00:00
Now here's the part
where you're like,
"Yeah, yeah, yeah.
I know about these things."
But I want you to understand
these are three factors that
you can't do anything about:
Age.
00:11
As you age until about age 64,
hypertension is more common in men,
but women are more likely to develop
hypertension after 65.
00:21
So keep that in mind.
00:23
Generally, as a patient ages,
we expect their blood pressure
to go up a little bit.
00:27
That's why we have to be on guard
for monitoring it,
and dealing with the
risk factors we can modify.
00:34
Now, race is the
second non-modifiable.
00:37
Means like it's the card
you're dealt.
00:39
You don't change that.
00:40
Patients with African heritage
often develop at an earlier age.
00:44
So they're going to get
hypertension development
at an earlier age.
00:48
Now, serious complications such as
stroke, and heart attack,
and kidney failure
are also more common in patients
of African heritage.
00:56
So that means as a patient,
I know if I have these
non-modifiable risk factors,
I've really need to be taking
significant steps
to monitor my health and take
control of my diet and lifestyle.
01:11
Now, if you have
a family history
doesn't matter what
your race or age is,
you also had an increased risk
to develop high blood pressure,
because high blood pressure
tends to run in families.
01:22
All right, before we move on,
I want you to have solid
in your mind,
what are three non-modifiable
risk factors?
Age, race, and family history.
01:32
Why are we spending
so much time on this?
Because excellent nurses know the
risk factors for their patients.
01:38
And students who are taking exams
also need to recognize
who's most at risk to
develop hypertension.
01:45
because that's a very common exam
format question.
01:49
You'll see four patients
with different factors
and they'll ask you,
rank them in order from
most to least at risk for
diabetes, hypertension,
whatever.
01:58
So it behooves you
to invest some time
in recognizing and remembering
these risk factors.
02:05
Now let's get personal.
02:06
Let's talk about the things
that you can modify.
02:10
Now being overweight or obese is a
risk factor for hypertension.
02:14
You knew that before you started
nursing school.
02:17
But I want you to be able to
explain it to the patient in a
non-judgmental way.
02:22
People who are overweight,
know they're overweight.
02:25
You're not telling them something
they don't know.
02:28
But sit down and have a
rational conversation about these
modifiable risk factors
without appearing judgmental.
02:37
help them to understand,
the reason being overweight
is a challenge for your body
in developing hypertension is:
the more you weigh,
the more blood you need
to supply oxygen and nutrients
to your tissues.
02:49
So as that volume
of blood increases
and it's circulating
through your blood vessels,
the pressure on your artery walls
also increases.
02:57
That's why overweight kind of goes
along with hypertension.
03:01
So we can help the patient
make healthier choices
and move toward
a healthier weight,
they'll have less blood volume,
and they'll see a usually
a pretty significant drop
in their blood pressure.
03:13
I also understand
that very thin people
who are super active
can also be hypertensive.
03:17
But this is a pretty
common occurrence
that someone's carrying
some extra weight.
03:21
This is why their blood pressure
tends to be a little higher.
03:25
Now along with that
is not being physically active.
03:28
Here's the reason:
Can everybody knows
being overweight
and not exercising
are not healthy habits.
03:35
But talk to your patients for a way
that will make sense to them.
03:39
When you're not active,
when you're inactive,
your heart rate is
relatively higher.
03:44
that just goes with it.
03:45
Most people will
get that straight up.
03:47
We explain,
when you exercise you're going to be
able to lower your heart rate.
03:51
Here's why this will benefit you.
03:53
Because the higher
your heart rate,
the harder your heart has to work
with each contraction
and the stronger
the force it needs
to pump that through
the rest of your body.
04:03
and that means there's more force
on your arteries.
04:06
So lack of physical activity
also increases your risk
of being overweight.
04:11
So these two are people's
least two favorites to talk about.
04:15
But if you can come at it
from a little bit different angle,
you can help them understand
how just small changes
and small steps toward
improvement in their health
will make a big overall difference.
04:27
Now, the third one.
04:28
People can get pretty self-righteous
if they don't smoke, right?
Like I know I'm overweight,
but I don't smoke.
04:34
It doesn't matter.
04:36
All of us have something that's
harder for us to say no to.
04:41
But smoking and chewing tobacco
does some things to your
cardiovascular system,
they're a little unique.
04:46
Because smoking or chewing tobacco
immediately raise your blood
pressure temporarily.
04:51
But it's the chemicals
in the tobacco
that can damage the lining
of your artery walls.
04:56
Yeah, yeah,
I'm not talking about your lungs.
04:58
You know that that's hard
on your lungs.
05:00
But there's chemicals in tobacco
that actually damage
the lining of your arteries.
05:05
Well, that puts you at risk for
atherosclerosis.
05:09
So you have damaged, in fact,
that's how atherosclerosis starts.
05:12
There's a damage to the artery,
then the body responds
with these fatty issues,
and then they have the
inflammatory markers
that gets trapped in the wall,
and hangs out there long enough
that the wall gets bigger.
05:24
You've got really thick,
fibrous plaque.
05:28
Now, this leads to arteries
that are narrow
and increases your risk of
heart disease.
05:34
So, dealing with people
who are using tobacco,
you have to approach them
with respect.
05:40
Same way you're dealing
with an obese patient,
talking about their food.
05:43
Same thing with tobacco,
it's a tough habit to quit.
05:47
You don't have
to convince them.
05:49
I've never usually met a smoker
who hasn't thought about quitting.
05:54
Most people do want to quit.
It's just really tough.
05:58
So this is one way you can
help them understand
why it might be worth them
taking that step.
06:04
I cannot emphasize enough
and we're going to talk about
motivational interviewing.
06:08
But how you approach
these conversations
is really, really important.
06:13
None of us are perfect.
06:14
None of us do everything right.
06:16
So this is just one
other behavior,
not worse or better
than any other habit.
06:22
There's too much salt in your diet.
06:24
Wow, man,
we're really meddling here, right.
06:26
The more salt you have in your diet,
the more water you hang on to
because wherever salt goes,
water follows.
06:32
So when that happens,
you have volume on board,
it's hard on your body,
your blood pressure is up,
your hearts got to work harder,
all those things.
06:40
But it's not just
salt that we watch.
06:42
Too little potassium in your diet
can be a problem.
06:45
Now before we go on,
there's a relationship
between salt and potassium.
06:50
The more salt I have on board,
the less potassium I'll have.
06:54
Because as you hang on to salt
you get rid of potassium.
06:57
And you need potassium
it helps you keep balance.
07:00
so the sodium in your cells.
07:02
So if you don't get enough
potassium in your diet
or retain enough potassium,
you may accumulate extra sodium
even more.
07:09
So it's really important
that you get the healthy amount
of potassium in your diet.
07:16
Now we've talked about
overweight, smoking, exercise.
07:20
Now we're going to hit the last one
in alcohol.
07:23
This really feels like meddling in
people's lives.
07:26
But over time, heavy drinking can
damage your heart.
07:29
It's not just your liver
that takes a hit,
but your heart can also
have a problem.
07:34
So having more than
one drink a day for women
and more than
two drinks a day for men
may affect their
blood pressure.
07:40
So what you can recommend
to your patients
is if you drink alcohol,
if you can ask them to consider
doing it in moderation.
07:46
So for healthy adults,
that means
up to one drink a day for women
and up to two drinks a day for men.
07:51
One drink equals about
12 ounces of beer,
or five ounces of wine,
or one and a half ounces of left
of 80 proof liquor.
08:01
So those are just some guidelines.
08:03
I know you're probably
breaking out in a sweat,
just thinking about
having these conversations.
08:07
But it really doesn't
have to be that way.
08:09
I'm going to teach you how to
approach patients in a way.
08:13
so you clearly communicate to them.
08:15
You recognize how difficult it is
what you're asking them to do.
08:20
And you're going to try
to give them some small steps
that can help them be successful.
08:25
Now stress.
08:25
Everyone kind of at least
in America wears that like
as a badge of honor, right?
Oh, I'm so busy.
08:30
I'm so important.
08:31
I'm so stressed.
08:32
But high levels of stress
really can lead to a temporary
increase in blood pressure.
08:37
And then if the patient
tries to relax
by like eating more, or
using tobacco, or drinking alcohol,
now we're really making things
problematic.
08:45
So stress should be something that
we all recognize
that we can control.
08:50
It's how we respond to situations.
08:53
So we have more control over the
stress we allow in our life,
then we realize.
09:00
Then lastly,
I love when we wrap up
something with these kind of
certain chronic conditions.
09:04
I know. Real helpful, right?
And you're welcome.
09:07
But we'll talk about those.
09:09
There are certain chronic conditions
that it can increase your risk
of high blood pressure,
like kidney disease, diabetes,
and sleep apnea.
09:18
Okay, let's pause for just a minute
and I want to give you time
to write those in.
09:22
Kidney disease, diabetes,
and sleep apnea.
09:27
Now, we're listing these under
modifiable risk.
09:31
Yeah, cuz we can do things
to help protect your kidneys.
09:33
We can help you prevent
type two diabetes,
and sleep apnea, we can treat
with a CPAP mask at night.
09:41
So there's things we can do
to try to modify
those particular risk factors.