SMALL TEST OF CHANGE BY DENISE NICOLE THOMAS DR. SANDERSON

SMALL TEST OF CHANGE BY DENISE NICOLE THOMAS DR. SANDERSON

1 Among the elderly patients with coronary artery disease and hypertension, will monitoring blood pressure at home in addition to routine blood pressure taken during an office visit, improve blood pressure management? Although high blood pressure usually cannot be cured, in most cases it can be prevented and controlled. By evaluating, monitoring and then treating the patient's blood pressure, the nurse practitioner can discover if the treatment is useful in lowering hypertension within the person. In treating the elderly for hypertension, it is necessary to consider their history/physical and other medical conditions. Hypertension is one of the most prevalent chronic diseases for which treatment is available, however, hypertension usually goes untreated in the elderly. Since there are no symptoms it is often referred to as the "silent killer".

2 Evidence-Based Practice Recommendations When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that: For each blood pressure recording, two consecutive measurements are taken, at least 1 minute apart and with the person seated. Blood pressure is recorded twice daily, ideally in the morning and evening. Blood pressure recording continues for at least 4 days, ideally for 7 days.

3 ABOUT THE SMALL TEST THERE WILL BE TEN PATIENTS FROM THE HEART GROUP AT THE EASTERN SHORE CARDIOLOGY GROUP! These Patients will be of the elderly population age 72 to 88 Years Of Age. These Patient Will Be Using Their Own blood Pressure Monitoring Machine to Implement This Small Test Of Change.

4 AIM OF THE SMALL TEST AIM STATEMENT LET S TAKE BACK CONTROL Patients will be educated on their blood pressure Patient will be educated on their blood pressure and and how to use home monitor blood pressure how to use home monitor blood pressure systems! systems! Patients will will have have better better control control of of their their own own blood pressure blood pressure by implementing by implementing their home their monitoring home monitoring systems. systems

5 4 There There will will be be a small small test test of performed change done at The at Heart The Heart Group Group of the of the Eastern Eastern Shore Shore Cardiology Cardiology.. The A small small test test of of change change will will be be implemented implemented on on ten ten patients patient within within in the the Eastern Eastern Shore Shore Cardiology. Group. The The patient s patient s age age is is of of the the elderly elderly population population ranging ranging from from 72 72 years years of of age age to to 88 88 years years of of age. age. PLAN PHASE These patient s that will take part in this implementation for this small test The of patients change that all have will take insurance part in and this blood test of pressure change monitors will all have with them insurance at home. and a home blood pressure monitor. The The charts charts have containing been reviewed the patients on these information patients have information been reviewed and demographic along with their have demographics. been closely looked a pond. This This proposed project will will measured consists of by graphs, charts and questionnaires and that this I have will created. be created by myself.

6 DO PHASE This phase of the proposed project has already started with the phone calls to the This phase of the proposed project has already started with patient phone calls patient s within the Heart Group of the Eastern Shore. within the Heart Group of the Eastern Shore. The relationship between the patient s willing to do this project with myself has I have already established relationships with the patients. already been established. The patients race is black and white, male and female, with ages of 72 years and The patient s chosen are of race from black and white, female and male and patient s over. over the age of 72 years of age. The patients chosen have problems keeping their blood pressure under control. The patient s chosen have a problem with keeping their blood pressure under control, These were chosen to challenge the project. this was chosen to give a little bit of a challenge to the project. The proposed project takes place at the Heart Group of the Eastern Shore. Phone The proposed project will take place at the Heart Group of the Eastern Shore and calls will be made to the patients once a week for five consecutive weeks to see if phone calls will be a part of this project. Phone calls will be made once a week for the patients have questions and whether they are on track with their blood pressure five weeks for this small test project to see if patient have any questions and if they monitoring. are staying on the right track with their home blood pressure monitoring. Blood pressures will be recorded on a log for each patient. The American Heart Blood pressure log will be keep on each patient and the recommended standard of Associate recommends taking blood pressure twice a day as a standard. taking blood pressure from The American Heart Association is three times a day.

7 STUDY PROCESS! This The proposed project will will be be studied a to study see if to home determine blood pressure whether home monitoring blood pressure will help monitoring keep control will on the control elderly the patient elderly blood patients pressure. blood This pressure. will be obtained by phone calls, questionnaires The study consists that I will of phone provide, calls, charting questionnaires, their blood charting pressure their on graphs, blood keeping pressure a using log on graphs their own and blood the patient pressure. keeping a log of their The blood compliance pressure of readings. the patient charting The patient their own must blood be willing pressure, to I hope chart this their will blood not be pressure a problem. in order All my to patient establish seem a baseline. very excited The about being patients able are to participate receptive to in the my study project. and willing to participate. Home The blood patient pressure will be required monitoring machine furnish will their be blood provided pressure by the patient. monitor.

8 ACT PHASE This is will going be a five to be week a five small week small test among test among ten patients ten patient s with with uncontrolled uncontrolled hypertension. hypertension. Patients will will participate in in the log keeping. The a log. implementation Implementing in change will be based required off findings. Patient depending monitor their results. own blood With pressure the patient and monitoring will be educated their blood on how pressure, to bring they the can blood be educated pressure on down. controlling their blood pressure. Patient have agreed to answer Patients have agreed to call me phone calls if they have any if they have any questions questions or wish to go over regarding their blood pressure. anything about their blood pressure ACTING

9 DEVELOP A PLAN TO ADDRESS BARRIERS! The setting has already been approved, therefore I do not anticipate any barriers that would hinder the study of my proposed project. BARRIERS The patients will furnish their own blood pressure monitor which will be checked for accuracy prior to being used. There will be little cost to perform this project. There may be a small fee to print the patient s questionnaires, which I will absorb. The log books will be provided by the Heart Group of the Eastern Shore.

10 EVALUATION OF SMALL CHANGE! E D U C A T I O N In order for the patients to remain on track, their blood pressure needs to be checked consistently. Education is important among the elderly because they need to know why and what they are doing to keep their blood pressure under control.

11 REFERENCES Melnyk,B.M., & Fineout-Overholt, E., (2011). Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. Second Edition. Philadelphia, PA. Lippincott Williams & Wilkins. Schwartz, J.B, & Zipes D.P.,(2007) Cardiovascular disease in the elderly. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Eight Edition. Philadelphia, Pa. Saunders Elsevier. chap 75.