How to Care for My Patients with Hypertension

While on the job, both CNA’s and HHA’s will meet and care for clients with hypertension; more commonly known as high blood pressure.  Having a well-rounded knowledge about hypertension and understanding the health risks and complications will help you attend to your client’s needs and gain their trust.  It’s also important, as your patient’s/client’s advocate, to share your knowledge with family and friends, so they too can provide assistance, when or if, needed.

Typically, when you arrive at work you will be given a list of patients you will be helping during the day, along with specific information about each patient, like medical conditions, and updates or changes to their care routine.  Then, during he day you will document things, such as how much a patient ate, if they exercised, any complaints they have, etc.  Checking a patients vital signs and making sure they are taking their medications are two things you’ll do to make sure your patient’s blood pressure remains under control, if there is a sudden rise or fall in blood pressure, or a sign of something else that needs attention.

What is hypertension?

Hypertension¹ is a medical condition where the blood flowing through the arteries and veins is under greater pressure than is healthy or normal. Hypertension can be dangerous because it puts stress on the heart, increases the risk of heart attack, damages blood vessels, causes strokes and kidney problems, and can even lead to death.

Blood pressure can vary throughout the day, so it’s good to know that it is usually higher when a person wakes up in the morning if they are under stress, or when they are exercising.  Short periods of hypertension are normal and are not dangerous.  When the blood pressure is elevated for long periods of time, however, it can result in serious health conditions.

Measuring Your Client’s Blood Pressure at Home – HHA

HHA’s will typically monitor their client’s blood pressure weekly, daily, or sometimes several times a day as part of a normal routine to monitor your client’s vitals. If your patient is at risk of high blood pressure, you may want to assist your patient in purchasing a device (monitors can be purchased at most drug stores, pharmacies, or online) that monitors their blood pressure for when you aren’t there. That way, they can keep help an eye on any changes or fluctuations and report their findings to you when you’re in their home. The monitor, you and your patient choose, should have easy instructions and should be simple to use.  It should fit around your patient’s arm properly, because if the cuff does not fit right, it won’t give a proper reading.

You will want to teach your client, as well as any family members the correct way to use their monitor, what the numbers mean, and the best times during the day to take their blood pressure. If you take your patient to a doctor’s visit, you may bring your patient’s monitor along so it can be tested test to see if it gives the same reading as the monitor at the doctor’s office.

The Cost of Home Monitors

Home blood pressure monitors vary in cost depending on what type of monitor you select.  Monitors can cost between $40 and $150 USD, depending on the features. You will want to recommend your client check to see if their insurance company covers the cost of the blood pressure monitor before purchasing one.

So, How Common is High Blood Pressure?

Hypertension is extremely common.  It is a chronic condition that usually doesn’t go away once you have it.  It affects people of all ages, but is especially common in people over 65 years old.  About 77.9 million individuals, (or one out of every three adults) in the US suffer from high blood pressure².

Lowering blood pressure can decrease the chances of developing heart failure, kidney failure, heart attack, stroke, and other health conditions.

The biggest problem with high blood pressure is that many people are not aware they have it, so it’s often left untreated.  If you suspect a patient has high blood pressure, based on daily monitoring, or if you notice changes or fluctuations in a patient’s blood pressure, document your findings, report your findings to the nurse or doctor in charge, and notify family members.  Because high blood pressure can lead to other serious health conditions, taking immediate action can save your patient’s life.

Let’s review a bit…

What the Numbers Mean

• A normal blood pressure is less than 120/80. (120 is the systolic number, and 80 is the diastolic number).
• People who have a blood pressure reading between 120/80 and 139/89 are considered to have “prehypertension”, which indicates that the blood pressure is higher than it should be and that your patient may carry a risk of developing high blood pressure in the future.
• Blood pressure that is greater than 140/90 much of the time is considered hypertension, and your patient(s) may begin to show complications from an elevated blood pressure.

Monitoring the blood pressure is the only way to know if it is elevated.  Because blood pressure can vary from one patient to another, it is good to determine a baseline by measuring your patient’s blood pressure once a day, or once every other day for a month.  In high-risk cases, it is measured several times per day over a period of several months.  There may be no visible symptoms of high blood pressure, so it is vital to measure it regularly, even if you don’t feel as though it is elevated.

Risk Factors for Hypertension

CNA’s are the eyes, ears, hands, and nose of the nurses. They use these senses to assist the charge nurse by reporting and documenting valuable patient information that may avert a serious problem.  Having an understanding of the many risk factors for high blood pressure³ will help you in determining a patient’s tendencies toward hypertension.  Risk factors, include:

• The risk of hypertension increase as a person gets older.
• Family history. If your patient has other family members with hypertension, they are more likely to suffer from the disease themselves.
• High blood pressure is more common among African Americans.
• Being physically inactive. People who don’t exercise tend to have elevated heart rates. A lack of exercise also contributes to obesity.
• Being obese. Often, the more weigh your patient carries around, the higher their blood pressure will be.
• Tobacco use. Cigarette smoking or using chewing tobacco can raise a person’s blood pressure temporarily, but also lead to hypertension.  A person can get hypertension from secondhand smoke as well.
• Too much salt in the diet. Too much sodium in the diet can cause fluid retention, which raises the blood pressure.
• Too little potassium in the diet. Potassium is necessary to balance the sodium in the cells of the body. If this gets out of whack, it can raise blood pressure.
• Drinking excessive amounts of alcohol. Over time, drinking too much alcohol can result in high blood pressure, and even heart damage.
• Elevated levels of stress can contribute to a temporary rise in blood pressure.
• Chronic conditions. There are chronic conditions that can raise the blood pressure, including sleep apnea, diabetes, and kidney disease.

Complications of Hypertension

The higher the blood pressure and the longer it goes without treatment, the greater the damage to your patient’s heart.

Untreated hypertension can lead to the following:

• Difficulty with understanding or memory problems
• Eye problems
• Kidney problems
• Heart failure
• Aneurysm
• Heart attack or stroke

It’s true that many of these symptoms are not only related to hypertension, but to other medical problems as well.  However, being alert and observant of each of these signs may save you patient from further, more serious health problems later on.

The Goals of Treatment

If your patient is older than 60 years of age and uses medications to lower their blood pressure, they won’t need to change their blood pressure medications unless they cause a negative side effect or influence your patient’s quality of life.  Monitor your patient for any side effects, document and report your findings to the nurse in charge, or your patient’s doctor.  Although there are many non-life-threatening side effects, such as headache, rash, nausea, fatigue and insomnia.  As your patients’’ CNA or HHA, you should be aware of all side effects, and monitor any changes on a daily basis.

If your patient doesn’t take their medications exactly as the doctor recommends, they may not be effective in controlling the blood pressure.  If your patient skips doses or stops taking the medications because of the cost or because they are complaining to you about side effects they’re having, talk to the nurses so that a solution can be found.

Lifestyle Changes to Manage Hypertension

Regardless of the medications your patient takes for hypertension, you should still need to encourage them to make lifestyle changes, including the following:

• Keeping at a healthy weight
• Decreasing alcohol intake
• Not smoking
• Regularly exercising
• Eating a diet that contains less salt

This is where you can really help.  You, as a CNA or HHA, are closer to the patient during each day then any other staff.  You know if they are sneaking a few extras cookies at night, or taking smoking breaks during the afternoon.  You get to observe situations up close and personal and intervene if you suspect your patient(s) are putting their health at risk.  Explaining how and why smoking can affect hypertension, why eating less salt can help to maintain regular blood pressure, and why you care about them as a patient is all part of the job – the good part.  That’s what’s so great about being a CNA or HHA – your relationships with your patients/clients are built on trust and respect, because you see them at their best, and at their worse.

Care of the Patient/Client with Hypertension

As their CNA or HHA, you are in a position to help your patient make lifestyle changes that can reduce the blood pressure, with or without medications.  Being proactive by finding solutions to your patient’s hypertension, such as setting a goal to stop smoking, is better than waiting for something bad to happen.  A conscientious CNA or HHA will set priorities based on their patient’s or client’s needs, and recognize that patients don’t always understand what’s going on with their health, or if their symptoms are serious or not.  It’s your job to listen to your patient’s complaints or problems, help them understand, and go out of your way to help them if they are frightened or anxious.   Hypertension can be controlled, and it’s your job to help your patients, as best you can, do just that.

References

• About Hypertension (High blood pressure); PubMed Health Glossary; (Source: NIH – National Institute of Diabetes and Digestive and Kidney Diseases)
• American Heart Association; Statistical Fact Sheet 2013 Update; High Blood Pressure

Mayo Clinic; Causes; High blood pressure (hypertension); by Mayo Clinic Staff; Nov. 2015