CNA scope

Congestive Heart Failure: Watching the Fluid

In congestive heart failure (CHF), the heart cannot pump strongly enough to meet the body's needs. Blood backs up, and fluid collects in the lungs and body tissues. Because weakened pumping develops gradually, the CNA's daily observations are often the earliest warning.

Key signs of fluid retention to observe and report:

• Weight gain: residents with CHF are often weighed daily, at the same time, on the same scale, in similar clothing. Report a gain of 2-3 pounds in one day or about 5 pounds in a week — fluid weighs, so the scale detects retention before the eye can
• Edema: swelling in the feet, ankles, and legs. Press a finger over the shin bone; a dent that stays is pitting edema. Also note sacral swelling in residents who stay in bed
• Dyspnea: shortness of breath, especially when lying flat (orthopnea). The resident may need the head of the bed elevated or extra pillows to breathe comfortably
• A new cough, crackling or wet-sounding breathing, fatigue, and decreased urine output

CHF care also means following fluid-restriction and sodium orders exactly as written, measuring intake and output accurately when ordered, and applying anti-embolic stockings only if the care plan directs them.

Stroke (Cerebrovascular Accident) and TIA

A stroke, also called a cerebrovascular accident (CVA), happens when blood flow to part of the brain is blocked (ischemic stroke) or a vessel bursts (hemorrhagic stroke). Brain cells begin to die within minutes, so stroke is always an emergency. Learn the FAST acronym exactly:

A transient ischemic attack (TIA), or mini-stroke, causes the same signs but they resolve within minutes to a few hours. Do not be reassured when signs go away: a TIA is a powerful warning that a full stroke may follow, and it is always reported to the nurse at once.

Left vs. Right Stroke: Caring for the Weak Side

Each side of the brain controls the opposite side of the body, so stroke effects depend on which hemisphere was damaged:

• Right-brain stroke causes left-sided weakness or paralysis, plus impulsiveness, poor judgment, and spatial-perceptual problems
• Left-brain stroke causes right-sided weakness or paralysis, plus aphasia — difficulty speaking, understanding speech, reading, or writing — and often cautious, frustrated behavior

Care principles for the affected (weak) side: dress the weak side first and undress it last; place the call light, personal items, and food on the strong (unaffected) side within reach; approach and speak from the side the resident can see and hear; and support a weak arm or leg during transfers rather than pulling on it. For a resident with aphasia, speak slowly in short simple sentences, allow extra time to respond, use gestures and pictures, and never pretend to understand — the resident's mind may be fully intact even when words are not.

COPD and Chronic Respiratory Disease

Chronic obstructive pulmonary disease (COPD) — including emphysema and chronic bronchitis — permanently narrows and damages the airways, so air moves out of the lungs slowly and incompletely. Residents live with chronic shortness of breath, and your care can make breathing easier or harder:

• Positioning: an upright position helps the lungs expand. Offer a semi-Fowler's or high-Fowler's position, or let the resident sit leaning forward on the overbed table with pillows (the tripod position) when breathing is hard
• Oxygen safety: oxygen is a drug with a prescribed flow rate. Never adjust the flow, and keep the tubing unkinked. Post no-smoking rules, keep flames and sparking items away, and report equipment problems to the nurse
• Pacing activities: shortness of breath worsens with exertion. Break bathing, dressing, and grooming into small steps with rest periods between them, and schedule care when the resident has the most energy
• Encourage pursed-lip breathing (in through the nose, out slowly through pursed lips) if the care plan includes it, and report increased breathlessness, bluish lips or nail beds (cyanosis), confusion, or a change in sputum color or amount

Chest Pain: Your Immediate Response

Chest pain, pressure, or squeezing — possibly radiating to the arm, jaw, or back, sometimes with sweating, nausea, or shortness of breath — may signal a myocardial infarction (heart attack). Your response is simple and non-negotiable:

1. Stay with the resident — never leave the person alone
2. Call for the nurse immediately (use the call light or emergency bell; send someone if needed)
3. Help the resident into a comfortable position, usually semi-reclined, and loosen tight clothing
4. Note the time, what the resident reports, and your observations to tell the nurse

Do not give food, fluids, or medication. Do not walk the resident to the nurse's station or wait to see if the pain passes. Fast reporting saves heart muscle — and lives.