Question

Clinical practice guidelines related to hypertension and the nurse’s role

Answer 1

CLINICAL PRACTICE GUIDELINES

In the general population aged greater than or equal to 60 years ,initiate pharmacologic treatment to lower BP at systolic blood pressure(SBP)>150 mmhg or equal to 150mmhg and diastolic blood pressure  (DBP)>90 mmhg or equal to 90 mmhg

IN general population less than 60 years initiate pharmacologic treatment to lower BP at SBP >140 MMHG OR EQUAL TO 140 or DBP >90MMhg to a goal SBP <140 MMHG AND GOAL DBP <90MMHG

HYPERTENSION should be diagnosed on the average of two or more accurate blood pressure measurments during two or more consultations with health care providers

THE ROLE OF NURSES AND NURSE PRACTITIONERS IN HYPERTENSION MANAGEMENT INVOLVE ALL ASPECTS OF CARE ,INCLUDING

1)detection ,referral ,and follow up - once BP is measured unrecorded the nurse analyses data to determine if the readings are in the normal or hypertensive range per site protocol.A system to flag records can help ensure that uncontrolled hypertension is recognized and treated.In addition nurses assess the patients level of cardio vascular risk.Nurses play an important role implementing referrals and educating patients regarding the purpose and importance of referral.Follow up between visits via telephone,mail or digital strategies can be effective to reinforce goals of entering and remaining in care and engaging in treatment.

2)diagnosis and medication management

Nurses are also responsible for the diagnostic and pharmacological aspects of hypertension management using well defined protocol based on national treatment guidelines.

3)patient education

Nurses actively engage patients in care using a combination of strategies to prevent,recognize and respond to adherence problem and there by minimizing the long term adherence and BP control.

Educate about conditions and treatment

Inform patients about blood pressure level .

Establish patients with a goal BP

Inform patient about recommended treatment providing specific oral and written information

Elicit concerns and questions and provide opportunity for the patient to state specific behaviors to carry out treatment recommendations.

Emphasize need to continue treatment.

Teach self monitoring skills

4)coordination of care

Long term maintenance of hypertension control continual monitoring of BP refilling of prescriptions,provision of counseling and reinforcement of behavior change efforts and titration of therapy as indicated.Nurses are skilled building and maintaining both informal and formal collaborative linkages among providers,resources and services withing and external to their practice setting.

5)performance measurment and quality improvement

The universal need to measure and improve the hypertension care process and outcome is well established.It is the nurse in the hypertension care setting who has responsibility for leading these efforts.With the expanding evolution of health information technologies,strategies such as electronic health records,registry databases,telehealth,digital heath and the using the mobile computing and communication technologies are increasingly deployed by the nurse and the other members of healthcare team as tools to facilitate improvements in health behaviors and hyper tension controlls.