Blood Pressure PDF

BLOOD PRESSURE Buying a BP monitor ○ Look for a blood pressure monitor approved by Hypertension Canada Heart with check mark (gold or silver check) Gold Meets the highest & most current international standards...

BLOOD PRESSURE Buying a BP monitor ○ Look for a blood pressure monitor approved by Hypertension Canada Heart with check mark (gold or silver check) Gold Meets the highest & most current international standards Silver Meets the highest international standards prior to recent updates ○ Have your arm measured for the right cuff size by a healthcare professional ○ Wrist, finger, devices without cuffs monitors not recommended Having one elevated blood pressure reading means that you have high blood pressure. ○ False ○ Blood pressure varies from day to day and can be affected by many factors. ○ Many people will have normal blood pressure on retesting after one high reading ○ Generally, several readings must be taken to confirm a high blood pressure diagnosis. ○ If someone’s blood pressure remains elevated after 3 or 4 repeat measures, it probably means the person does have high blood pressure. What is blood pressure? Blood pressure is created by the force of blood against the walls of the arteries as it circulates. It ensures oxygen and nutrients are delivered throughout the body. Each time you measure your blood pressure, you measure the pressure in your arteries during contraction and relaxation With each heartbeat, your heart contracts, pushing the blood into the arteries. After the heartbeat, your heart relaxes Systolic vs. Diastolic ○ Systolic pressure occurs during the contraction of the heart, pushing blood into the arteries. 120 ○ Diastolic pressure happens when the heart relaxes, and pressure in the arteries decreases. 80 Importance of Normal Pressure  ○ Proper blood pressure levels help deliver blood effectively without damaging arteries or organs. works without hurting the walls of your arteries or organs ○ Abnormal pressure (too high or too low) can lead to health issues like hypertension, which stresses arteries, or hypotension, which reduces blood flow to vital organs. HIGH blood pressure High Blood Pressure = Hypertension too much pressure in your blood vessels during your hearts contraction and relaxation constricted blood vessels, which increases resistance to blood flow ○ The heart must work harder to pump blood through these narrower vessels, raising blood pressure. The only constant thing about blood pressure is that it changes constantly depending on the time of day and what you are doing “Silent killer” : most people can’t tell whether their blood pressure is high Harm to the body? ○ Memory loss/stroke ○ Impaired vision ○ Angina, heart attack, pain ○ Kidney damage ○ Decreased sexual ability Causes ○ Factors you can control Diet, smoking, alcohol, lack of exercise, obesity, diabetes, kidney disease, stress, sleep apnea 30 to 60 minutes of exercise per day losing 10 lbs (5 Kg) will reduce high blood pressure (if overweight) fresh fruits & vegetables, low fat dairy, whole grains, low fat meat, fish, poultry ○ Foods with 5% or less of the daily value of sodium Limit alcohol to less than 2 drinks a day for men and approximately 1 drink a day for women ○ You can’t control Age, sex, family history Blood Pressure & AGE Blood pressure increases with age because blood vessels narrow as we age ○ As a result, your heart works harder to pump blood through your blood vessels ○ This causes the pressure in your blood vessels to increase What should your blood pressure be? (target ranges for specific groups of patients) Low-to-moderate risk patients: ○ below 140/90 mmHg. High-risk patients (cardiovascular disease (CV), chronic kidney disease (CKD), or age ≥ 75): ○ below 120 mmHg. with diabetes ○ less than 130/80 mmHg What does mmHg mean mmHg stands for millimeters of mercury, a unit of pressure measurement. It is commonly used to measure blood pressure and other pressures in the body How to lower blood pressure (“PRESSURE”) P = physical activity R = reduce weight E = eat a healthy diet S = stop smoking S = sodium (less) U = yoU can control your BP R = take youR medications E = Excess alcohol What if I have high blood pressure? Medication adherence ○ Most meds take up to 6 weeks to show full effect ○ Meds don’t cure high blood pressure, just control it ○ Many drugs that lower blood pressure also prevents heart attacks and strokes ○ Most people need 2 or more drugs to control blood pressure, usually life long Lifestyle changes needed How do I know if I have high BP? Can’t feel it Have to measure BP to know The most trusted blood pressure numbers are the ones you get at home How to measure BP? Sitting position Back supported  Use appropriate cuff size ○ Cuff markings must line up ○ Measure around midpoint of upper arm ○ Cuff must be same manufacturer as the blood pressure machine Feet flat on floor, legs uncrossed Don’t talk or move Take 2 readings, 1 minute apart Middle of cuff at heart level Bare arm is preferred or thin layer of clothing Go to the bathroom before taking your BP Don’t smoke, coffee 30 mins before Eat a big meal 2 hours before Talk or watch TV during Don’t measure if you are cold, nervous, uncomfortable, pain How OFTEN to measure BP? When a patient is first diagnosed ○ take 2 measurements in the morning ○ 2 in the evening for 7 days When a patient is stable on their blood pressure medications, ○ 2 readings once or twice a week, or a few times a month  NASAL, EYE, EAR, OTHER DEVICES How to use Nasal spray 1. Wash hands with soap 2. Blow nose gently 3. Insert bottle tip into one nostril and close off the other nostril with finger ○ point the tip slightly outward (toward the outer wall of your nostril), away from the center (nasal septum) 4. Keep head upright 5. Breath in quickly while squeezing the bottle 6. Repeat in other nostril 7. Wash hands with soap Steroid Nasal Sprays ○ Avamys, flonase, nasacort, omnaris Sinus Rinses: NeilMed (how to use) Fill clean bottle with distilled water Pour package contents into bottle Place one finger over the tip and shake bottle Stand in front sink, bend forward, and tilt head down Keeping mouth open, without holding breath, place cap against nasal passage Squeeze bottle gently until solution starts draining from opposite nasal (some may drain from your mouth) Keep squeezing until at least ¼ or ½ (60-120 mL) of the bottle is used Do not swallow solution Blow nose gently without pinching nose completely to avoid pressure on eardrums General Counselling points (Nasal inhalers) Shake before use Prime before use & unused for more than 2 weeks Protect from light Point inhaler up the nose and out towards the car (location of the sinuses) Do not blow nose for 15 mins after using Common errors to avoid ○ Forgetting to prime ○ Skipping doses ○ Holding head in wrong position (tilted forward not back) ○ Pushing nozzle too hard or far up the nose ○ Blow nose after spraying (medicine is lost) ○ Sniffing hard after spray (med goes into throat instead)  ○ Using saline rays or irrigations after med instead of before Should flush before Eye DROPS (how to use) 1. Wash hands 2. Tilt head back, look at the ceiling 3. Using index finger, pull down lower eyelid to form a pocket 4. Gently squeeze 1 drop into pocket, don't let bottle tip touch your eye, fingers, or anything else 5. Close your eyes, lightly press on the insides corners of your eyes 6. Carefully blot away any excess liquid that may on your skin Counselling ○ Wait 5-10 mins between drops ○ Most eye drops safe for 4 weeks/1 month ○ Patients go through eye drops faster than they should due to improper technique ○ Calculate day supply correctly - 20 drops per ml Non compliance ○ Major problem with glaucoma, infections, dry eyes ○ Patients may have unsteady hands, inability to grip and squeeze, blink reaction, which results in missing the eye with the drop ○ There are assistive devices for this Autodrop Guard is placed against the eye socket Eye OINTMENTS (how to use) Similar to eye drops but thicker Applied to inner lid (like a strip of glue) Once applied patient should close their eyes and: ○ rotate eyeballs left to right ○ Up and down Ear DROPS (how to use) 1. Wash hands with soap 2. Warm bottle by holding in palm for a few minutes. Makes the drops more comfortable to instill 3. Gently shake bottle for 10 secs (if indicated by pharm or doctor) 4. Remove cap, make sure nothing touches the tip 5. Tilt your head to one side, or lie down ○ With affected ear facing up 6. Straighten ear canal ○ Adults & 3+ : gently pull the top of the ear upward and backwards (towards back of head)  ○ Children >3 : pull bottom ear down and back 7. Instill drops as instructed ○ Ensure dropper or tip does not touch the ear or other surfaces (contamination) 8. Keep ear tilted 3-5mins 9. Replace and tighten cap or dropper right away Adults vs Child ○ Under 3: pull bottom ear down and backwards ○ Over 3: pull top ear up and backwards Counselling ○ Which way to tilt ear, important for children under 3 ○ Don’t touch tip of ear dropper ○ Never put cotton balls in ears Can cause wax impaction, infections, damage to eardrum Ear Bulb Syringe (how to use) 1. Put some clean warm (not hot) water in a bowel. Squirt the bulb syringe in the water a few times to fill it up with the warm water 2. Hold your head to one side so the affected ear is facing upwards. You can do this in the shower or bath or lie on the bed with a towel underneath your head 3. Gently pull your ear in an upward and back direction so that the water gets better access to the ear canal 4. Hold the nozzle inside the ear canal (not too deeply) and GENTLY squirt the water from the bulb syringe into the ear. Leave the water in your ear for 1-3 minutes to soften the wax 5. Now tilt your head over the sink so the water can fall out. Wiggle the outer part of the ear to help the water and wax come out. You can repeat the procedure if required INJECTIONS (non insulin) Incretins ○ metabolic hormones that are released after eating and help to lower blood sugar levels by increasing insulin secretion. ○ inhibit glucagon release, which reduces glucose production in the liver. ○ Two main incretins are GLP-1 (Glucagon-Like Peptide-1) and GIP (Gastric Inhibitory Polypeptide). GLP-1 has additional benefits (promoting satiety and slowing gastric emptying, which can aid in weight loss management) ○ Incretin-based therapies are particularly useful in type 2 diabetes management due to their multifaceted approach to glucose control. GLP-1 Agonist (Glucagon-Like Peptide) Victoza (Liraglutide) ○ Once daily ○ S/C ○ Starting dose: 0.6mg Increased based on blood glucose control ○ Side effects: nausea (pt start on low dose and gradually increase) ○ Store unopened in refrigerator ○ Opened: room temp for 1 month ○ Injection sites Front thighs, abdomen, upper arm (deltoid) Similar to insulin injections Trulicity (Dulaglutide) ○ Once weekly ○ Pre- filled single dose ○ S/C ○ Contains 4 pens = 1 month supply ○ Opened: room temp 14 days ○ No extra pen tips needed, one time injection, needle is in, NO PRIMING Easy for patients ○ Injection sites same as insulin Ozempic (Semaglutide) ○ Once weekly ○ 0.25, 0.5, 1mg pens ○ S/C ○ Opened: room temp 56 days ○ Rotate sites (Lipodystrophy) ○ Shown significant efficacy in weight loss