NAME REG NUMBER COURSE LECTURER DUE DATE

THOMAS MUNDIETA R089447M PHARMACY PRACTICE MRS T.G MONERA PENDUKA 18 OCTOBER 2011

1. Describe the correct procedure for measuring a) Blood pressure - Include normal and abnormal ranges, conditions for referral and non-pharmacological management options. [25marks]
STEPS 1. CHECKING THE EQUIPMENT. The equipment should not be used if any problems are found. a. The Manometer should be at zero. b . The cuff is checked for any breaks in stitching or tears in the fabric. c. The rubber tubing is checked for cracks or leaks, especially at connections. d.Three sizes of cuffs should be accessible (small, regular, and adult large). 2. The manometer is placed so it can be viewed straight on and within 15 inches of the viewer. 3. The Left arm should be used when possible. Upper arm should be bare and unconstricted by clothing ( at least one finger should fit under a rolled-up sleeve.) 4. The appropriate size cuff is selected. The bladder width should equal at least 40% of the circumference of the upper arm, and the length of the bladder should be 80% of the circumference of the arm, but no more than 100%. 5. The location of the brachial artery is palpated (on the upper arm's inner aspect) and the centre of the cuff's bladder is positioned over the brachial artery. 6. The cuff is applied evenly and snugly one-inch (2.5 cm) above the antecubital fossa (bend of arm). 7. The arm is positioned so that the cuff is at heart level. The arm should rest firmly supported on a table, slightly abducted and bent, with palm up. 8. The Patients legs should be uncrossed, feet resting firmly on the floor and the back supported while blood pressure is being measured. (Patients may need to be reminded to keep quiet and relax each time a blood pressure reading is being taken.)

9. Record the final Reading on the electronic sphygmomanometer and counsel the patient.

INTERPRETATION OF B.P VALUES Description Normal Blood Pressure(mmHg) 120/80 Inference Good

High Normal

130/85

Counsel Patient

Low Normal Borderline Low Low High

110/75 90/60 60/40 140/90

Counsel Patient Refer Refer Refer

Non Pharmacological Management of Hypertension 1. Eat Healthy, Balanced Meals Whole, unprocessed foods that are low in fat are the healthiest, so hypertension patients should try to avoid fast food as much as possible. Specific foods that have been shown to reduce blood pressure levels include whole grains, fresh fruits, fresh vegetables and coldwater fish. It is also important to consume the daily recommended amount of potassium. Reduce Sodium Intake A diet that is high in sodium can greatly contribute to high blood pressure. People should consume no more than 2,400 mg of sodium a day. This is equal to 6 g of salt. Since salt is hidden in many processed foods, it is best for patients with high blood pressure to stay away from table salt altogether.

Exercise Regularly Regular physical activity will improve a patient's overall health, particularly the cardiovascular system. When the heart is healthy and strong, it can pump blood with ease. This lightens the stress on arteries and naturally lowers blood pressure. The Mayo Clinic recommends about 30 minutes of aerobic activity on most days of the week. This doesn't have to take place in a gym, however. Activities such as mowing the lawn, climbing stairs and walking will suffice. 2. Quit Smoking/Drinking Tobacco smoke and excessive alcohol intake are bad for the system in many ways. However, these habits are even more detrimental to those with hypertension, as they greatly increase the risk of stroke and heart attack. Those who are looking to naturally lower their blood pressure should give up smoking altogether. Although drinking in moderation is usually fine, anything more than one or two drinks a day is considered unhealthy. Manage Stress The long-term effects of stress on hypertension are not clear, but it is known that stress can cause temporary spikes in blood pressure due to secretion of cortisol. Those who deal with a lot stress, whether at home or work, need to learn to relax in order to get their blood pressure under control. Breathing exercises, meditation and positive daily affirmations are but a few ways to manage stress. In some cases, it might be best to make a major life change, such as finding a new career path that is less stressful.

b) Blood glucose monitoring

The glucose meter is prepared and the testing strip is inserted according to the manufacturers instructions. This usually involves checking that it has been calibrated for the particular batch of testing strips that are being used by ensuring the product code on the display matches the code on the testing strip container. The expiry date on the test strips is checked to ensure their reliability. The test strip is inserted into the meter in the direction of the arrow. Before pricking the patients finger, the hand is held downwards to encourage blood flow, and a light tourniquet is made with the hand around the finger to ensure a sufficient blood is present in the tip of the finger. Milkingblood into the finger should be avoided as the local blood composition may be disturbed by intermingling with tissue fluid. Taking time to encourage blood flow before pricking the finger will reduce the need for pricking again, which can be distressing for the patient . A touch of blood is applied to the test strip according to manufacturers instructions. The patient is asked to press on the site, using the gauze swab / cotton wool ball, to stem bleeding and reduce the risk of bruising.

The lancet is removed after reading and recording the digital display of the result. All sharps and contaminated waste is disposed in the appropriate containers. Blood Glucose Values The blood sugar level is the amount of glucose in the blood which is expressed as millimoles per litre (mmol/l).Normal range for adults throughout the day is 4-7 mmol/lUsually higher after meals and lowest in the morning.It can be <10 mmol/l90 minutes after a meal. Non Pharmacological Management of Diabetes Mellitus. uced2007 a) Diet The aims of dietary management are to achieve and maintain ideal body weight, euglycemia and desirable lipid profile to prevent and postpone diabetes mellitus related complications. b) Regular Exercise Regular exercise is an essential component in the management of Type II Diabetes mellitus. Recommended exercise is gradual increase in aerobic exercise. This increases insulin sensitivity. c) Management of Stress Diagnosis of diabetes mellitus is a Stressful situation in life of an Individual and appropriate management requires a holistic approach that includes behavioural modification to develop positive attitudes and healthy lifestyle. d) Avoidance of Tobacco Smoking and Alcohol Tobacco should not be smoked at all while alcohol may be beneficial in moderation. However, alcohol increases the risk of stroke in excess.

2a) Outline the correct instructions for administering a home pregnancy test.
COLLECTION OF URINE FOR THE TEST

Any urine specimen is appropriate for Pregnancy Testing but the first morning urine specimen is optimal because of its highest concentration of HCG. Urine specimens may be collected in any clean, dry, plastic or glass container.

CARRYING OUT THE TEST. 1. The test strip and urine have to be at room temperature (15-30C) for testing. 2. The test strip is removed from the sealed pouch. 3. The strip is immersed into the urine with the arrow pointing towards the urine to just below the maximum mark. The strip is taken out after 3 seconds and laid flat on a clean, dry, nonabsorbent surface (such as the mouth of the urine container).

READING OF RESULTS. Results are read in five minutes without exceeding this time limit. INTERPRETATION OF RESULTS Negative (not pregnant) : Only one color band appears in the Control Zone. No apparent band on the Test Zone. This indicates that no pregnancy has been detected. Positive (pregnant) : Distinct color bands appear in the Control and Test Zones. It indicates that the patient is pregnant. The color intensity of the test bands may vary since different stages of pregnancy have different concentrations of HCG hormone.

b) What other urine test kits are there?

i) Glucose test kits ii) Albuminuria test kit iii) Ovulatory test kit

3) With the aid of a simple diagram define what is meant by

a) Colostomy bag This is a bag worn over an artificial anus to collect feces. Diagram

b) Incontinence bag [10 marks] This is a bag used to collect urine and faeces in patients nability to prevent the discharge of any of the excretions, especially of urine or feces.

References

1) BlowsWT(2001)Thebiologicalbasisofnursing:Clinicalobservations.London,Routle dge 2) Ferguson,A(2005)Blood glucose monitoring.NursingTimes.101(28),p28-9 3) Nicol(2004)Essential nursing skills.London,Mosby 4) SkinnerS(2005)Understanding clinical investigations:A quick reference manual.2nd Edition.London,BaillireTindall