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Liz Rhodes, RN ECU Student Nurse1

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

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List four modifiable risk factors for strokes State the importance of controlling blood pressure. List different types of foods which are healthy and not

OBJECTIVES

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 medications4

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.

BLOOD PRESSUREIt'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=44 735

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).

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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 AfricanAmericans have high blood pressure, compared to 25 percent of Caucasians7

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 provider8

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

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Blood Pressure GuidelinesCategory Normal Systolic BP (mm Hg) Less than 120 Diastolic BP (mm Hg) Less than 80 Treatment recommendations Lifestyle changes encouraged Lifestyle changes necessary Drugs for compelling indications* Prehypertension 120139 8089 Lifestyle changes necessary Thiazide diuretic for most people May also consider other blood pressure drugs alone or in combination Drugs for compelling indications*

Stage 1 hypertension

140159

9099

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.

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Why is Blood Pressure Management For 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

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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.

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Modifiable Risk Factors of Strokes High cholesterol Hypertension (high blood Alcohol

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

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PREVENTION Eating a well balanced diet Exercise Compliance with medications Management of:

Diabetes HTN Heart disease

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STROKE RISK AWARENESS SURVEYCheck 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.

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Risk assess cont. BLOOD PRESSURE

____ Your blood pressure is 140/90 mm Hg or higher, or youve been told thatyour 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.jhtml?identifier=3034972

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Stroke is a Medical Emergency

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ABCs of Preventing Heart Disease, Stroke and Heart Attack

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http://www.strokeassociation.org/presenter.jhtml?ide

ntifier=303497219

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.

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TIPS continued Oils Use olive, canola, corn, or safflower oil in cooking. Use calorie-free, fat-free cooking spray to provide a nonstick 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.

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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

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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 Control25

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

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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, P

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