Greene County Health Fair: Hypertension Stephen Wagner Miami University Department of Nursing
Health Fair Project: Hypertension A year ago at the Greene County Health Fair, our BSN class was checking blood pressures. The clients often asked us questions regarding the meaning of the blood pressure readings, their medications, and how to manage their high blood pressure. We had to rely on our instructors to answer those questions since we did not have the appropriate knowledge at the time. This year we are taking the role of an educator. Our goal is to assist clients with strategies for better self care management; therefore being able to maintain a higher quality of life. Hypertension, also known as high blood pressure, is a condition in which blood pressure levels are above the normal range. According to the American Heart Association, hypertension “is defined in an adult as a blood pressure greater than or equal to 140 mm Hg systolic pressure or greater than or equal to 90 mm Hg diastolic pressure” (American Heart Association, 2008). It causes the heart to work harder, if the increased force is maintained for a longer period of time, which will increase the risk for heart failure, myocardial infarction, kidney failure, and stroke. In addition, hypertension is also known as a “silent” killer. The AHA pointed out in their website, “According to recent estimates, about one in three U.S. adults has high blood pressure, but because there are no symptoms, nearly one-third of these people don't know they have it. In fact, many people have high blood pressure for years without knowing it” (2009). The cause of hypertension is not known but it is associated with several modifiable and non-modifiable risk factors. The non-modifiable risk factors include: age greater than 60 years, family history of hypertension, and African-American ethnicity (Ignatavicius & Workman, 2006). Modifiable risk factors are physical inactivity, hyperlipidemia, diabetes, obesity, smoking, and stress (Ignatavicius & Workman, 2006). Excessive intake of alcohol, calories, sodium,
caffeine and low intake of potassium, calcium and magnesium are also considered modifiable risk factors (Ignatavicius & Workman, 2006). Organizations like Healthy People 2010 and the American Heart Association recognized hypertension as a major health problem that needs to be controlled. Healthy People 2010 developed four objectives that focus on improving blood pressure control in adults and reducing the proportion of those having high blood pressure (n.d.). One of the objectives is, â€œincrease the proportion of adults with high blood pressure who are taking action to help control their blood pressureâ€? (Ignatavicius & Workman, 2006, p. 783). The American Heart Association provided useful and simple instructions for clients to manage their blood pressure at home (2009). The current evidenced-based medical-surgical nursing practice for hypertension starts with teaching lifestyle modifications, which would include tobacco and caffeine avoidance, weight reduction, relaxation techniques, sodium restriction, exercise, and moderation of alcohol intake. If lifestyle modifications do not work then patient-individualized antihypertensive drug regimens will be prescribed (Ignatavicius & Workman, 2006, p. 786). Examples of drugs that can be used are calcium channel blockers, beta blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, aldosterone receptor antagonists, thiazide diuretics, loop diuretics, and potassium-sparing diuretics. Often thiazide-type diuretics are used for initial drug therapy due to its lower cost (Ignatavicius & Workman, 2006, p.788). The role of the medical-surgical nurse relating to hypertension involves care, education, and collaboration. Care would include assessment, carrying out a plan of care such as medication administration, and other nursing interventions. Next, the most important role of nursing is education because it requires commitment and knowledge from the client relating to self care management and their quality of life. Components of education are lifestyle modifications of
medication management, exercise, nutrition, weight reduction, and smoking cessation. It is important to teach safety precautions relating to side effects of medications because the client will be at risk for injury. The client will also need assistance in developing skills relating to coping and empowering them to take control of their health. Another task for the nurse is collaboration, where the nurse contacts various members of the health care team such as the dietician, physical therapist, and social worker to help the patient to develop strategies for successful disease management. The rising cost of health care is a major barrier when it comes to self-care management. According to the American Heart Association, â€œpeople with lower income levels tend to have higher levels of blood pressureâ€? (American Heart Association, 2008). Hypertension is also more prevalent in individuals with a large body mass index, which is also a rising problem in the United States. Often a client may get overwhelmed with all the information presented to them at once. There are local resources in Greene County offers further support for clients to receive self-care management instructions at no cost. The Greene Memorial Hospital has programs that focus on drug, alcohol, diabetes support, and weight management (2008). Wright Patterson Medical Center Health and Wellness Center provides classes on nutrition, exercise, stress reduction, and tobacco cessation that are open to active duty and retired military and their dependents (age 18 and older), and the Department of Defense civilian employees (n.d.). The Greene County Combined Health District developed a hypertension screening and education program that provides a free blood pressure screening/monitoring, education, and referral to a physician when needed (2008). It is important to be aware that Americans who are sixty years or older are affected by hypertension, with a sixty-seven percent prevalence rate (Ostchega et al., 2008). Taking
medications daily can have a significant impact on their quality of life. Many seniors face barriers that prevent them from achieving optimal health and wellness. Such barriers include adverse side effects, polypharmacy, insurance companies often not covering all prescription medications, and fixed incomes such as social security and retirement savings. Due to these barriers, seniors may not be able to afford the medications that help control their blood pressure, which in turn increases their risk for complications from hypertension. The Greene County Council on Aging developed the Medication Management Assistance Program that would help local seniors using specialists available to help research and apply for Medicare Health Plans and Part-D prescription plans that are appropriate for each individual (2009). In conclusion, it is extremely vital that nurses take on an active role in educating clients to manage their modifiable risk factors because hypertension is a “force to be reckoned with.” Reducing hypertension significantly reduces the dangerous complications, which in turn will lead to a higher quality of life and significant cost savings. Even the slightest “reduction in blood pressure could reduce the risk of heart failure, stroke, and myocardial infarction markedly” (Ong et al., 2006). According to the U.S. Department of Health and Human Services, “High blood pressure causes more doctor visits than any other condition—just a 10 percent decline in the number of visits would save $450 million a year and its complications cost the U.S. economy more than $100 billion each year” (n.d.). Because the major problems faced with Hypertension, health promotion has been increasingly more important to assist clients in better self care management to achieve a high quality of life. The presentation of this project will follow the outline of the brochure and poster. We will begin with the definition of high blood pressure and its causes. This will continue with the importance of why managing this disease is important. The first learning goal for these
clients will begin with their understanding of what hypertension, high blood pressure, is and why it is to their benefit to manage this disease. Next we will present the concept of risk factors and how they affect the client. With that information the client will be able to identify what their personal risk factors are. The ability to identify the modifiable risk factors will be the first step to good self care management. The second learning goal is the client being able to identify their personal risk factors that can be altered to change their disease process. After building this foundation, the presentation will continue with teaching the client about ideas for lifestyle changes. With this information the client can build a personalized plan for their life style adjustments. The question will be, what changes is the client willing or able to make? Having the client involved in the choices and decisions will aid in their commitment to these alterations. The Lifestyle changes and Hints sections will be helpful for the client to get started on the choices to be made in their life. Encourage the client to think of ideas of their own that applies to their life such as improved nutrition, beginning an exercise program and quitting smoking. Therefore the next learning objective is the client making a plan of lifestyle alterations that will help them in the self management of the disease. The last learning objective is the management of what can be a complicated drug regimen. There are ideas in the Hints sections to aid in this management. In the summation, the learning goals for a hypertension client are to be able to verbalize what hypertension is and know their risk factors. They need to be able to identify the lifestyle changes that apply to them. A plan needs to be started that the client helps construct and they are able to commit to implementing. Finally, the client needs to find strategies that will support the successful management of their drug regimen.
References American Heart Association. (2008, October 15). High blood pressure. Retrieved April 12, 2009, from http://www.americanheart.org/presenter.jhtml?identifier=2114 American Heart Association. (2009). Home monitoring of high blood pressure. Retrieved April 12, 2009, from http://www.americanheart.org/presenter.jhtml?identifier=576 Greene County Council on Aging. (n.d.). Medication management assistance program. Retrieved April 12, 2009, from http://www.gccoa.org/MAAP.htm Greene County Combined Health District. (2008). Hypertension screening and education. Retrieved April 12, 2009, from http://www.gcchd.org/CHS/Blood%20Pressure/blood%20pressure%20clinic.htm Greene Memorial Hospital. (2008). Outpatient services. Retrieved April 12, 2009, from http://www.greenehealth.org/services/outpatient_services/ Healthy People 2010. (n.d.). Heart disease and stroke. Retrieved April 12, 2009, from http://www.healthypeople.gov/data/midcourse/html/focusareas/FA12Objectives.htm Ignatavicius, D.D. & Workman, M.L. (2006). Medical-surgical nursing: Critical thinking for collaborative care (5th ed.). Philadelphia, PA: Elsevier Inc. NANDA-I. (2007, p. 130). Nursing diagnoses: definitions & classifications 2007-2008. Philadelphia, PA: NANDA International. Ong, K. L., Cheung, B. M., Man, Y. B., Lau, C. P., & Lam, K. S. (2006). Prevalence awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension, 69-75. doi:10.1161/01.HYP.0000252676.46043.18
Ostchega, Y., Yoon, S. S., Hughes, J., & Louis, T. (2008, January). In Hypertension awareness, treatment, and control-continued disparities in adults: United States, 2005-2006. Retrieved April 12, 2009, from http://www.cdc.gov/nchs/data/databriefs/db03.pdf The Wright-Patterson Medical Center Health and Wellness Center. (n.d.). Retrieved April 12, 2009, from http://www.wpafb.af.mil/library/factsheets/factsheet_print.asp?fsID=9393&page=1 U.S. Department of Health and Human Services. (n.d.). High blood pressure in the United States. Retrieved April 12, 2009, from http://hp2010.nhlbihin.net/mission/abouthbp/abouthbp.htm