Blood Pressure Management

1
Blood Pressure Management

• Liz Rhodes, RN
• ECU Student Nurse

2
PROBLEM

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

3
GOAL

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

4
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
•  

5
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.americ
  anheart.org/presenter.jhtml?identifier4473

6
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).

7
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

8
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

9
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

10
Blood Pressure Guidelines
11
Why is Blood Pressure ManagementFor Stroke
Prevention Important?

• Strokes
• Leading Cause of Disability in the U.S.
• 3rd 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

12
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.

13
Modifiable Risk Factors of Strokes

• High cholesterol
• Hypertension (high blood pressure)
• Exercise
• Diet
• Tobacco
• Doubles stroke risk
• Increases blood pressure
• Obesity

• Alcohol
• 4 oz. wine or equivalent may be protective
• Diabetes
• Cardiac Disease
• Atrial Fibrillation
• TIA/Prior stroke

14
PREVENTION

• Eating a well balanced diet
• Exercise
• Compliance with medications
• Management of
• Diabetes
• HTN
• Heart disease

15
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/dL or
  higher.
• ____ Your HDL (good) cholesterol level is less
  than 40 mg/dL if youre a man or less than 50
  mg/dL if youre a woman.
• ____ You dont know your total cholesterol or HDL
  levels.

16
Risk assess cont.

• BLOOD PRESSURE
• ____ Your blood pressure is 140/90 mm Hg or
  higher, or youve been told that your blood
  pressure is too high.
• ____ You dont know what your blood pressure is.
• PHYSICAL INACTIVITY
• ____ You dont 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.jhtm
  l?identifier3034972

17
Stroke is a Medical Emergency
18
ABCs of Preventing Heart Disease, Stroke and
Heart Attack
19

• http//www.strokeassociation.org/presenter.jhtml?i
  dentifier3034972

20
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
  low-fat dairy fruits, vegetables and whole-grain,
  high-fiber foods is essential to good health.

21
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.
•  

22
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.
•  

23
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.
•  

24
AREA DIETICIANS

• Renee L Kemske
• MPH RD LDN
• Orange County Health Dept
• 2501 Homestead Rd
• Chapel Hill, NC 27514
• Phone [phone] x309
• Email rkemske_at_co.orange.nc.us
• Areas of Practice
• Individual Counseling, Group Counseling,
  Programs/Workshops,
• Cardiovascular/Hypertension, Diabetes, General
  Nutrition/Wellness, Gerontology, Weight Control

25
AREA DIETICIANS

• Anne-Marie Scott
• UNC Wellness Center
• Health Education Dept
• 100 Sprunt St
• Chapel Hill, NC 27517
• Phone [phone]
• Email a_scott_at_uncg.edu
• Areas of Practice
• Individual Counseling, Group Counseling,
  Programs/Workshops
• Cardiovascular/Hypertension, General
  Nutrition/Wellness, Gerontology, Weight Control

26
AREA DIETICIANS

• Elizabeth A Watt
• RD LDN
• The Wellness Center at MeadowMont
• 100 Sprunt St
• Chapel Hill, NC 27517-7811
• Phone [phone]
• Email ewatt_at_unch.unc.edu
• Areas of Practice
• Individual Counseling, Group Counseling,
  Programs/Workshops,
• Cardiovascular/Hypertension, General
  Nutrition/Wellness, Weight Control

27
AREA DIETICIANS

• Kara M Mitchell
• MS RD LD
• Duke Center for Living
• 1300 Morreene Rd
• Durham, NC 27710
• Phone [phone]
• Email mitch068_at_mc.duke.edu
• Areas of Practice
• Individual Counseling, Group Counseling,
  Programs/Workshops
• Cardiovascular/Hypertension, Diabetes, General
  Nutrition/Wellness, Vegetarian, Weight Control

28
FITNESS CENTERS

• Carolina Fitness
• 503-C West Main StCarrboro, NC 27510
• phone [phone]
• O2 Fitness
• View Website
• 300 Market Street, 110 (Southern
  Village),Chapel Hill, NC 27516
• phone [phone]

29
FITNESS CENTERS

• The Wellness Center at Meadowmont
• View Website
• 100 Sprunt StChapel Hill, NC 27517
• phone [phone]
•  
• World-Renowned Residential Program-- Duke
  University Diet and Fitness Center
• 1-800-235-3853
• http//www.dukehealth.org/Services/DietAndFitness/
  About/index/DFC20Brochure20Inside.pdf
• Check with your physician be for starting any
  physical fitness program

30
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)

31
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 911
  immediately! (See the following signs
  symptoms)

32
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

33
Thank You
34
Resources

• American Heart Association AHA. (2008). Diet
  and Nutrition. Site accessed on September 29,
  2008 at http//americanheart.org/presenter.jhtml?i
  dentifier1200010
• American Heart Association. (2008). Personal risk
  assessment form. Accessed on September 12, 2008
  at http//www.strokeassociation.org/presenter.jhtm
  l?identifier3034972
•  American Heart Association AHA, (2008). Stroke
  risk factors. Site accessed on September 29, 2008
  at http//www.americanheart.org/presenter.jhtml?id
  entifier9217
•  
• American Heart Association AHA/American Stroke
  Association ASA. (2007). Lets talk about
  lifestyle changes to prevent stroke. Site
  accessed on September 29, 2008 at
  http//www.strokeassociation.org/downloadable/stro
  ke/1219770019473Lifestyle20Chgs20to20Prevent20
  Stroke.pdf
•  
• American Stroke Association ASA. (2008).
  Converging risk factors. Site accessed on
  September 29, 2008 at http//www.strokeassociation
  .org/presenter.jhtml?identifier3027394
• American Stroke Association ASA. (nd). Stroke
  risk awareness survey. Site accessed on
  September 29, 2008 at http//www.strokeassociation
  .org/downloadable/stroke/1130509929967PTES20Risk
  20Assessment20Card.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?puid1c66ebdb-25c5-4042-bd9b-051cb3f9e6
  23xidgslps_kwcidblood20pressure2525548814gc
  lidCMyQ8Z6rzZYCFQS7sgodBWgGzQ
• Kaplan, N. Rose B. (2008). What is goal blood
  pressure in treatment of hypertension? Retrieved
  on October 19, 2008 from Up to date at UNC
  -Chapel Hill.
• Sebastian, J. G. in M. Stanhope J. Lancaster
  (2008). The nurse leader in the community. Public
  health nursing Population-centered health care
  in the community. (7th ed.). St. Louis, MO
  Mosby.