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The Nurse’s Role in Patient Education
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define prehypertension, hypertension stage I and hypertension stage II according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. describe lifestyle modifications that can reduce blood pressure. list at least 2 recommendations regarding OTC drug and supplement use for older adults who take medication for hypertension. identify classes of antihypertensive medications that interact with grapefruit. synthesize and apply information learned to case studies.
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Navigate to http://www.nhlbi.nih.gov/guidelines/hypert ension/express.pdf http://www.nhlbi.nih.gov/guidelines/hypert ension/express.pdf Read pages 18-19 Take note of current hypertension definitions
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Navigate to http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf Read pages 18-22 Consider possible results of uncontrolled hypertension and how to present that information to a patient newly diagnosed with hypertension.
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Navigate to http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf Read pages 23-24 Navigate to http://eurheartj.oxfordjournals.org/content/32/24 /3081.short and skim this article. http://eurheartj.oxfordjournals.org/content/32/24 /3081.short Navigate to http://dashdiet.org/ and peruse this website.http://dashdiet.org/ From these activities, note lifestyle modifications you would recommend to a person newly diagnosed with prehypertension.
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Diuretics are especially concerning for use with those in the geriatric population. This population is at risk for hypotensive reactions, specifically regarding orthostatic hypotension and resulting falls. It is important for the nurse to emphasize to the patient the importance of changing positions slowly. For example, getting out of bed in stages: sitting up, dangling feet over the edge, standing carefully and taking lots of time for each stage. It is also important to emphasize that the patient alert the provider if s/he experiences muscle weakness, dizziness or light-headedness. (Edmunds, 2010)
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Patients need to be aware of possible side effects of antihypertensive drugs. Common side effects include headache, nausea, weakness, dizziness, drowsiness, and for men impotence can be a problem. Cough is common for ACE Inhibitors. Patients need to alert their healthcare provider of any side effects they experience as a change in medication can alleviate some symptoms.
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Navigate to http://ispub.com/IJANP/5/1/9172 Read this article to glean at least two recommendations that ought to be made to elderly patients being treated with antihypertensive medications regarding the use of over-the-counter medications and supplements. Also make note of interactions of antihypertensive medications with alcohol.
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Grapefruit and grapefruit juice have recently been implicated in the overactivity of various drugs. Grapefruit juice also tends to be more commonly drunk by members of the geriatric population. Navigate to http://www.drugs.com/slideshow/grapefruit- drug-interactions-1028#slide-1 and watch the slide show titled “Love Grapefruit Juice? Drug Interactions are Numerous” Take note of which types of drugs are a problem when combined with grapefruit juice.
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Mr. Heston, 70 yrs old, has BP readings of 137/84 and 133/87 in his last too clinic visits. He doesn’t have diabetes or other co- morbidities. What is his blood pressure status according to the latest definitions of hypertension? What are your recommendations to him? Be sure to include reasons that controlling hypertension is important.
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Mr. Heston comes back to the clinic for blood pressure checks. Over the next 6 months, his blood pressure readings have climbed. Now his average reading is 145/93. He starts on Hydrochlorothiazide. Knowing that this is a thiazide diuretic, what does he need to know? Write out a possible conversation with Mr. Heston.
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Mr. Heston’s blood pressure still isn’t under control and the decision is made to start him on a calcium channel blocker. What additional patient teaching is necessary regarding possible food and OTC interactions and side effects? Since Mr. Heston is male, what additional teaching do you need to provide regarding a possible side effect which could be alleviated by changing the med?
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Post your answers to the case study questions in the appropriate drop boxes on Angel. Thank You. If you have questions, feel free to contact me by email through the Angel communicate tab.
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Bailey, D.G., Dresser, G., & Arnold, J.M. (2013). Grapefruit-medication interactions: Forbidden fruit or avoidable consequences? Canadian Medical Association.Journal, 185(4), 309-16. Retrieved from http://search.proquest.com/docview/1349168416?accountid=14902 DASH Diet (2013). Retrieved November 5, 2013 from http://dashdiet.org/what_is_the_dash_diet.asphttp://dashdiet.org/what_is_the_dash_diet.asp Edmunds, M.W. (2010). Introduction to Clinical Pharmacology (6 th ed.) Mosby Elsevier: St. Louis, MO. Frisoli, T.M., Schmieder, R.E., Grodzicki, T., & Messerli, F.H. (2011). Beyond salt: lifestyle modifications and blood pressure. European Heart Journal, 32, 3081-3087. doi: 10.1093/eurheartj/ehr379 JNC7 (2003). Retrieved November 5, 2013 from http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf McCance, K.L. & Huether, S.E. (2010). Pathophysiology: The Biologic Basis for Disease in Adults and Children (6 th ed.) Mosby Elsevier: Maryland Heights, MO. Neafsey, P.J., Shellman, J. (2002). Adverse self-medication practices of older adults with hypertension attending blood pressure clinics: adverse self-medication practices. Internet Journal of Advanced Nursing Practice, 5(1), 30-43.
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