Blood Pressure Management Liz Rhodes RN ECU Student

Blood Pressure Management Liz Rhodes, RN ECU Student Nurse 1

PROBLEM Uncontrolled blood pressures related to medications, poor diet, and decreased physical activity 2

GOAL To motivate a change in behavior patterns and activities to control blood pressure for stroke prevention 3

OBJECTIVES List four modifiable risk factors for strokes State the importance of controlling blood pressure. List different types of foods which are healthy and not healthy. Verbalize the importance of a healthy lifestyle to prevent a stroke Interpret BP results after participation in blood pressure screening and document results if follow-up required Complete the stroke risk factor form from using obtained knowledge of program Be aware that there are others available for assistance Desire a more positive healthy life style Identify reasons for not taking medications 4

BLOOD PRESSURE How can I tell if I have high blood pressure? High blood pressure usually has no symptoms. Many people have high blood pressure for years without knowing it. It's called the "silent killer. " Hypertension is the medical term for high blood pressure. It doesn't refer to being tense, nervous or hyperactive. You can still have high blood pressure even if you are a calm, relaxed person. http: //www. americanheart. org/presenter. jhtml? identifier=44 73 5

Why is Blood Pressure Management Important? There is a progressive increase in the risk of: stroke Elevated BP one of the most common reasons Elevated BP places unnecessary stress on blood vessels Coronary (heart) disease (Kaplan & Rose, 2008). 6

Factors related to High Blood Pressure A family history of high blood pressure Age - The incidence of high blood pressure rises in men after age 35 and in women after age 45 Gender - Men are more likely to have high blood pressure than women Race - Approximately 33 percent of African. Americans have high blood pressure, compared to 25 percent of Caucasians 7

Potential Reasons For Not Taking Medications Poor eye sight Impairs ability to read prescription and understand labeling on bottle Limited hearing Critical communication from health care provider is diminished Limited mobility Decreased mobility and dexterity can limit a person's ability to have prescriptions filled to open and close childproof containers Memory Loss Problem with recalling prescription instructions from healthcare provider 8

Potential Reasons For Not Taking Medications Economic Condition Limited income Increase in prescription costs Depression Social and Health Beliefs beliefs can be based on: misconceptions faulty information cultural conditioning 9

Blood Pressure Guidelines Category Systolic BP (mm Hg) Diastolic BP (mm Hg) Treatment recommendations Normal Less than 120 Less than 80 Lifestyle changes encouraged Prehypertension 120– 139 80– 89 Lifestyle changes necessary Drugs for compelling indications* Stage 1 hypertension 140– 159 90– 99 Lifestyle changes necessary Thiazide diuretic for most people May also consider other blood pressure drugs alone or in combination Drugs for compelling indications* Stage 2 hypertension 160 or higher 100 or higher Lifestyle changes necessary Two or more blood pressure drugs for most people Drugs for compelling indications* *Compelling indications: diabetes, chronic kidney disease, previous heart attack, congestive heart failure, previous stroke, high cardiac risk Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is classified as stage 1 hypertension, not prehypertension. Source: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, December 2003. 10

Why is Blood Pressure Management For Stroke Prevention Important? Strokes Leading Cause of Disability in the U. S. 3 rd Leading Cause of Death in the U. S. N. C. lies in the Stroke Belt The Stroke Belt has the highest morbidity and mortality from Stroke in the U. S. The Buckle of the Belt includes NC, SC and Georgia 11

TYPES OF STROKES Hemorrhagic Stroke Blood vessels in the brain rupture Ischemic Stroke Blood clots or fatty deposits block vessels that supply the brain with blood. 12

Modifiable Risk Factors of Strokes High cholesterol Alcohol Hypertension (high blood pressure) Exercise Diet Tobacco Doubles stroke risk Increases blood pressure Obesity 4 oz. wine or equivalent may be protective Diabetes Cardiac Disease Atrial Fibrillation TIA/Prior stroke 13

PREVENTION Eating a well balanced diet Exercise Compliance with medications Management of: Diabetes HTN Heart disease 14

STROKE RISK AWARENESS SURVEY Check all that applies to you. ***If you check two or more, please see a healthcare professional and determine what you can do to lower your risk. AGE ____ You are a man over 45 or a woman over 55 years old. FAMILY HISTORY ____ Your father or brother had a heart attack before age 55 or your mother or sister had one before age 65. MEDICAL HISTORY ____ You have coronary artery disease, or you have had a heart attack. ____You have had a stroke. ____You have an abnormal heartbeat. Tobacco SMOKE ____ You smoke, or live or work with people who smoke every day. Total CHOLESTEROL and HDL cholesterol ____ Your total cholesterol level is 240 mg/d. L or higher. ____ Your HDL (“good”) cholesterol level is less than 40 mg/d. L if you’re a man or less than 50 mg/d. L if you’re a woman. ____ You don’t know your total cholesterol or HDL levels. 15

Risk assess cont. BLOOD PRESSURE ____ Your blood pressure is 140/90 mm Hg or higher, or you’ve been told that your blood pressure is too high. ____ You don’t know what your blood pressure is. PHYSICAL INACTIVITY ____ You don’t accumulate at least 30 minutes of physical activity on most days of the week. Excess BODY WEIGHT ____You are 20 pounds or more overweight. DIABETES ____ You have diabetes or take medicine to control your blood sugar. American Heart Association. (2008). Personal risk assessment form. Accessed on September 12, 2008 at http: //www. strokeassociation. org/presenter. jhtml? identifier=3034972 16

Stroke is a Medical Emergency 17

ABCs of Preventing Heart Disease, Stroke and Heart Attack 18

http: //www. strokeassociation. org/presenter. jhtml? ide ntifier=3034972 19

Heart-Healthy Cooking Tips Eat less cholesterol, salt and saturated and trans fats. Eating less saturated fat and trans fat helps to lower blood cholesterol levels. Eating fewer calories will help you lose weight, especially when you also enjoy regular physical activity. Eating less salt and more potassium helps control blood pressure in most people. Focusing your diet on foods such as fat-free and lowfat dairy fruits, vegetables and whole-grain, high-fiber foods is essential to good health. 20

Here are some tips to help make your meals healthful: Frying Steam, stir-fry, broil, or bake foods in olive oil or canola instead of deep-frying in bacon grease or shortening. Salt Use lemon juice, vinegar, garlic, hot red pepper flakes, and onions or other low-salt spices instead of salt. Use little or no salt when you cook, spaghetti, noodles, hot cereal or rice. Salad Dressing Use low-fat, low-calorie or fat-free salad dressings. 21

TIPS continued Butter Use soft tub margarine instead of butter, or use other spreads that are lower in trans fat, cholesterol, and saturated fat such as a stick of margarine. Eggs Limit egg yolks to three or four per week, or eat egg whites instead. Meat Buy fresh lean cuts of meat and trim the fat before cooking. Eat chicken, turkey, and very lean pork or beef. Remove the skin from poultry before cooking except when roasting a whole chicken. Roast, broil, or bake meats instead of frying them. 22

TIPS continued Oils Use olive, canola, corn, or safflower oil in cooking. Use calorie-free, fat-free cooking spray to provide a non -stick surface for grills, bake ware, and wok-ware. Fat Limit saturated calories to less than 7 percent of your total calories and trans-fat calories to less than 1 percent of your total calories. 23

AREA DIETICIANS Renee L Kemske MPH RD LDN Orange County Health Dept 2501 Homestead Rd Chapel Hill, NC 27514 Phone: (919) 968 -2022 x 309 Email: rkemske@co. orange. nc. us Areas of Practice: Individual Counseling, Group Counseling, Programs/Workshops, Cardiovascular/Hypertension, Diabetes, General Nutrition/Wellness, Gerontology, Weight Control 24

AREA DIETICIANS Anne-Marie Scott UNC Wellness Center Health Education Dept 100 Sprunt St Chapel Hill, NC 27517 Phone: (919) 843 -2163 Email: a_scott@uncg. edu Areas of Practice: Individual Counseling, Group Counseling, Programs/Workshops Cardiovascular/Hypertension, General Nutrition/Wellness, Gerontology, Weight Control 25

AREA DIETICIANS Elizabeth A Watt RD LDN The Wellness Center at Meadow. Mont 100 Sprunt St Chapel Hill, NC 27517 -7811 Phone: 919 -843 -2163 Email: ewatt@unch. unc. edu Areas of Practice: Individual Counseling, Group Counseling, Programs/Workshops, Cardiovascular/Hypertension, General Nutrition/Wellness, Weight Control 26

AREA DIETICIANS Kara M Mitchell MS RD LD Duke Center for Living 1300 Morreene Rd Durham, NC 27710 Phone: (919) 660 -6818 Email: mitch 068@mc. duke. edu Areas of Practice: Individual Counseling, Group Counseling, Programs/Workshops Cardiovascular/Hypertension, Diabetes, General Nutrition/Wellness, Vegetarian, Weight Control 27

FITNESS CENTERS Carolina Fitness 503 -C West Main St Carrboro, NC 27510 phone (919) 960 -9910 O 2 Fitness View Website 300 Market Street, #110 (Southern Village), Chapel Hill, NC 27516 phone (919) 942 -6002 28

FITNESS CENTERS The Wellness Center at Meadowmont View Website 100 Sprunt St Chapel Hill, NC 27517 phone (919) 966 -5500 World-Renowned Residential Program-- Duke University Diet and Fitness Center 1 -800 -235 -3853 http: //www. dukehealth. org/Services/Diet. And. Fitness/A bout/index/DFC%20 Brochure%20 Inside. pdf Check with your physician be for starting any physical fitness program 29

Prescription Drugs WALMART/SAM'S CLUB $4 Prescription Drug Program Heart Health & Blood Pressure Medications Target $4 Prescription Drug Program UNC Hospital Program for free medications. An application needs to be filled out and submitted. It does go by income. **(Check with your physician for generic medication prescription for area programs) 30

Things to Remember Help decrease your risk for a stroke or recurring stroke by: Maintaining a healthy diet Exercise Program Check with your physician before starting Control your blood pressure Monitoring/keep tract of results Medications Medical follow-up **If you think you are having a stroke, call immediately! (See the following signs & symptoms) 911 31

Signs & Symptoms of Strokes Sudden numbness or weakness Sudden confusion, trouble speaking or understanding Sudden trouble seeing Sudden trouble walking, dizziness, or loss of balance or coordination Sudden, severe headache 32

Thank You 33

Resources American Heart Association [AHA]. (2008). Diet and Nutrition. Site accessed on September 29, 2008 at http: //americanheart. org/presenter. jhtml? identifier=1200010 American Heart Association. (2008). Personal risk assessment form. Accessed on September 12, 2008 at http: //www. strokeassociation. org/presenter. jhtml? identifier=3034972 American Heart Association [AHA], (2008). Stroke risk factors. Site accessed on September 29, 2008 at http: //www. americanheart. org/presenter. jhtml? identifier=9217 American Heart Association [AHA]/American Stroke Association [ASA]. (2007). Let’s talk about lifestyle changes to prevent stroke. Site accessed on September 29, 2008 at http: //www. strokeassociation. org/downloadable/stroke/1219770019473 Lifestyle%20 Chgs%20 to%20 Prevent%20 Stroke. pdf American Stroke Association [ASA]. (2008). Converging risk factors. Site accessed on September 29, 2008 at http: //www. strokeassociation. org/presenter. jhtml? identifier=3027394 American Stroke Association [ASA]. (nd). Stroke risk awareness survey. Site accessed on September 29, 2008 at http: //www. strokeassociation. org/downloadable/stroke/1130509929967 PTES%20 Risk%20 Assessment%20 Card. pdf Dufresne, J. & Greene, V. (1990). Medication regimens: Causes of non-compliance. Department of Health and Human Services: Offices of Inspector General. Accessed on October 6, 2008 at http: //www. oig. hhs. gov/oei/reports/oei-04 -89 -89121. pdf Every Day Health Network. (2008). Stroke center: Blood pressure guidelines Accessed on October 27, 2008 at http: //www. everydayhealth. com/publicsite/index. aspx? puid=1 c 66 ebdb-25 c 5 -4042 -bd 9 b 051 cb 3 f 9 e 623&xid=gslp&s_kwcid=blood%20 pressure|2525548814&gclid=CMy. Q 8 Z 6 rz. ZYCFQS 7 sgod. BWg. Gz. Q Kaplan, N. &Rose B. (2008). What is goal blood pressure in treatment of hypertension? Retrieved on October 19, 2008 from Up to date at -Chapel Hill. UNC Sebastian, J. G. in M. Stanhope & J. Lancaster (2008). The nurse leader in the community. Public health nursing: Population-centered health in the community. (7 th ed. ). St. Louis, MO: Mosby. care 34