Practicum Experience

In clinical settings, advanced practice nurses frequently use various strategies to treat and manage patients with hypertension and other cardiovascular disorders. These strategies often include pharmacologic and nonpharmacologic therapies, natural remedies, and/or changes in patient behavior. For hypertension patients, behavioral changes including increased exercise, healthier diet, and smoking cessation have proven to be particularly beneficial. However, it is important to recognize that treatment and management plans centered around changes in behavior often require greater patient commitment. This creates the need for patient-provider collaboration, as well as appropriate patient education. When patients are actively involved in their own care and better understand implications of their disorders, they are more likely to adhere to treatment plans.

To prepare:

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• Review Part 11 of the Buttaro et al. text and the National Heart Lung Blood Institute article in this week’s Learning Resources.
• Reflect on your Practicum Experiences and observations. Select a case from these experiences that involves a patient who presented with a hypertension problem. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
• Think about the patient’s history including drug treatments and behavioral factors such as diet, exercise, smoking, etc.
• Review the National Heart Lung Blood Institute article in the Learning Resources. Reflect on health promotion strategies for the patient. Consider ways to reinforce hypertension management.

By Day 3

Post a description of a patient who presented with a hypertension problem during your Practicum Experience. Explain the patient’s history including drug treatments and behavioral factors. Then, suggest two health promotion strategies for the patient. Include suggestions for reinforcing hypertension management.

National Heart Lung Blood Institute

http://www.nhlbi.nih.gov/files/docs/resources/heart/pphbp.pdf

A direct positive relationship between blood pressure and cardiovascular risk has long been recognized. This relationship is strong, continuous, graded, consistent, independent, predictive, and etiologically significant for those with and without coronary heart disease (CHD);1F,2F it has been identified in both men and women, younger and older adults, different racial and ethnic groups, and different countries; and applies to those with high-normal blood pressure as well as those with hypertension.1F,3F

Despite progress in prevention, detection, treatment and control of high blood pressure, hypertension remains an important public health problem. Based on the Third National Health and Nutrition Examination Survey (NHANES III), approximately 43 million noninstitutionalized U.S. adults, 18 years of age or older, met the criteria for diagnosis of hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medication) recommended in The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).4X,5Pr,6X Almost 13 million additional persons had been diagnosed as having hypertension by a health care professional but did not meet the previously mentioned JNC VI criteria.6X Approximately 20 million of the estimated 43 million persons with hypertension were not being treated with antihypertensive medication, and almost 12 million of the nearly 23 million for whom such medication was being prescribed had inadequately controlled hypertension.6X More than 23 million adults had high-normal blood pressure (130–139 mmHg systolic or 85–89 mmHg

diastolic), and almost 38 million had normal but above optimal blood pressure levels (120–129 mmHg systolic or 80–84 mmHg diastolic).

Primary prevention of hypertension provides an opportunity to interrupt and prevent the continuing costly cycle of managing hypertension and its complications.7Pr The purpose of this article is to update the 1993 National High Blood Pressure Education Program Working Group Report on Primary Prevention of Hypertension7Pr and to address the public health challenges of hypertension described in the JNC VI report.5Pr