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Liz Rhodes, RN

ECU Student Nurse


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PROBLEM
 Uncontrolled blood pressures related to medications,
poor diet, and decreased physical activity

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

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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
 
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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=44
73

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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).

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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
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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

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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

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Blood Pressure Guidelines
Category Systolic BP (mm Hg) Diastolic BP (mm Hg) Treatment recommendations

Normal Less than 120 Less than 80 Lifestyle changes encouraged

Lifestyle changes necessary


Prehypertension 120–139 80–89
Drugs for compelling indications*

Lifestyle changes necessary


Thiazide diuretic for most people
Stage 1 hypertension 140–159 90–99 May also consider other blood pressure drugs alone or in
combination
Drugs for compelling indications*

Lifestyle changes necessary


Stage 2 hypertension 160 or higher 100 or higher Two or more blood pressure drugs for most people
Drugs for compelling indications*

*Compelling indications: diabetes, chronic kidney disease, previous heart attack, congestive heart failure, previous stroke, high cardiac risk

Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example,
150/85 mm Hg is classified as stage 1 hypertension, not prehypertension.

Source: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, December 2003.

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Why is Blood Pressure Management
For 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

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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.

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

 Obesity

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PREVENTION
Eating a well balanced diet
Exercise
Compliance with medications
Management of:
 Diabetes
 HTN

 Heart disease

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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.

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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

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Stroke is a Medical Emergency

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ABCs of Preventing Heart
Disease, Stroke and Heart Attack

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http://www.strokeassociation.org/presenter.jhtml?id
entifier=3034972

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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.

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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.
 
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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.
 

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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.
 

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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

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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

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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

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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

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FITNESS CENTERS
Carolina Fitness
503-C West Main St
Carrboro, NC 27510
phone (919) 960-9910

O2 Fitness
View Website
300 Market Street, #110 (Southern Village),
Chapel Hill, NC 27516
phone (919) 942-6002

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FITNESS CENTERS
The Wellness Center at Meadowmont
View Website
100 Sprunt St
Chapel 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/A
bout/index/DFC%20Brochure%20Inside.pdf

 Check with your physician be for starting any physical fitness program
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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)
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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 911


immediately! (See the following signs & symptoms)

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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

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Thank You

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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.

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