Liz Rhodes, RN ECU Student Nurse

1. Liz Rhodes, RN ECU Student Nurse

2. PROBLEM • Uncontrolled blood pressures related to medications, poor diet, and decreased physical activity

3. GOAL • To motivate a change in behavior patterns and activities to control blood pressure for stroke prevention

4. OBJECTIVES • List four modifiable risk factors for strokes • State the importance of controlling blood pressure. • List different types of foods which are healthy and 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 follow-up 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

5. BLOOD PRESSURE • How can I tell if I have high blood 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=4473

6. 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).

7. 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 Caucasians

8. 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 • Memory Loss • Problem with recalling prescription instructions from healthcare provider

9. 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

10. Blood Pressure Guidelines

11. Why is Blood Pressure ManagementFor 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

12. 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.

13. Modifiable Risk Factors of Strokes • High cholesterol • Hypertension (high blood pressure) • Exercise • Diet • Tobacco • Doubles stroke risk • Increases blood pressure • Obesity • Alcohol • 4 oz. wine or equivalent may be protective • Diabetes • Cardiac Disease • Atrial Fibrillation • TIA/Prior stroke

14. PREVENTION • Eating a well balanced diet • Exercise • Compliance with medications • Management of: • Diabetes • HTN • Heart disease

15. 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 you’re a man or less than 50 mg/dL if you’re a woman. • ____ You don’t know your total cholesterol or HDL levels.

16. Risk assess cont. • BLOOD PRESSURE ____ Your blood pressure is 140/90 mm Hg or higher, or you’ve been told that your blood pressure is too high. ____ You don’t know what your blood pressure is. • PHYSICAL INACTIVITY ____ You don’t 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

17. Stroke is a Medical Emergency

18. ABCs of Preventing Heart Disease, Stroke and Heart Attack

19. http://www.strokeassociation.org/presenter.jhtml?identifier=3034972http://www.strokeassociation.org/presenter.jhtml?identifier=3034972

20. 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 whole-grain, high-fiber foods is essential to good health.

21. 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.

22. 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.

23. 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.

24. 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

25. 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

26. 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

27. 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

28. FITNESS CENTERS • Carolina Fitness • 503-C West Main StCarrboro, NC 27510 • phone (919) 960-9910 • O2 Fitness • View Website • 300 Market Street, #110 (Southern Village),Chapel Hill, NC 27516 • phone (919) 942-6002

29. FITNESS CENTERS • The Wellness Center at Meadowmont • View Website • 100 Sprunt StChapel 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/About/index/DFC%20Brochure%20Inside.pdf • Check with your physician be for starting any physical fitness program

30. 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)

31. 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, call 911immediately! (See the following signs & symptoms)

32. 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

33. Thank You

34. Resources • 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). Let’s 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 • 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%20pressure|2525548814&gclid=CMyQ8Z6rzZYCFQS7sgodBWgGzQ • 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: Population-centered health care in the community. (7th ed.). St. Louis, MO: Mosby.