NURSING PRACTICE: FOCUS ON INTEGRATED CARE

Name: Bhima Devi Poudel Adhikari

Student Number: 220179000

Unit Code: HSNS263

Writing Assignment-2

part A (Essay)

Unit Co-Ordinator: Rikki Jones

Due Date: 5 May 2019

Word Count: 1078 words

According to Heart Foundation of Australia (2017), hypertension is also called as high blood

pressure (HBP) where the pressure exerted by the arteries is considerably high (systolic blood

pressure (SBP) ≥ 140 mm of Hg and diastolic blood Pressure (DBP) ≥ 90 mm of Hg). The symptoms

of HBP may not be identified or noticed until the disease gets worse so, it is also named as the

silent killer. HBP is one of the most common cardiovascular disease (CVD) in Australia.

Incidence and prevalence:

HBP has become one of the largest health issues in Australia. In 2003, 42 out of every 100 cases

of CVD’s were hypertension and was became leading burden in Australia (Heart Foundation,

2017). In 2011-2012, almost 1 in 3 (31.6%) Australian adults were affected by HBP (SBP and DBP

≥ 140/90 mmHg) or were taking medications (Australian Bureau of Statistics (ABS), 2013).

Similarly, in 2014/2015, 34% Australian adults age ≥ 18 were suffered from HBP where 2/3rd of

them (68%) were unmanaged high BP (Heart Foundation, 2017), among which more male were

affected than female (24.4% and 21.7 % respectively) while the percentage of measured HBP in

Australia increased with age. In 2012-13, ABS (2014) added that 20% (1 in 5) of Aboriginal and

Torres Strait Islander age ≥ 18 were found with HBP. It also reported that indigenous people were

more likely to suffer from measured HBP than non-indigenous Australians.

Causes and Risk Factors:

Kaplan (2010) stated that the exact cause of high BP is not known, however heredity, obesity,

age, smoking, psychological stress, poor diet, salt intake, certain medications, underlying diseases

and physical inactivity may be the risk factors of HBP. In contrast, Falkner (2006) stated that there

is no immune against HBP and it may be measured in young thin people without having any family

history. Janus, Bunker, Kilkkinen, Namara, Philpot, Tideman and Dunbar (2008) revealed that

unmanaged diet and childhood obesity are the main causes of HBP especially in Australia.

American Heart Association (AHA) (2017) divided the causative factors into modifiable and non-

modifiable.

Modifiable causative factors can be controlled which includes obesity, lack of exercise, unhealthy

diet (high in sodium), smoking, alcohol consumption, sleep apnea, stress, high cholesterol level

and Diabetes mellitus (Kaplan, 2010). Non-modifiable factors are out of control such as age, sex,

family history or ethnic backgrounds (AHA, 2017). The risk of HBP is increased with increasing age

and more male are likely to have HBP than female (Heart Foundation, 2017). Similarly, adults

with family history of HBP have higher chance to develop HBP than without family history

(Kaplan, 2010). Ethnic background also plays a key role to develop HBP for example Australian

Aboriginals, Inuit population of Canada and black Americans have been shown more prevalent

to HBP (ABS, 2014; Hackam, Khan, Hemmelgarn, Rabkin, Touyz, Campbell and Quinn, 2010;

Krause, Lovibond, Caulfield, McCormack & Williams, 2011).

Grades of HBP:

Depending on the range of pressure exerted by the blood on the arteries, High BP is divided into

three grades (Krause, et al., 2011; Mancia, 2005). Mancia (2005) stated that in grade 1

hypertension (mild) SBP is 140-159 mmHg and DBP is 90-99 mmHg, grade 2 HBP (Moderate)

where systolic BP is 160-179 mmHg and diastolic BP is 100-109 mmHg, grade 3 HBP (severe) is

represented by ≥180 SBP and ≥110 DBP (Krause et al., 2011). In addition, a condition with

increased systolic BP >140 with normal diastolic BP (<90) is named as isolated systolic HBP, and

in isolated systolic BP with widened pulse pressure, SBP is >160 where DBP is <70 mmHg (Krause

et al., 2011). A critical situation which requires immediate medical response is Hypertensive crisis

where both systolic and diastolic BP is >180 and > 120 mmHg respectively (AHA, 2017).

Management:

Management of each stages of HBP is vital and depends on the complete clinical assessment of

CV system and diagnosis of condition which may help to identify the stages of HBP {National

Institute for Health and Care Excellence (NICE), 2016}. Mild and moderate HBP can be maintained

through the control of modifiable causative factors followed by lifestyle modification includes,

modification of diet, involving in physical activities, reducing salt intake, smoking cessation and

reduce alcohol intake (Kaplan, 2010; AHA, 2017).

AHA (2016) acknowledged that diet management could be possible by having the food rich in

fruits, vegetables, low fat dairy products, nuts and seeds along with reduced saturated and trans-

fat. Hackam et al. (2010) concluded that salt intake of 1500 mg/day for children and adults <50

years and 1300mg/day for adults >50 years is adequate to prevent development of mild and

moderate HBP. Physical activity such as running, jogging or aerobic exercises can reduce 5-

10mmHg of systolic BP (Barrios & Calderón, 2010). Nicotine from tobacco and cigarette can cause

vasoconstriction and increase BP and is same in alcohol consumption. So, limitation of smoking

and alcohol consumption help to decrease BP (NICE, 2016). In case of unsuccessful with life style

changes in grade 1 HBP with low risk of CVD, Antihypertensive drugs should be provided (NICE,

2016).

Severe (grade 3) hypertension is difficult to control only by life style changes as blood pressure

is very high. Antihypertensive drug therapy is vital to control BP and prevent complications (Heart

Foundation of Australia, 2017). High risks of developing various CVDs and multiple organs failure

are the results of prolonged untreated BP (Hackam et al., 2010). Therefore, management of HBP

as soon as possible is crucial. NICE (2016) suggested to provide antihypertensive medication

followed by life style modification to manage isolated systolic BP as it may also develop various

CVDs such as stroke, heart attack and other complications. Moreover, isolated systolic HBP with

widened pulse pressure can be treated with antihypertensive drugs and life style modification

(Barrios & Calderón, 2010).

Education plane for Trevor and Katrina:

Goals Interdisciplinary Interventions Citations

Team

Maintain Physiotherapist Educate an importance of Kaplan (2010)

healthy daily exercise to reduce stress

Community nurse Hackam et al. (2010)
lifestyle e.g. e.g. yoga or meditation.

regular Registered nurse Janus et al. (2010)

Educate the idea of doing
exercise
aerobics and anaerobic

exercise.

Suggest patients to involve in

playing sports or games with

friends and family member

during spare time.

Daily moderate exercise of 30

to 60 minutes is

recommended for Trevor.

Maintain Dietician Educate patients about DASH AHA (2017)

healthy diet (Dietary Approach to Stop

Registered nurse Dorner et al. (2013)
Hypertension) which includes:
 the food rich in calcium and
Community nurse Hackam et al. (2010)
potassium, fruits and

Doctor vegetables, whole grains,

skinless poultry and fish, nuts

and legumes, and low-fat milk

products.

Try to involve all family

members along with patients

in selection and preparation of

healthy foods.

Suggest the patient to limit

intake of saturated fats,

sodium 1500mg/day (for

children and adults < 50 years)

and 1300mg/day (for adult

>50 years), red meat and

sweet beverages.

Both Katrina and Trevor along

with their family members

should focused on low salt,

 green vegetables and fresh

fruits.

Advise Trevor to limit smoking,

alcohol consumption of 14

standards/week and increase

the amount of water intake.

Reduce stress Clinical psychologist Advise the patient regarding Varvogli & Darviri

and promote disease condition, relaxation (2011)

Registered nurse
health therapy and life style changes.
Heart Foundation
Social health
Bring patients and their family (2017)
workers
members together to provide

holistic aspects of care.

Provide social, emotional and

psychological support to

Trevor and Katrina along with

their family.

Reduce body Physiotherapist Advice patients to limit daily Barrios & Calderón

weight calorie intake and do regular (2010)

Registered nurse
 physical activity to maintain
Community nurse Dorner et al. (2013)
BMI within the normal range

from 20-24 and < 85 waist

circumferences.

Reduction of Cardiologist Explain the importance of Heart Foundation

cardiac proper checkup and regular (2017)

Registered nurse
complications follow up to deter cardiac
NICE (2016)
Community health complications.

nurse
Provide awareness regarding

heart diseases and its

complications in both

indigenous and non-

indigenous society.

Prescription of Physician Antihypertensive medication Hackam et al. (2010)

medication should be prescribed (e.g.

Cardiologist Kaplan (2010)
glyceryl Trinitrate 600

microgram sublingual was Barrios & Calderón

prescribed for Trever to (2010)

maintain his BP) and Aspirin

300mg oral to reduce dull

aching pain.

Antibiotic such as Amoxicillin

was prescribed to Katrina for

staphylococcal infection which

may develop rheumatic fever

and later other types of heart

diseases.

All information regarding drug

dose, time, route and its side

effects should be provided to

both Trevor and Katrina along

with their family members.

Furthermore, encourage

patients and family members

for regular checkup and follow

up.
 Prevent family Registered nurse Explain the family members Hackam et al. (2010)

members regarding genetic CVDs.

Community health Heart foundation
from further
nurse Encourage regular and follow (2017)
cardiac
up checkup for both Trevor
complications. Social health
and Katrina’s families because
workers
they come under the risk

group.

From the given case study, Trevor is having atorvastatin which act as HMG CoA reductase

inhibitor mainly prescribed for patient with high risk of CVD with DM and atherosclerosis

(Lennernäs, 2003). One month later, GTN was prescribed to Trevor as he had mild hypertension

(Barrios & Calderón, 2010). Dietary management and physical activities should be suggested to

him as he is under the high risks of further developing HBP. According to diabetic Australia (2015),

every six months of BP measurement is recommended to Trevor.

Secondly, Katrina is from Indigenous group of Australia which has high prevalence of HBP than

other Australians (ABS, 2014). In addition, Amanda (Katrina’s mother) is on Avapro for her

hypertension which is another risk of developing hypertension to Katrina (Kaplan, 2010).

Education regarding drug dose and its side effects such as weight loss, slight headache, vomiting

or sometimes swellings should be provided to Amanda and their family members. Dietary

management and reducing salt intake and alcohol consumption are main areas of education plan

for Katrina and her family (Hackam et al., 2010).

Reference:

American Heart Association (2017). Managing Blood Pressure with a Heart-Healthy Diet.
Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/changes-
you-can-make-to-manage-high-blood-pressure/managing-blood-pressure-with-a-heart-
healthy-diet

Australian Bureau of Statistics (2013). Australian Health Survey: Health service Usage and
health related actions, 2011-12. Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/lookup/322DB1B539ACCC6CCA257B39000F
316C?

open document

Australian Bureau of Statistics (2014). Australian Aboriginal and Torres Strait Islander Health
Survey: First Results, Australia, 2012-13. Retrieved from
https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4727.0.55.006~2012
%E2%80%9313~Main%20Features~Measured%20high%20blood%20pressure~15

Barrios, V., Escobar, C., & Calderón, A. (2010). Clinical profile and management of patients with
hypertension and chronic ischemic heart disease according to BMI. Obesity, 18(10),
2017-2022.

Diabetic Australia (2015). Blood Pressure. Retrieved from

https://www.diabeticsaustralia.com.au/blood-pressure

Dorner, T. E., Genser, D., Krejs, G., Slany, J., Watschinger, B., Ekmekcioglu, C., & Rieder, A.
(2013). Hypertension and nutrition. Position paper of the Austrian Nutrition Society.
Herz, 38(2), 153-162.

Falkner, B. (2006). Hypertension in children. Pediatric Annals, 35(11), 795-801. Retrieved from
http://search.proquest.com.ezproxy.une.edu.au/docview/217546408?accountid=17227
Hackam, D. G., Khan, N. A., Hemmelgarn, B. R., Rabkin, S. W., Touyz, R. M., Campbell, N. R., ... &
Quinn, R. R. (2010). The 2010 Canadian Hypertension Education Program
recommendations for the management of hypertension: part 2–therapy. Canadian
Journal of Cardiology, 26(5), 249-258.

Heart Foundation (2017). Heart Disease in Australia: High Blood Pressure. Retrieved from
https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-
australia/high-blood-pressure-statistics

Janus, E. D., Bunker, S. J., Kilkkinen, A., Namara, K. M., Philpot, B., Tideman, P., ... & Dunbar, J.
A. (2008). Prevalence, detection and drug treatment of hypertension in a rural
Australian population: The Greater Green Triangle Risk Factor Study 2004–2006. Internal
medicine journal, 38(12), 879-886.

Kaplan, N. M. (2010). Kaplan's clinical hypertension. Lippincott Williams & Wilkins.

Krause, T., Lovibond, K., Caulfield, M., McCormack, T., & Williams, B. (2011). Management of
hypertension: Summary of NICE guidance. BMJ: British Medical Journal (Online), 343 doi:
https://doi.org/10.1136/bmj.d4891

Lennernäs, H. (2003). Clinical pharmacokinetics of atorvastatin. Clinical pharmacokinetics,

42(13), 1141-1160.

Mancia, G. (2005). Proceedings of the symposium: 'A straightforward strategy for all grades of
hypertension'. Journal of Human Hypertension, 19, S1. doi:
http://dx.doi.org.ezproxy.une.edu.au/10.1038/sj.jhh.1001885

National Institute for Health and Care Excellence (NICE) (2016). Hypertension in adults:
diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/cg127

Varvogli, L., & Darviri, C. (2011). Stress management techniques: evidence-based procedures
that reduce stress and promote health. Health science journal, 5(2), 74.