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BNURS20 Nursing

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Course Code: BNURS20
University: Holmesglen Institute

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Country: Australia

Question:
Discuss about the Changes in Blood Pressure Classification.
 
 
Answer:

Introduction:
Hypertension is the most prevalent disease in Australia. Hypertension mainly occurs due to irregular food habit and unhealthy lifestyle. Hypertension can be classified into different categories based on the level of blood pressure. There are varied complications and different treatment options are associated with each category of hypertension. In this essay case of Amanda and Jim is discussed. Amanda and Jim belong to different grades of hypertension. Hence, different goals should be set and different treatment should be given to Amanda and Jim.    Educational plan for control of hypertension in case of Amanda and Jim is also discussed. This educational plan should comprise of education for food, physical exercise, smoking and alcohol consumption, psychological and social issues, blood pressure monitoring and medication.      
Prevalence of hypertension:
High blood pressure (≥ 140/90 mmHg) is the most frequently treated disease in Australia. In Australia, approximately 9 out of 100 patients are hypertensive patients treated at general practitioner. Majority of these patients are with chromic hypertension and only 4.5 % patients are newly diagnosed patients. Prevalence of hypertension is slightly higher in men (34 %) as compared to the women (29 %). 50 % patients of hypertension are generally associated with other heart and cardiovascular complications and approximately 11 % are associated with diabetes. In Australia, it is observed that high blood pressure increases with the age of the person (ABS, 2013).
Primary hypertension can be mainly caused due to the smoking, being overweight or obese, alcohol consumption, lack of exercise, unhealthy diet comprising of high salt and saturated fat and family history of high blood pressure. Secondary hypertension can be mainly caused due to kidney disease, endocrine disease and narrowing of aorta. Secondary hypertension can also be caused due to steroidal drugs, contraceptive pill and pregnancy (Harrison et al., 2017).
Grading system for hypertension:
Blood pressure can be graded in three categories like grade 1 (SBP 140-159 or DBP 90-99), grade 2 (SBP 160-179 7or DBP 100-109) and grade 3 (SBP ≥ 180 or DBP ≥ 110). Grade 1 hypertension mainly occurs due to circulatory, vascular or renal response to environmental and  genetic stimuli. In grade 1 hypertension, there are structural and functional alterations in heart and arteries of the patient. There can be occurrence of more than one risk factors in grade 1 hypertension patients. There would not be target organ damage in patients with grade 1 hypertension. Amanda may be suffering through grade 1 hypertension. Grade 1 hypertension patients should be assessed to identify early stage cardiovascular marker in the patient and identify specific treatment to attenuate these markers (Trana and Giangb, 2014; Kim et al., 2017). Patients of grade 1 hypertension should be traded with antihypertensive drugs like angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor antagonists. For Amanda also same drug was prescribed.
Grade 2 hypertension is considered as the progressive disease. Grade 2 hypertension can occur due to inability of heart and cardiovascular system to control blood pressure. This may occur due to the persistent structural and functional changes in the heart and arteries. Grade 2 hypertension can be associated with the more than two risk factors. If grade 2 hypertension doesn’t controlled before certain level it may lead to the target organ damage. This susceptibility of the target organ damage in grade 2 patients should be identified through research studies. This would be helpful to manage the condition effectively and in cost effective manner. Jim might have grade 2 hypertension, because he was diagnosed with type 2 diabetes mellitus and atherosclerosis. In grade 2 hypertensive patients, there is moderate to high rise in blood pressure accompanied by at least two target organ damage. Hence in these patients antihypertensive drugs like ACE inhibitors or angiotensin II receptor blockers or beta blockers or calcium channel blockers or renin inhibitors can be used (Varounis et a., 2017; Yoon et al., 2015). Along with antihypertensive drugs, there should be administration of medication for target organ pathology. In patients with hypertension associated with atherosclerosis, there should be administration of statins which lowers levels of cholesterol. For Jim also, Lipitor was prescribed. Moreover, there was clear indication of organ damage in Jim.
 
Patients with grade 3 hypertension are apparently associated with the target organ damage. Patients of this category generally exhibit sustained cardiovascular events irrespective of the level of blood pressure. Aging and association of other risk factors generally exaggerate condition of the grade 3 hypertensive patients and it may lead to the morbidity and mortality. Special emphasis should be given for reducing cardiovascular risk factors in grade 3 hypertensive patients. In patients with grade 3 hypertension, emergency antihypertensive drugs like nitrates should be administered along with the other antihypertensive drugs. In addition, medications for other risk factors should be administered in patients with grade 3 hypertension. Modifiable features of hypertension comprises of smoking, physical activity, low density lipoprotein (LDL), triglyceride levels, obesity, body mass index (BMI), diabetes mellitus and psychological stress. Non-modifibale features of hypertension comprises of family history, age, gender and genetic factors (Materson et al., 2014).                         
Nurse should set different goals for Amanda and Jim. Nurse should set goal for Amanda to reduce her blood pressure to SBP 130-149 or DBP 80-89. Nurse should set goal for Jim to reduce his blood pressure to SBP 140-159 7or DBP 90-99. Nurse should set goal for Jim to reduce his cardiovascular complications and manage his type 2 diabetes mellitus condition. Nurse should give special attention for diastolic pressure in case of Jim because there should not be more reduction in diastolic pressure in patients with diabetes.
Educational Plan:

Food

Nurse should educate Amanda and Jim for dietary habit to control hypertension. Nurse should advise them to eat food comprising of fruits, vegetable, whole grains, low-fat dairy products and fish. Nurse should advise them to consume more amount of potassium and fewer amounts of saturated fats. Specifically Jim, should avoid sugar containing products and food containing saturated fatty acids because he was diagnosed with type 2 diabetes mellitus and atherosclerosis. Nurse should prepare diet plan for Amanda and Jim, in consultation with dietician. These products exaggerate blood pressure in hypertension patients. Nurse should advise them to consume not more than 2000 mg per day salt because salt has negative impact on hypertension and its related risks like diabetes and kidney disease (Chen et al., 2014, Khan et al., 2014).

Physical exercise

Nurse should advise them to keep control on their body weight. Due to increase in body weight, BMI also can increase. Increased BMI is one of the prominent risk factor for the hypertension. Amanda should give special attention to control her body weight because her BMI is 28. BMI in this range indicates, Amanda is overweight. For maintaining optimum body weight both Amanda and Jim should increase their physical activity. Amanda should be very particular about physical activity because she should reduce her body weight. Amanda and Jim should perform approximately 150 minutes aerobic activity per week. Physical activity on the regular basis would be helpful for Amanda and Jim for controlling hypertension, managing stress due to increased blood pressure, reducing risks associated with hypertension and reducing body weight. Nurse should prepare exercise schedule for Amanda and Jim in consultation with exercise physiologist (Lauziere et al., 2013; Zinat Motlagh et al., 2015).

Smoking and alcohol consumption

Nurse should advise them to avoid alcohol because alcohol can increase blood pressure in normal persons also. Nurse should advise them to avoid smoking because smoking can produce injuries to blood vessels and facilitate hardening of the blood vessels (Lauziere et al., 2013; ; Zinat Motlagh et al., 2015)

Psychological education

Nurse should advise them to live stress free life. They should practice muscle relaxation and deep breathing for living stress free life. Physical activity and sufficient sleep also would be helpful in reducing stress (Lauziere et al., 2013; ; Zinat Motlagh et al., 2015)

Blood pressure monitoring

Nurse should teach them to monitor blood pressure at home. She should educate them to check blood pressure prior to and after medications. Nurse should incorporate cardiovascular technologist for teaching them measurement of blood pressure. This would be helpful in assessing effectiveness of medications. Nurse should also advise them to consult doctor immediately, if they observed noteworthy variation in their blood pressure (Lauziere et al., 2013)    

Social education

Both Amanda and Jim should link themselves to the different community healthcare societies. In these societies they can share their experience and gain knowledge about the disease. It would be helpful for them for self management of the disease. It would also be helpful in relieving psychological issues like stress and burden of the disease. They should consult social worker to get link themselves to community healthcare societies (Park et al., 2011).   

Education about Lipitor and Avapro

Nurse should educate Jim for Lipitor consumption. Nurse should advise him to take this drug once daily at the same time every day. Nurse should advise him to take regular blood tests for cholesterol and triglycerides. Nurse should also advise him to take liver function test. Nurse should advise him to inform healthcare provider about Lipitor consumption, if doctor wishes to prescribe him medicines for acute illness. Nurse should inform him that there may be nausea, vomiting and joint pain due to consumption of this medication. Nurse should tell him that, he should report muscle pain, weakness, fever, swelling and change in color of urine during consumption of Lipitor (Barber et al., 2012). Nurse should educate Amanda that she should not consume Avapro, if she has diabetes. Nurse should tell her that she should not use Avapro, if she is dehydrated. Nurse should inform her that she should monitor blood pressure on regular basis during consumption of Avapro. If she didn’t find improvement in blood pressure, she should consult doctor. She should not stop taking Avapro, even if she found improvement in her blood pressure. She should keep Avapro away from heat and light. Nurse should tell her that she should stop alcohol and potassium supplements while taking Avapro. Both Amanda and Jim should consult pharmacist to get more information about their respective drugs (Barber et al., 2012).

Conclusion:
In Australia, highest number of treatments at general practitioners is for hypertension. Male are more affected with hypertension as compared to the female. There are different treatment options are available for different grades of hypertension. Along with medications use change in food habit and lifestyle should be incorporated in the management of hypertension. Amanda and Jim are having different grade of hypertension. There should be different goals and education plan for Amanda and Jim in hypertension management. With effective implementation of medical, social, psychological and physical interventions, hypertension in Amanda and Jim can be effectively controlled.
 
References:
Australian Bureau of Statistics (ABS). (2013). Hypertension. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/lookup/322DB1B539ACCC6CCA257B39000F316C?opendocument. On 17.04.2017.
Barber, P., Parkes, J., and Blundell, D. (2012). Further Essentials of Pharmacology for Nurses. McGraw-Hill Education. 
Chen, Y., Hu, S., Li, Y., Yan, B., Shen, G., and Wang, L. (2014). Systematic review of hypertension clinical practice guidelines based on the burden of disease: a global perspective. Journal of Evidence-Based Medicine, 7(1), 52-9.
Kim, S., Lewis, J.R., Baur, L.A., Macaskill, P., and Craig, J.C. (2017).  Obesity and hypertension in Australian young people: results from the Australian Health Survey 2011-2012. Internal Medicine Journal, 47(2), 162-169.
Khan, M.S., Bawany, F.I., Mirza, A., Hussain, M., Khan, A., and Lashari MN. (2014). Frequency and predictors of non-compliance to dietary recommendations among hypertensive patients. Journal of Community Health, 39(4), 732-6.
Lauziere, T. A., Chevarie, N., Poirier, M., Utzschneider, A., & Belanger, M. (2013). Effects of an Interdisciplinary Education Program on Hypertension: A Pilot Study. Canadian Journal of Cardiovascular Nursing, 23(2), 12-19.
Materson, B.J. (2014). Diagnostic evaluation: Classification of hypertension. Journal of the American Society of Hypertension, 8(9), 680-1.
Park, Y., Song, M., Cho, B., Lim, J., Song, W., & Kim, S. (2011). The effects of an integrated health education and exercise program in community-dwelling older adults with hypertension: A randomized controlled trial. Patient Education and Counseling, 82(1), 133-137.
Trana, T.M. and Giangb, N.M. (2014). Changes in blood pressure classification, blood pressure goals and pharmacological treatment of essential hypertension in medical guidelines from 2003 to 2013. IJC Metabolic & Endocrine, 2, 1–10.
Varounis, C., Katsi, V., Nihoyannopoulos, P., Lekakis, J., and Tousoulis, D. (2017). Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature. Frontiers in Cardiovascular Medicine, 3(51), doi: 10.3389/fcvm.2016.00051.
Yoon, S.S., Gu, Q., Nwankwo, T., Wright, J.D., Hong, Y., and Burt, V. (2015). Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension, 65(1), 54-61.
Zinat Motlagh, S.F., Chaman, R., Ghafari, S.R., et al., (2015). Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran. International Journal of Hypertension, 897070, doi: 10.1155/2015/897070.

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