Hill-Bone Hypertension Analysis

The population of interest in the proposed evidence-based project includes adults; (i) with a primary diagnosis of hypertension (values >140/90 mmHg or a mean daytime systolic BP of130 mm for diabetic patients), (ii) aged 18 years or over, and (iii) able to express themselves in written or spoken English. Patients with a diagnosis of end-stage renal disease, severe cognitive impairment or any other form of illness that would make their participation in the quality improvement

According to JNC 8 guidelines, close monitoring is essential when patients start on new hypertensive medication. Therefore, Mr. Hightower will require frequent visits to the clinic to ensure improvement in his health condition. His blood pressure will be monitored at each visit and blood work will be done to monitor his kidney and liver functions and to determine his adherence to treatment. In case of noncompliance, a third category of antihypertensive must be added to improve hypertension outcomes and prevent cardiovascular disease.

The algorithm begins with an indication that is used for adults over the age of 18 and noted that lifestyle interventions should be continued throughout management. Goal blood pressures are separated by age and presence of chronic disease. The goal for patients over 60 is SBP < 150 mmHg and DBP < 90 mmHg. The goal for patients under 60 is < 140 mmHg and DBP < 90 mmHg. Different goal values are presented for patients with chronic conditions. Treatment with medication is categorized by: general population nonblack, general population black, chronic conditions black, and chronic condition all races. Based on the algorithm black patients should only be prescribed thiazide type diuretics and/or calcium channel blockers. While non-black patients can take all of the medications listed in JNC 8 (thiazide type diuretics, ACEI, ARB, and/or CCB). If patient does not reach goal blood pressure then three strategies are listed, along with lifestyle adherence. The algorithm also explains not to use ACEI and ARB together. The final option for patients not at goal blood pressure includes additional medications and/or referral to physician with an expertise in hypertension

Ross, S., Walker, A., & MacLeod, M. J. (2004). Patient compliance in hypertension: Role of illness perceptions and treatment beliefs. Journal of Human Hypertension, 18(9), 607-613. Retrieved from http://dx.doi.org/10.1038/sj.jhh.1001721

The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.

In order to assess treatment, I would ask to see the patients’ blood pressure diary. In starting a new medication, I would ask that the patient continue to utilize this tool and consistently obtain a home blood pressure every evening. This would provide for an accurate analysis of diuresis considering I have asked the patient to take this medication every morning. In addition, I would asses for adherence. The initial onset of side effects may cause noncompliance. If the patient is experiencing hypotension upon standing or dizziness, they may be non-compliant with the medication. Reviewing the medications effects and adjustments may alleviate this apprehension of

Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.

Studies evaluating hypertensive patients’ perceptions of causes prompting their self-management have demonstrated that obstacles are multifactorial. Studies have shown that family members often play a vital role in patients’ hypertension self-management, including providing support with food choice and preparation, helping patients to follow the behavioral recommendations (for example, smoking cessation), and supporting patients with medication and medical appointment adherence. Family members may also play a central role in easing patient–provider thoughts about hypertension care (Wassertheil et al,

This article, written by healthcare professionals in the greater Philadelphia area, describes the methodology and findings of the early phase of a long-term study to determine the best ways to improve medicine taking compliance. A total of 132 subjects were selected through random sampling procedures from regular hypertension programs at The Hospital of the University of Pennsylvania in Philadelphia, PA. Patients were interviewed and filled out a questionnaire regarding how often they took their blood pressure medication. The results showed a positive relationship between blood pressure control and compliance, especially when compliance was differentiated between those who missed the occasional pill and those who missed three or more. The article notes that it is important to realize that, because the study relied on patients to accurately detail their behavior, some of the information must be taken with a grain of salt. Three variables were also found to contribute to explaining self-reported medication taking compliance. These were control over health matters, perceived barriers, and duration of treatment.

According to the above selection, the patient needs to be compliant, satisfied, and knowledgeable. Jozien Bensing, the author of this article, believes that “a nontraditional dimension which involves concern for psychosocial aspects of care” and patient satisfaction are most important for effective communication. Bensing believes that the attitude of the physician when he/she is speaking with the patient is also important. She suggests that with good attitude and affective behavior towards the patient makes for a better understanding. This article talks about studies that were performed on patients with hypertension and how all of the aspects Bensing claimed were important were in each study. There were general practitioners that consulted

I was extremely excited to do this chart audit since I am conducting my DNP project on this topic. In my first audit last year our clinic had only 45% compliance with the guidelines and we were still following JNC 6 Guideline. However, after starting the project, the compliance has increased to 80% and care has been improved. This audit had brought in numbers that I could discuss with him in a professional way and it reflects a vast difference in quality improvement. Initially, chart auditing did not seem very appealing to the doctor but now it has become a norm for our clinic to do chart audit periodically. We still have to work hard in the area of patient compliance to the medications to prevent hypertension

Finally, it was suggested that adherence rate measured by ‘tablet count’ was comparable to adherence rate confirmed by both methods, and that almost half of patients assumed to be medication adherent did achieve appropriate blood pressure control compared to only 14% of those assumed not to be medication adherent [Onzeroot et al, 2010].

In this essay, I will be talking about Hypertension(HTN) or High Blood Pressure. I have chosen this topic for it is a common sickness, unfortunately, in America. Many people do not understand it and many do not know how to treat it. I used to have Hypertension about a year before I am writing this essay. Starting in summer 2015 I decided to start taking action to lose weight and fix my High Blood Pressure. I decided to stop eating fast food all the time and made only once a month. I started drinking more water and eating healthier. I lost 10 pounds in 2 months. I eventually gained the weight back due to me growing taller in such short time. I continue to eat healthier and strive to make a certain goal.

Sounds good, Morgan. But, what is your inclusion and exclusion criteria for your sample? I was just wondering if other medical conditions were considered. Non-compliance is a commonn finding in primary care, but trying to manage a patient's blood pressure in the presence of hyperlipidemia, diabetes, and obesity is challenging. Good luck, and I am looking forward to hearing more.

The two major types of hypertension are primary and secondary. Primary hypertension accounts for more than 90% of all cases and has no known cause, although it is hypothesized that genetic factors, hormonal changes, and the altercations in sympathetic tone all may play a role in its development. Secondary hypertension develops as a consequence of an underlying disease or condition. The prevention and treatment of hypertension is a major public health issue. When blood pressure is controlled, cardiovascular, renal disease, and stroke may be prevented. The JCN, reported more than 122 million individuals in American are overweight or obese, consume large amounts of dietary sodium and alcohol, and do not eat adequate amounts of fruits and vegetables; less than 20% exercise regularly. Both modifiable and non-modifiable factors play a role in the development of hypertension