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

OBJECTIVES

not 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 followup 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

How can I tell if I have high blood

BLOOD PRESSURE

pressure?

High blood pressure usually has no symptoms. Many people have high blood pressure for years

without knowing it.

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=4
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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 African-Americans have high blood pressure, compared to 25 percent of

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 Problem with recalling prescription instructions from healthcare provider

Memory Loss

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 Systolic BP (mm Hg) Diastolic BP (mm Hg) Treatment recommendations Normal Prehypertension Less than 120 120139 Less than 80 8089 Lifestyle changes encouraged Lifestyle changes necessary Drugs for compelling indications* Stage 1 hypertension 140159 9099 Lifestyle changes necessary Thiazide diuretic for most people May also consider other blood pressure drugs alone or in combination Drugs for compelling indications*

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.

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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

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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.

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Modifiable Risk Factors of Strokes

High cholesterol Hypertension (high Alcohol

blood 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

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PREVENTIO N
Eating a well balanced diet Exercise Compliance with medications Management of:

Diabetes HTN Heart disease

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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.

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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
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Stroke is a Medical Emergency

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ABCs of Preventing Heart Disease, Stroke and Heart Attack

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

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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 low-fat dairy fruits, vegetables and whole20 grain, high-fiber foods is essential to good

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.

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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.

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TIPS
continued
Oils
Use olive, canola, corn, or safflower oil in

cooking. Use calorie-free, fat-free cooking spray to provide a non-stick 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.

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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

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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
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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

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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

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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
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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
Check with your physician be for starting any physical

fitness program

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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)

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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,

911 immediately!

call
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(See the following signs & symptoms)

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

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Thank You

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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 stroke. 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

Resources

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-bd9b-051cb3f9e623&xid=gslp&s_kwcid=blood%20press

Kaplan, N. &Rose B. (2008). What is goal blood pressure in treatment of hypertension? Retrieved on October 19, 2008 from Up to date at UNC -Chapel Hill. Sebastian, J. G. in M. Stanhope & J. Lancaster (2008). The nurse leader in the community. Public health nursing: Populationcentered health care in the community. (7th ed.). St. Louis, MO: Mosby.

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