Liz Rhodes, RN ECU Student Nurse

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29 Οκτ 2013 (πριν από 3 χρόνια και 11 μήνες)

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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, 200
8
).


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,
hig
h cardiac risk


Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the hig
her

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


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



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/dL or higher.


____ Your HDL (“good”) cholesterol level is less than 40 mg/dL if you’re a man
or less than 50 mg/dL 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 low
-
fat 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 x309


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 MeadowMont


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:
mitch068@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



O2 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/DietAndFitness/A
bout/index/DFC%20Brochure%20Inside.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 911

immediately!
(See the following signs & symptoms)


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 str
oke
. Site accessed on
September 29, 2008 at
http://www.strokeassociation.org/downloadable/stroke/1219770019473Lifestyle%20Chgs%20to%20Prevent%20Stroke.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/1130509929967PTES%20Risk%20Assessment%20Card.pdf




Dufresne, J. & Greene, V. (1990). Medication regimens: Causes of non
-
compliance. Department of Health and Human Services: Office
s 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=1c66ebdb
-
25c5
-
4042
-
bd9b
-
051cb3f9e623&xid=gslp&s_kwcid=blood%20pressure|2525548814&gclid=CMyQ8Z6rzZYCFQS7sgodBWgGzQ




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. (7
th

ed.).
St. Louis, MO: Mosby.




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