1. Obesity and Hypertension: Vulnerable Population Care Plan Nicole Chan GNRS 587 July 16, 2015

2. Vulnerability ●In California, 25.4% of adults and 15.8% of adolescents are obese o Obesity rates are significantly higher in low- income children ●Studies show that the relative risk (RR) for hypertension increases sharply for those who are obese o Strongest relative risk seen in younger individuals o Hispanics and Blacks are the most likely to be obese ●Hypertension is the leading cause of death in the US and California o HTN also increases the risk for heart disease and stroke, the two other leading causes of death ●The cost of obesity, and obesity-related diseases to the state of California is estimated at $15.2 billion

3. Vulnerable Population Model Flaskerud and Winslow Research Practice, Ethical, & Policy Analysis Resource Availability: Lack of Education, Poor Diet, Minimal to Low Exercise, and Lack of Support Relative Risk: Low income, young, Black, Hispanic Health Status: Hypertension, Heart Disease, Stroke, Morbidity and Mortality Ethics: Beneficence and Nonmaleficence Policy: Legislative Advocacy & Nursing Influence Practice: Reduce risk for obesity and hypertension

4. Patient Profile ●The obese and hypertensive patient ●Priority health needs: reduce risk for obesity and hypertension ○Primary Level of Prevention: Education ■Prevent obesity and reduce the risk of hypertension by teaching vulnerable populations (low-income, Hispanic and Black, younger age) about diet, exercise, medication compliance ○Secondary Level of Prevention: Screening ■Make sure the patient is seen by PCP regularly and evaluate weight, monitor BP, check blood levels, etc. ○Tertiary Level of Prevention: Health Maintenance/Treatment ■Weight loss programs, BP medications, change in diet, exercise plan

5. Interventions and Outcome Measures Interventions ●Primary - Education o Encourage a healthy lifestyle from infant through adulthood o Educate regarding risks associated with obesity and HTN o Educate regarding healthy lifestyle  diet  exercise ●Secondary - Screening o Regular PCP visits to monitor weight and BP ●Tertiary - Treatment and Maintenance o Weight loss programs o BP Medications

6. Interventions and Outcome Measures Outcome Measures ●BMI ○Normal or healthy weight: 18.5- 24.9 ○Overweight: 35.0-29.9 ○Obese: 30.0 and above ●BP Levels ○Normal: Systolic ≤ 120 and Diastolic ≤ 80 ○Prehypertension: Systolic 120-139 or Diastolic 80-90 ○HTN Stage 1: Systolic 140-159 or Diastolic 90-99 ○HTN Stage 2: Systolic 160+ or Diastolic 100+

7. Resources UCSD Weight Management Program CDC.gov

8. NCLEX Question A patient inquires if his blood pressure is normal. The nurse responds that normal blood pressure is defined as less than: A.160/70 mm Hg B.128/60 mm Hg C.139/89 mm Hg D.130/85 mm Hg

9. NCLEX Question Answer B.128/60 mm Hg Rationale: Normal BP is defined as Systolic ≤ 120 and Diastolic ≤ 80

10. References https://www.cdph.ca.gov/programs/cpns/Documents/ObesityinCaliforniaReport.pdf https://www.cdph.ca.gov/pubsforms/Pubs/OHIRhypertensionDeaths2004.pdf http://health.ucsd.edu/specialties/surgery/bariatric/non-surgical/Pages/default.aspx Institute of Medicine. Evaluating obesity prevention efforts. http://www.iom.edu/About-IOM/Leadership-Staff/Boards/Food-and-Nutrition-Board/ObesityReports.aspx. Accessed March 28, 2015 Koebnick, C., Smith, N., Huang, K., Martinez, M. P., Clancy, H. A., & Kushi, L. H. (2012). The prevalence of obesity and obesity-related health conditions in a large, multiethnic cohort of young adults in California. Annals Of Epidemiology,22609-616. doi:10.1016/j.annepidem.2012.05.006 http://www.sandiegocounty.gov/hhsa/programs/phs/documents/CHS-EconomicBurdenofChronicDisease2010.pdf.