role of primary heath care nurse in caring hypertensive patient & family

Patient with

Hypertension

Role of PHC Nurse

By. Ms Shanta Peter

NURSING INTERVENTIONS

Objective Focuses on lowering and controlling BP without adverse effects and without undue cost

Patient attitude to treatment & medicine is influenced by:

» Cultural difference»Beliefs»Previous experience with Health Care

system

We have to………..• Build Trust• Identify the attitude • Good communication with patient and family

Promoting home & community based care

• Teaching patient self care• Therapeutic regimen is responsibility of pt----

but we collaborate the education – goals, and social support to achieve control of BP

• Involve family members in education programs – they support patient effort to control HBP

Health Teaching.. ………….you must Know • The family and patient• Environment• Lifestyle- patient & family..• Consumption factors --- smoking… alcohol• Occupational factors• Exercise– Leisure activities (TV , Comp) sedentary ,

obesity, Diseases• Food habits• Other behaviors • Self assessment of BP

Supply written information on – medications – expected effects – and side effects • Side effects – reportable – how to manage • Rebound hypertension--- if suddenly

stopped – • Beta blockers – sexual dysfunction • Measure their BP at home –Monitoring B.P,

maintaining chart • Encourage their own care – increase in BP if

not taken medicine

Teach patient to ..• Adhere treatment regimen – by

implementing lifestyle changes – & taking medications in time

• Regular follow up ,monitor BP

• Identify and treat any complications

Increasing knowledge

• Understand disease process – lifestyle changes , medications can control HTn.

• Emphasis on concept of controlling – rather than curing

• Encourage to consult dietician – plan for weight loss – less Na, fat --- more fruits & vegies --- (1st 2-3 mths taste bad)

• Regular physical activity – regular exercise regimen

• Avoid Tobacco —that it will increase the risk higher

• Support groups – smoking—weight loss –stress reduction

Continue care----Follow-up……….. • Important – disease process should be assessed –

and treat • Physical exam is mandatory at each visit ………..• Find out all potential problems … -- specially

medication related problems --- (..postural/orthostatic hypo tension – dizziness or light headiness'.. )

• Reinforce – compliance with self care (Non compliance is a main problem --- in lifetime mgt )(50% discontinue medications in 1 yr BP control is achieved only by 27%

• Greater sense of BP control--- achieve compliance with self care – that is self monitoring BP –diet-- medications etc…

(They get immediate feed back )• Lifestyle modifications. /taking regular

medications – (achieve by much effort ) • Some people effort is unreasonable • They are asymptomatic without medications –

but may have side effects of medications • Continue education-- regular reminder follow up

Need encouragement to accept the regimen and adhere to treatment plan

Potential problems Monitoring / Managing

•  Symptoms – of progressing HBP –detect early involving target systems– so that treatment can be initiated

• Assess all body systems – when come for follow up……… especially eyes—

Blurred vision- spots in front of eyes.. diminished visual acuity

• Heart , Nervous system, kidneys -assess and exam – additional diagnostic assessments also should be done

Medications maybe changed based on these.

EVALUATION Expected outcomes

1. Maintain adequate tissue perfusion:• BP maintain at less than 140/90 – with

medications and lifestyle modifications• Has no symptoms of angina palpitations, or vision

changes • Stable BUN & S. Crea. levels• Peripheral pulses are palpable

2.Complies with self care program• Adheres to dietary regimen as directed – low cal, low Na, fat – increased vegetables fruits • Regular exercise• Takes medications as instructed and report undue

actions • Measure BP regularly• Abstains from Tobacco – alcohol• Keeps follow-up appointments

3. Has no complications • Report no changes in vision• No retinal damage – vision treating• Maintains – Pulse rate – rhythm—resp. rate – normal• No dyspnea or edema• Maintains urine output consistent with intake • Renal function / all profiles in normal range• No speech- motor- sensory deficits• No head ache- dizziness, weakness, changes in gait

or falls

Client Education

Family & Care taker

Patient /Family Education • Importance of compliance with treatment• Disease process- symptoms not develop until major

organs involve• Initiate a regular exercise program- avoid – weight lifting

& isometric exercise—Develop the exercise gradually• Encourage to express about stress—identify ways to

reduce stress—Teach relaxation techniques in daily activities

• Checking and Monitor BP – diary for BP • Lifelong medication and need to follow-up treatment• Dietary restrictions – Na, Fat, Calories cholesterol- shop

and prepare low Na diet, (list of food)

…Pt/family education….• Select food – reading labels – for Na ,MSG – • Ways to cook- bake- grill- roast - avoid salt- add in

cooked food. • Avoid canned food – use fresh – vegies & fruits.• Actions- side effects--- contact physician-- do not

stop scheduling medications - avoid OTC medicines.

• Importance of follow up care.

DASH Diet…Dietary Approach to Stop Hypertension

DASH……………….Less……SALT …Sodium • Less salt…..( 1tsp (5ml) /day … • Limit salt in cooking and none at table • Avoid salty food• Choose fresh/frozen foods • Avoid canned foods• Check the label for -- Sodium…• Use other seasoning – herbs… spices … lemon juice• Choosing correct food while eating out

Easy ways to start.. DASH diet• Determination• Change gradually• Add food of your taste ---- Add fruits and

vegies • Reduce fat foods • Limit meat

Common foods to avoid – while on low sodium diet

• Any pre salted – canned foods, meat, snacks• Foods preserved by sodium addition• Soups , bouillon and gravies• Condiment and sauces• Cheese, butter, and cheese spreads• Seasoning prepared with salt, garlic/onion salt • Frozen fish, pizza or sausage products Herbs and spices to substitute salt.. as like …………Lemon…………….

Teaching ………

• Explain the consequences and risk of non compliances ---- and the benefit of compliance

• Refer/introduce to support group • Encourage the family to become involved with

treatment regimen –especially lifestyle modifications

• Teach them to check BP , weight – weekly and keep record

• Praise the patient ( family) for compliance of treatment

Adequate EXERCISE….

Behavior modification program—• Identify the behavior to be changed with patient’s

approval• Make it written like a contract – goal oriented – Be

sure it is realistic, measurable, positively stated, and timed with deadline

• Let patient and nurse- family sign the contract – give a copy to them

• Make sure the follow up occurs on the stated date- renegotiation is done if necessary

• Identify the reward for patient if the behavior is achieved

Finally … Expected Outcome…. Goal achieved ………

• Maintain BP less than 140/90 with medications and lifestyle modifications• Complies with self care program

• Has no complications

High BP lead to STROKE . Warning signs ……(AHA)a) Sudden numbness/weakness of face, arm, leg especially on one side of the bodyb) Sudden confusion, trouble speaking or understandingc)Sudden trouble seeing in one or both eyesd) Sudden trouble walking, dizziness, loss of balance or coordinatione) Sudden severe head ache with no known cause

Not all have the same sign