Adult Hypertension Screening Standard of Care
Within Congregational Nursing
Background: Health issues are not new to the people of faith. From the monastic hospitals of the Middle Ages to the faith-based teaching hospitals of today, health and salvation has been the central mission of worshipping communities. Today, faith communities are being recognized anew as a valuable component of the health care system. Faith communities as social, cultural and religious institutions have always been providing health promotion services. People gather as communities of faith to mark major life events as well as for social support, personal and spiritual growth. Worshipping communities have an established social support function and structure. Through their social networks, members offer each other sustained mutual support of behavior change. The centrality and possibility of behavior change is recognized as crucial in the journey toward wholeness. Behavior change is critical in many preventive health efforts, which is an essential component of hypertension control.
Purpose: To reclaim the healing mission of the church. To promote wellness and wholeness by identifying individuals at risk for hypertension and to make appropriate referrals. To offer healing opportunities revealed in the process of health screening.
Policy: Blood pressure assessment, monitoring, support and education within congregational nursing is consistent with the standards and procedures recommended by the American Heart Association (Human Blood Pressure Determination by Sphygmomanometry) and National Institutes of Health, National Heart, Lung, and Blood Institute.
Preparation: Reserve a quiet room for the screening, so that you will be able to hear clearly, as well as hold confidential conversations.
I. Assessment
A. History
1. Listen to the human story that accompanies the blood pressure screening. Ministry takes place as we give our total attention to this person.
2. Medical History
a. Hypertension
b. Heart Disease
c. Heart Attack
d. Stroke
e. Kidney Disease
f. Diabetes
g. Obesity
h. Mental Status
i. Other
3. Family Medical History
a. Hypertension
b. Heart Disease
c. Heart attack
d. Stroke
e. Kidney Disease
f. Diabetes
g. Obesity
h. Other
4. Prescribed Medications
a. What medications are currently prescribed for you? – name, dose and frequency
b. How do you take them? – when and how much
c. How do you decide about taking your medications?
5. Over the counter and Herbal Medications
a. Yes or No?
b. If yes, what and amount per day?
6. Tobacco, Alcohol and Other Drug Use
a. Yes or No?
b. If yes, what and amount per day?
c. Years of use
7. Caffeine
a. Yes or No?
b. If yes, what and amount per day?
8. Nicotine
a. Yes or No?
b. If yes, what and amount per day?
c. Years of use
9. Dietary
a. Describe diet
b. Number of meals per day
c. Typical snacks
d. Who prepares meals?
e. Recent weight loss or gain?
10. Psychosocial factors that may influence hypertension control
a. Level of family support, family situation, educational and literacy level
b. Employment, working conditions, employment status, finances, insurance, drug coverage, utilization of health services, transportation
c. Self-care and learning readiness and barriers
11. Leisure and physical activity
12. Stress reduction strategies
B. Blood Pressure Measurement
1. Client factors
a. Body position
i. Seated with back supported and feet flat on the floor – relaxed and quiet for at least five minutes
ii. Arm bared and supported at heart level
b. Refrain from smoking for thirty minutes prior to measurement
c. Ask client not to talk during measurement
2. Equipment
a. Cuff
i. The width of the cuff should be no smaller than 40% of the circumference of the arm
ii. The length of the cuff should be at least 80% of the circumference of the arm. If the cuff is marked, use the range and index lines to determine the correct cuff length.
iii. Place the bladder center directly over the center of the brachial artery. The lower edge of the cuff should be placed 2 cm above the antecubital fossa. The cuff should be snug.
b. Sphygmomanometer – Take the measurement with a mercury manometer, an aneroid manometer that has been checked against a mercury manometer within the last six months or a validated electronic device.
3. Measurement
a. Make a palpatory estimate of the systolic blood pressure to determine the maximum inflation level.
i. Palpate the radial pulse.
ii. Inflate the cuff rapidly to about 70 mm. Hg; then increase the pressure in approximately 10 mm. Hg increments.
iii. Continue to increase the pressure until the pulse can no longer be felt. This is the palpatory estimate.
iv. Add 30 mm. to this reading to determine how far to pump the cuff when auscultating the blood pressure.
v. Deflate the cuff completely. Wait 30 seconds before proceeding.
b. Measure the blood pressure. Take the measurement in both arms at the first client encounter. Record both readings. Take subsequent readings in the arm with the higher reading. Significant differences (20 mm or more) should be brought to the physician’s attention.
i. Inflate the bladder rapidly to the predetermined level.
ii. As the pressure in the bladder falls, note the level of pressure on the manometer at the first appearance of repetitive sounds (Phase I).
iii. Note the muffling of the sounds (Phase IV).
iv. Note when the sounds disappear (Phase V).
c. Record the results.
i. Immediately record the systolic (Phase I) and the diastolic (Phase V).
ii. Record Phase IV, when sounds are heard nearly to a level of 0 mm. Hg. E.g. 120/80/0.
iii. In addition to blood pressure, record date, time, arm on which the measurement was made, subject’s position and the cuff size (when a non-standard cuff is used).
iv. Give a copy of the results to the client.
II. Intervention/Planning – Follow-up and Referral
A. Initial Screening
Blood Pressure
|
Systolic |
Diastolic |
Category |
Follow-up Recommended |
|
<120 |
<80 |
Normal |
Recheck in 2 years |
|
120-139 |
80-89 |
Prehypertension |
Lifestyle modification Recheck in 1 year |
|
140-159 |
90-99 |
Stage 1 Hypertension* (Mild) |
Confirm within 2 months and then refer |
|
160-179 |
100-109 |
Stage 2 Hypertension* (Moderate) |
Evaluate or refer to source of care within 1 month |
|
180-209 |
110-119 |
Stage 3 Hypertension* (Severe) |
Evaluate or refer to source of care within 1 week |
|
³210 |
³120 |
Stage 4 Hypertension* (Very Severe) |
Evaluate or refer to source of care immediately |
*Based on the average of two or more readings taken at each of two visits following an initial visit.
B. Scheduling
1. The scheduling of follow-up should be modified by reliable information about past blood pressure measurements, other cardiovascular risk factors or target-organ disease.
2. If the systolic and diastolic categories are different, follow the recommendations for the shorter time follow-up.
C. Education
1. Provide education about lifestyle modification to those who have high normal blood pressure and above. Areas to discuss include:
a. Weight reduction or maintenance of normal body weight.
b. DASH eating plan – Diet rich in fruits, vegetables and low-fat dairy products with reduced content of saturated and total fat.
c. Dietary sodium reduction.
d. Regular aerobic physical activity (e.g. brisk walking) at least 30 minutes per day, most days of the week.
e. Moderation of alcohol consumption. (Men: limit to 2 or fewer drinks per day; Women and lighter weight persons: limit to 1 or less drinks per day.)
f. Stress management, including prayer and meditation.
2. High blood pressure education can be given through workshops, classes or meetings.
3. Provide education about the adverse effects of hypertension if the condition is not treated.
4. Offer information about wellness and health promotion.
C. Follow-up
1. Talk with the client about who will contact the health care provider.
2. Contact the health care provider, if the client requests that you do so.
3. Provide information for the health care provider. The client may take it to the appointment or it can be mailed prior to the visit.
4. If the client does not have a health care provider, assist in finding one.
5. Schedule revisit for those with prehypertension and above.
III. Evaluation
A. Assess the level of the client’s understanding.
B. Were appointments kept?
C. Reevaluate blood pressure.
D. Evaluate life style changes.
E. Evaluate the need for advocacy.