Page 841 - Cardiac Nursing

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Hyper
C HAPTER 35 / Hypertensiontension 817
CHAPTER 35
DISPLAY 35-5 Preventing, Monitoring, and Addressing Problems of Adherence
Educate About Conditions and Treatment cycling, which may increase cardiovascular morbidity
and mortality.
Assess patient’s understanding and acceptance of the diag-
nosis and expectations of being in care. Provide Reinforcement
Discuss patient’s concerns and clarify
misunderstandings. Provide feedback regarding blood pressure level.
Inform patient of blood pressure level. Ask about behaviors to achieve blood pressure control.
Agree with patient on a goal blood pressure. Give positive feedback for behavioral and blood pressure
Inform patient about recommended treatment and provide improvement.
specific written information. Hold exit interviews to clarify regimen.
Elicit concerns and questions and provide opportunities for Make appointment for next visit before patient leaves the
patient to state specific behaviors to carry out treatment office.
recommendations. Use appointment reminders and contact patients to confirm
Emphasize need to continue treatment, that patient cannot appointments.
tell if blood pressure is elevated, and that control does Schedule more frequent visits to counsel nonadherent
not mean cure. patients.
Contact and follow up patients who missed appointments.
Individualize the Regimen Consider clinician–patient contracts.
Include patient in decision making. Promote Social Support
Simplify the regimen.
Incorporate treatment into patient’s daily lifestyle. Educate family members to be part of the blood pressure
Set, with the patient, realistic short-term objectives for control process and provide daily reinforcement.
specific components of the treatment plan. Suggest small group activities to enhance mutual support
Encourage discussion of side effects and concerns. and motivation.
Encourage self-monitoring. Collaborate with Other Professionals
Minimize cost of therapy.
Indicate you will ask about adherence at next visit. Draw on complementary skills and knowledge of nurses,
When weight loss is established as a treatment goal, dis- pharmacists, dieticians, optometrists, dentists, and
courage quick weight loss regimens, fasting, or unscien- physician assistants.
tific methods, because these are associated with weight Refer patients for more intensive counselling.
From National High Blood Pressure Education Program (1994). The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (NIH Pub-
lication No. 93-1088). Bethesda, MD: U.S. Department of Health and Human Services.
BP is at or below goal, with the requirement that treatment should
also remain well tolerated. SUMMARY
Role of Health Care Organizations In summary, HTN is a common risk factor for cardiovascular, re-
Health care systems must be adequately resourced and structured nal, and cerebrovascular disease. HTN often occurs without
to deliver effective HTN treatment and prevention and to pro- symptoms and the cause is unclear in most cases. Effective treat-
mote public and professional education. 226 Specific strategies such ment of HTN includes lifestyle modification and pharmacologic
as providing education for both providers and patients, setting treatment. Although evidence-based guidelines for HTN preven-
standards of care, implementing computerized data systems, doc- tion, detection, and treatment have been widely promulgated,
umenting the impact of care on patient outcomes, and determin- HTN control rates remain suboptimal. Achieving further im-
ing which types of care are cost-effective while maintaining qual- provements in HTN control will require activated patients,
ity of life, that health care organizations can take to improve HTN providers, and healthcare organizations.
control are included in Table 35-9. 221
R EFEREN C E S
Role of the Community
Communities, including employers, can play an active role in 1. American Heart Association. (2008). Heart disease and stroke statistics—
e
HTN screening and education and promote and support health 2008 update. Dallas, TX: Author.
visits and follow-up care. 226 Community-based interventions in 2.Hajjar, I., & Kotchen, T. A. (2003). Trends in prevalence, awareness,
treatment, and control of hypertension in the United States, 1988–2000.
the United States and Europe have demonstrated that community JAMA, 290(2), 199–206.
action can reduce the risks of CVD. 238,239 The National High 3.Ong, K. L., Cheung, B., Man, Y. B., et al. (2007). Prevalence, awareness,
Blood Pressure Program provides resources to support the devel- treatment, and control of hypertension among United States adults
9
9
opment of community programs with the goals of raising aware- 1999–2004. Hypertension, 49, 69–75.
ness of HTN risk factors, supporting entry into the health care 4. World Health Organization, International Society of Hypertension Writ-
ing Group. (2003). World Health Organization (WHO)/International
system, and supporting individual’s efforts to follow their HTN Society of Hypertension (ISH) statement on management of hyperten-
treatment plans. 7 sion. Journal of Hypertension, 21, 1983–1992.