1. The Nurse’s Role in Patient Education

2.  define prehypertension, hypertension stage I and hypertension stage II according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  describe lifestyle modifications that can reduce blood pressure.  list at least 2 recommendations regarding OTC drug and supplement use for older adults who take medication for hypertension.  identify classes of antihypertensive medications that interact with grapefruit.  synthesize and apply information learned to case studies.

3.  Navigate to http://www.nhlbi.nih.gov/guidelines/hypert ension/express.pdf http://www.nhlbi.nih.gov/guidelines/hypert ension/express.pdf  Read pages 18-19  Take note of current hypertension definitions

4.  Navigate to http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf  Read pages 18-22  Consider possible results of uncontrolled hypertension and how to present that information to a patient newly diagnosed with hypertension.

5.  Navigate to http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf http://www.nhlbi.nih.gov/guidelines/hypertension /express.pdf  Read pages 23-24  Navigate to http://eurheartj.oxfordjournals.org/content/32/24 /3081.short and skim this article. http://eurheartj.oxfordjournals.org/content/32/24 /3081.short  Navigate to http://dashdiet.org/ and peruse this website.http://dashdiet.org/  From these activities, note lifestyle modifications you would recommend to a person newly diagnosed with prehypertension.

6.  Diuretics are especially concerning for use with those in the geriatric population.  This population is at risk for hypotensive reactions, specifically regarding orthostatic hypotension and resulting falls.  It is important for the nurse to emphasize to the patient the importance of changing positions slowly. For example, getting out of bed in stages: sitting up, dangling feet over the edge, standing carefully and taking lots of time for each stage.  It is also important to emphasize that the patient alert the provider if s/he experiences muscle weakness, dizziness or light-headedness.  (Edmunds, 2010)

7.  Patients need to be aware of possible side effects of antihypertensive drugs.  Common side effects include headache, nausea, weakness, dizziness, drowsiness, and for men impotence can be a problem.  Cough is common for ACE Inhibitors.  Patients need to alert their healthcare provider of any side effects they experience as a change in medication can alleviate some symptoms.

8.  Navigate to http://ispub.com/IJANP/5/1/9172  Read this article to glean at least two recommendations that ought to be made to elderly patients being treated with antihypertensive medications regarding the use of over-the-counter medications and supplements.  Also make note of interactions of antihypertensive medications with alcohol.

9.  Grapefruit and grapefruit juice have recently been implicated in the overactivity of various drugs.  Grapefruit juice also tends to be more commonly drunk by members of the geriatric population.  Navigate to http://www.drugs.com/slideshow/grapefruit- drug-interactions-1028#slide-1 and watch the slide show titled “Love Grapefruit Juice? Drug Interactions are Numerous”  Take note of which types of drugs are a problem when combined with grapefruit juice.

10.  Mr. Heston, 70 yrs old, has BP readings of 137/84 and 133/87 in his last too clinic visits. He doesn’t have diabetes or other co- morbidities.  What is his blood pressure status according to the latest definitions of hypertension?  What are your recommendations to him? Be sure to include reasons that controlling hypertension is important.

11.  Mr. Heston comes back to the clinic for blood pressure checks. Over the next 6 months, his blood pressure readings have climbed. Now his average reading is 145/93. He starts on Hydrochlorothiazide.  Knowing that this is a thiazide diuretic, what does he need to know?  Write out a possible conversation with Mr. Heston.

12.  Mr. Heston’s blood pressure still isn’t under control and the decision is made to start him on a calcium channel blocker.  What additional patient teaching is necessary regarding possible food and OTC interactions and side effects?  Since Mr. Heston is male, what additional teaching do you need to provide regarding a possible side effect which could be alleviated by changing the med?

13.  Post your answers to the case study questions in the appropriate drop boxes on Angel.  Thank You.  If you have questions, feel free to contact me by email through the Angel communicate tab.

14.  Bailey, D.G., Dresser, G., & Arnold, J.M. (2013). Grapefruit-medication interactions: Forbidden fruit or avoidable consequences? Canadian Medical Association.Journal, 185(4), 309-16. Retrieved from http://search.proquest.com/docview/1349168416?accountid=14902  DASH Diet (2013). Retrieved November 5, 2013 from http://dashdiet.org/what_is_the_dash_diet.asphttp://dashdiet.org/what_is_the_dash_diet.asp  Edmunds, M.W. (2010). Introduction to Clinical Pharmacology (6 th ed.) Mosby Elsevier: St. Louis, MO.  Frisoli, T.M., Schmieder, R.E., Grodzicki, T., & Messerli, F.H. (2011). Beyond salt: lifestyle modifications and blood pressure. European Heart Journal, 32, 3081-3087. doi: 10.1093/eurheartj/ehr379  JNC7 (2003). Retrieved November 5, 2013 from http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf  McCance, K.L. & Huether, S.E. (2010). Pathophysiology: The Biologic Basis for Disease in Adults and Children (6 th ed.) Mosby Elsevier: Maryland Heights, MO.  Neafsey, P.J., Shellman, J. (2002). Adverse self-medication practices of older adults with hypertension attending blood pressure clinics: adverse self-medication practices. Internet Journal of Advanced Nursing Practice, 5(1), 30-43.