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Liz Rhodes, RN ECU Student Nurse

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PROBLEM
 Uncontrolled blood pressures related to medications,

poor diet, and decreased physical activity

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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 medications 4 .

 BLOOD PRESSURE It's called the "silent killer. http://www.   It doesn't refer to being tense. You can still have high blood pressure even if you are a calm. nervous or hyperactive.  Many people have high blood pressure for years without knowing it. How can I tell if I have high blood pressure?  High blood pressure usually has no symptoms.org/presenter. relaxed person."  Hypertension is the medical term for high blood pressure.americanheart.jhtml?identifier=44 73 5 .

2008). 6 .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.

The incidence of high blood pressure rises in men after age 35 and in women after age 45  Gender .Approximately 33 percent of AfricanAmericans have high blood pressure.Factors related to High Blood Pressure  A family history of high blood pressure  Age .Men are more likely to have high blood pressure than women  Race . 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 .

Source: Joint National Committee on Prevention. Detection. chronic kidney disease. physicians rate overall blood pressure by the higher category. previous heart attack. December 2003.Blood Pressure Guidelines Category 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 120–139 80–89 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 140–159 90–99 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. 10 . congestive heart failure. For example. previous stroke. and Treatment of High Blood Pressure. high cardiac risk Note: When systolic and diastolic pressures fall into different categories. Evaluation. 150/85 mm Hg is classified as stage 1 hypertension. not prehypertension.

S.C.Why is Blood Pressure Management For Stroke Prevention Important?  Strokes  Leading Cause of Disability in the U. lies in the Stroke Belt  The Stroke Belt has the highest morbidity and mortality from Stroke in the U.  The Buckle of the Belt includes NC.S.S.  N.  3rd Leading Cause of Death in the U. SC and Georgia 11 .

12 .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.

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  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.  MEDICAL HISTORY ____ You have coronary artery disease. or live or work with people who smoke every day.  AGE ____ You are a man over 45 or a woman over 55 years old.  ____ You don’t know your total cholesterol or HDL levels.  Tobacco SMOKE ____ You smoke.  FAMILY HISTORY ____ Your father or brother had a heart attack before age 55 or your mother or sister had one before age 65.  Total CHOLESTEROL and HDL cholesterol  ____ Your total cholesterol level is 240 mg/dL or higher. please see a healthcare professional and determine what you can do to lower your risk. ____You have an abnormal heartbeat.  ____ 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. or you have had a heart attack. ____You have had a stroke. ***If you check two or more. 15 .

Risk assess cont.  PHYSICAL INACTIVITY ____ You don’t accumulate at least 30 minutes of physical activity on most days of the week. Accessed on September 12. 2008 at http://www. American Heart Association.  BLOOD PRESSURE ____ Your blood pressure is 140/90 mm Hg or higher.strokeassociation.jhtml?identifier=3034972 16 . or you’ve been told that your blood pressure is too high.org/presenter.  DIABETES ____ You have diabetes or take medicine to control your blood sugar.  Excess BODY WEIGHT ____You are 20 pounds or more overweight. ____ You don’t know what your blood pressure is. (2008). Personal risk assessment form.

Stroke is a Medical Emergency 17 .

ABCs of Preventing Heart Disease. Stroke and Heart Attack 18 .

 http://www.jhtml?ide ntifier=3034972 19 .org/presenter.strokeassociation.

high-fiber foods is essential to good health. especially when you also enjoy regular physical activity.Heart-Healthy Cooking Tips  Eat less cholesterol. salt and saturated and trans fats. vegetables and whole-grain.  Eating fewer calories will help you lose weight.  Eating less salt and more potassium helps control blood pressure in most people. 20 .  Focusing your diet on foods such as fat-free and lowfat dairy fruits.  Eating less saturated fat and trans fat helps to lower blood cholesterol levels.

stir-fry. and onions or other low-salt spices instead of salt.Here are some tips to help make your meals healthful:  Frying  Steam. garlic. low-calorie or fat-free salad dressings. noodles.  Salt  Use lemon juice. hot red pepper flakes.  Salad Dressing  Use low-fat. hot cereal or rice. broil. 21 . spaghetti. or bake foods in olive oil or canola instead of deep-frying in bacon grease or shortening. vinegar.  Use little or no salt when you cook.

and saturated fat such as a stick of margarine. turkey.  Eat chicken. and very lean pork or beef. or use other spreads that are lower in trans fat. or eat egg whites instead.  Roast.TIPS continued  Butter  Use soft tub margarine instead of butter.  Eggs  Limit egg yolks to three or four per week.  Remove the skin from poultry before cooking except when roasting a whole chicken. 22 . broil.  Meat  Buy fresh lean cuts of meat and trim the fat before cooking. cholesterol. or bake meats instead of frying them.

23 .  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. bake ware. canola.TIPS continued  Oils  Use olive. fat-free cooking spray to provide a nonstick surface for grills. corn.  Use calorie-free. and wok-ware. or safflower oil in cooking.

us  Areas of Practice: Individual Counseling. General Nutrition/Wellness. Diabetes. Programs/Workshops. NC 27514  Phone: (919) 968-2022 x309  Email: rkemske@co.nc. Weight Control  24 . Gerontology.AREA DIETICIANS  Renee L Kemske  MPH RD LDN  Orange County Health Dept  2501 Homestead Rd  Chapel Hill.  Cardiovascular/Hypertension.orange. Group Counseling.

Weight Control 25 . General Nutrition/Wellness.AREA DIETICIANS  Anne-Marie Scott  UNC Wellness Center  Health Education Dept  100 Sprunt St  Chapel Hill. Programs/Workshops  Cardiovascular/Hypertension. Group Counseling. NC 27517  Phone: (919) 843-2163  Email: a_scott@uncg.edu  Areas of Practice:  Individual Counseling. Gerontology.

unc.  Cardiovascular/Hypertension.AREA DIETICIANS  Elizabeth A Watt  RD LDN  The Wellness Center at MeadowMont  100 Sprunt St  Chapel Hill. Group Counseling. Weight Control 26 . General Nutrition/Wellness. Programs/Workshops.edu  Areas of Practice:  Individual Counseling. NC 27517-7811  Phone: 919-843-2163  Email: ewatt@unch.

Weight Control 27 . General Nutrition/Wellness.edu  Areas of Practice:  Individual Counseling. NC 27710  Phone: (919) 660-6818  Email: mitch068@mc. Group Counseling.AREA DIETICIANS  Kara M Mitchell  MS RD LD  Duke Center for Living  1300 Morreene Rd  Durham.duke. Programs/Workshops  Cardiovascular/Hypertension. Diabetes. Vegetarian.

#110 (Southern Village). NC 27510  phone (919) 960-9910  O2 Fitness  View Website  300 Market Street. Chapel Hill. NC 27516  phone (919) 942-6002 28 .FITNESS CENTERS  Carolina Fitness  503-C West Main St Carrboro.

pdf  Check with your physician be for starting any physical fitness program 29 .FITNESS CENTERS  The Wellness Center at Meadowmont  View Website  100 Sprunt St Chapel Hill.dukehealth.org/Services/DietAndFitness/A bout/index/DFC%20Brochure%20Inside.Duke University Diet and Fitness Center  1-800-235-3853  http://www. NC 27517  phone (919) 966-5500  World-Renowned Residential Program-.

 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 .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.

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 immediately! (See the following signs & symptoms) 911 31 .

severe headache 32 .Signs & Symptoms of Strokes  Sudden numbness or weakness  Sudden confusion. trouble speaking or understanding  Sudden trouble seeing  Sudden trouble walking. or loss of balance or coordination  Sudden. dizziness.

Thank You 33 .

(2008). V.org/downloadable/stroke/1219770019473Lifestyle%20Chgs%20to%20Prevent%20Stroke. (2008). Resources American Heart Association [AHA]. Site accessed on September 29.jhtml?identifier=1200010 American Heart Association.org/presenter.strokeassociation.pdf Every Day Health Network. Accessed on October 6. MO: Mosby.americanheart.gov/oei/reports/oei-04-89-89121. Site accessed on September 29.org/downloadable/stroke/1130509929967PTES%20Risk%20Assessment%20Card. in M. Diet and Nutrition. St. Site accessed on September 29.strokeassociation. 2008 at http://www. 2008 at http://www.strokeassociation. Public health nursing: Population-centered health in the community. Converging risk factors. Stanhope & J. (2008). & Greene.oig. What is goal blood pressure in treatment of hypertension? Retrieved on October 19. (2008).).org/presenter. (2008).jhtml?identifier=3027394      American Stroke Association [ASA]. Sebastian.strokeassociation. Stroke center: Blood pressure guidelines Accessed on October 27. (1990).pdf American Stroke Association [ASA]. Site accessed on September 29. (2008). 2008 at http://www.pdf Dufresne.jhtml?identifier=9217 American Heart Association [AHA]/American Stroke Association [ASA]. UNC     care 34 . 2008 at http://www. The nurse leader in the community. Louis.org/presenter. Accessed on September 12. &Rose B. Stroke risk factors.hhs. (7th ed. Personal risk assessment form. (nd). 2008 from Up to date at -Chapel Hill.com/publicsite/index. Stroke risk awareness survey. (2007). J. Department of Health and Human Services: Offices of Inspector General. Medication regimens: Causes of non-compliance.org/presenter. J. Lancaster (2008). N. 2008 at http://americanheart. Site accessed on September 29. 2008 at http://www.aspx?puid=1c66ebdb-25c5-4042-bd9b051cb3f9e623&xid=gslp&s_kwcid=blood%20pressure|2525548814&gclid=CMyQ8Z6rzZYCFQS7sgodBWgGzQ Kaplan. 2008 at http://www.everydayhealth.jhtml?identifier=3034972 American Heart Association [AHA]. 2008 at http://www. Let’s talk about lifestyle changes to prevent str oke. G.