Liz Rhodes, RN ECU Student Nurse

PROBLEM
Uncontrolled blood pressures related to medications,

poor diet, and decreased physical activity

GOAL
To motivate a change in behavior patterns and

activities to control blood pressure for stroke prevention

 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

 How can I tell if I have high blood pressure? High blood pressure usually has no symptoms. Many people have high blood pressure for years without knowing it.

BLOOD PRESSURE
It's called the "silent killer."
Hypertension is the medical term for high blood

pressure.

It doesn't refer to being tense, nervous or hyperactive. You can still have high blood pressure even if you are a calm, relaxed person. http://www.americanheart.org/presenter.jhtml?identifier=44 73
5

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, 2008).

Factors related to High Blood Pressure

A family history of high blood pressure

Age - The incidence of high blood pressure

rises in men after age 35 and in women after age 45 Gender - Men are more likely to have high blood pressure than women Race - Approximately 33 percent of AfricanAmericans have high blood pressure, 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

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 120139 8089 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

140159

9099

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, chronic kidney disease, previous heart attack, congestive heart failure, previous stroke, high cardiac risk Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is classified as stage 1 hypertension, not prehypertension.

Source: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, December 2003.

10

Why is Blood Pressure Management For Stroke Prevention Important?

Strokes Leading Cause of Disability in the U.S. 3rd Leading Cause of Death in the U.S. N.C. lies in the Stroke Belt
The Stroke Belt has the highest morbidity and

mortality from Stroke in the U.S. The Buckle of the Belt includes NC, SC and Georgia

11

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.

12

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. ***If you check two or more, please see a healthcare professional and determine what you can do to lower your risk.
AGE
____ You are a man over 45 or a woman over 55 years old.

FAMILY HISTORY
____ Your father or brother had a heart attack before age 55 or your mother or sister had one before age 65.

MEDICAL HISTORY
____ You have coronary artery disease, or you have had a heart attack. ____You have had a stroke. ____You have an abnormal heartbeat.

Tobacco SMOKE
____ You smoke, or live or work with people who smoke every day.

Total CHOLESTEROL and HDL cholesterol ____ Your total cholesterol level is 240 mg/dL or higher. ____ Your HDL (good) cholesterol level is less than 40 mg/dL if youre a man or less than 50 mg/dL if youre a woman. ____ You dont know your total cholesterol or HDL levels.

15

Risk assess cont.

BLOOD PRESSURE

____ Your blood pressure is 140/90 mm Hg or higher, or youve been told that
your blood pressure is too high. ____ You dont know what your blood pressure is.

PHYSICAL INACTIVITY
____ You dont accumulate at least 30 minutes of physical activity on most days of the week.

Excess BODY WEIGHT

____You are 20 pounds or more overweight.

DIABETES
____ You have diabetes or take medicine to control your blood sugar. American Heart Association. (2008). Personal risk assessment form. Accessed on September 12, 2008 at http://www.strokeassociation.org/presenter.jhtml?identifier=3034972

16

Stroke is a Medical Emergency

17

ABCs of Preventing Heart Disease, Stroke and Heart Attack

18

 http://www.strokeassociation.org/presenter.jhtml?ide

ntifier=3034972
19

Heart-Healthy Cooking Tips

Eat less cholesterol, salt and saturated and trans fats.

Eating less saturated fat and trans fat helps to lower

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

Here are some tips to help make your meals healthful:

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

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

22

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

23

AREA DIETICIANS
Renee L Kemske

MPH RD LDN
Orange County Health Dept 2501 Homestead Rd

Chapel Hill, NC 27514

Phone: (919) 968-2022 x309 Email: rkemske@co.orange.nc.us
Areas of Practice:
Individual Counseling, Group Counseling, Programs/Workshops, Cardiovascular/Hypertension, Diabetes, General Nutrition/Wellness, Gerontology, Weight Control

24

AREA DIETICIANS
Anne-Marie Scott

UNC Wellness Center

Health Education Dept 100 Sprunt St

Chapel Hill, NC 27517

Phone: (919) 843-2163 Email: a_scott@uncg.edu
Areas of Practice:
Individual Counseling, Group Counseling, Programs/Workshops

Cardiovascular/Hypertension, General Nutrition/Wellness, Gerontology, Weight Control

25

AREA DIETICIANS
Elizabeth A Watt

RD LDN
The Wellness Center at MeadowMont 100 Sprunt St

Chapel Hill, NC 27517-7811

Phone: 919-843-2163 Email: ewatt@unch.unc.edu
Areas of Practice:
Individual Counseling, Group Counseling, Programs/Workshops, Cardiovascular/Hypertension, General Nutrition/Wellness, Weight Control

26

AREA DIETICIANS
Kara M Mitchell

MS RD LD
Duke Center for Living 1300 Morreene Rd

Durham, NC 27710
Phone: (919) 660-6818 Email: mitch068@mc.duke.edu
Areas of Practice:
Individual Counseling, Group Counseling, Programs/Workshops Cardiovascular/Hypertension, Diabetes, General Nutrition/Wellness, Vegetarian, Weight Control

27

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

FITNESS CENTERS
The Wellness Center at Meadowmont View Website 100 Sprunt St Chapel Hill, NC 27517 phone (919) 966-5500 World-Renowned Residential Program-- Duke

University Diet and Fitness Center

1-800-235-3853 http://www.dukehealth.org/Services/DietAndFitness/A

bout/index/DFC%20Brochure%20Inside.pdf
Check with your physician be for starting any physical fitness program
29

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. 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

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

Signs & Symptoms of Strokes

Sudden numbness or weakness Sudden confusion, trouble speaking or

understanding Sudden trouble seeing Sudden trouble walking, dizziness, or loss of balance or coordination Sudden, severe headache
32

Thank You

33

Resources
American Heart Association [AHA]. (2008). Diet and Nutrition. Site accessed on September 29, 2008 at http://americanheart.org/presenter.jhtml?identifier=1200010 American Heart Association. (2008). Personal risk assessment form. Accessed on September 12, 2008 at http://www.strokeassociation.org/presenter.jhtml?identifier=3034972 American Heart Association [AHA], (2008). Stroke risk factors. Site accessed on September 29, 2008 at http://www.americanheart.org/presenter.jhtml?identifier=9217 American Heart Association [AHA]/American Stroke Association [ASA]. (2007). Lets talk about lifestyle changes to prevent str oke. Site accessed on September 29, 2008 at http://www.strokeassociation.org/downloadable/stroke/1219770019473Lifestyle%20Chgs%20to%20Prevent%20Stroke.pdf American Stroke Association [ASA]. (2008). Converging risk factors. Site accessed on September 29, 2008 at http://www.strokeassociation.org/presenter.jhtml?identifier=3027394

American Stroke Association [ASA]. (nd). Stroke risk awareness survey. Site accessed on September 29, 2008 at http://www.strokeassociation.org/downloadable/stroke/1130509929967PTES%20Risk%20Assessment%20Card.pdf
Dufresne, J. & Greene, V. (1990). Medication regimens: Causes of non-compliance. Department of Health and Human Services: Offices of Inspector General. Accessed on October 6, 2008 at http://www.oig.hhs.gov/oei/reports/oei-04-89-89121.pdf Every Day Health Network. (2008). Stroke center: Blood pressure guidelines Accessed on October 27, 2008 at http://www.everydayhealth.com/publicsite/index.aspx?puid=1c66ebdb-25c5-4042-bd9b051cb3f9e623&xid=gslp&s_kwcid=blood%20pressure|2525548814&gclid=CMyQ8Z6rzZYCFQS7sgodBWgGzQ Kaplan, N. &Rose B. (2008). What is goal blood pressure in treatment of hypertension? Retrieved on October 19, 2008 from Up to date at -Chapel Hill. Sebastian, J. G. in M. Stanhope & J. Lancaster (2008). The nurse leader in the community. Public health nursing: Population-centered health in the community. (7th ed.). St. Louis, MO: Mosby. UNC

care

34