Hypertension is the most common reason for a visit to see a primary care provider and antihypertensive drugs are the most frequently prescribed medication in the community (Townsend & Anderson 2015). Hypertension is more prevalent among incarcerated persons than in the general community and a significant contributor to death, among inmates and former inmates, from cardiovascular disease (Binswanger, Krueger & Steiner 2009; Wang, et al 2009; Noon & Ginder 2014). Correctional nurses have a key role in screening, assessment and management of hypertension and other cardiovascular risk factors (Arries & Maposa 2013).
Revised guidelines for management of high blood pressure were released last year by the Eighth Joint National Committee. These are referred to as the JNC 8 (James, et al. 2014). These guidelines simplify the decision to treat hypertension, increase the options for initial drug treatment and ease the criteria defining good control (Mahajan 2014). Using the case example below, test your knowledge about treatment of hypertension in the correctional setting .
Case example: The patient you are seeing in nurse sick call has a blood pressure of 148/90 mm Hg. At intake, a month ago, his blood pressure was 154/92. He is being seen today for complaints of nasal allergies and a recent back strain.
- Based upon the reading today, this patient is at what stage of hypertension?
- Stage 1 hypertension
- Stage 2 hypertension
- Hypertensive crisis
- Which of the following is not a risk factor for hypertension?
- Family history
- Sexual orientation
- Alcohol use
- What lifestyle changes will you suggest to the patient?
- Weight loss
- Reduce salt
- Increase activity
- All of the above
- Patients with hypertension are seen monthly until…
- Blood pressure reaches the target goal
- Lab work is within normal limits
- Blood pressure readings stabilize
- The provider determines another interval
- If lifestyle changes are not sufficient to lower blood pressure, medication should be considered unless the patient…
- Is a diabetic
- Has liver disease
- Is over 60 years of age
- Has blurry vision
- Initial medication orders for treatment of hypertension are likely to include any of the following except…
- ACE inhibitors
- Beta blockers
- Calcium channel blockers
- Thiazide type diuretic
- The patient is placed on a low dose of lisinopril and hydrochlorothiazide. What lab work should be ordered to monitor this patient?
- BUN & GFR
- Albumin & bilirubin
- HgA1c & LDL
- Creatinine & potassium
- What lifestyle change are the most difficult to accomplish while incarcerated?
- Increased exercise
- Lower sodium intake
- Smoking cessation
- Limiting alcohol use
Next week we will review the answers to these questions. In the meantime, enjoy the Fourth of July holiday and stay safe!
For more on the correctional nurses’ role managing patients with chronic conditions like hypertension, cardiovascular disease, asthma, arthritis, diabetes, and seizure disorders see Chapter 6 of our book, Essentials of Correctional Nursing. Order your copy directly from the publisher or from Amazon today!
Arries, E. J. & Maposa, S. (2013). Cardiovascular risk factors among prisoners. Journal of Forensic Nursing 9 (1): 52
Binswanger I.A., Krueger, P.M., & Steiner, J.F. (2009). Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. Journal of Epidemiology and Community Health 63 (11): 912
James, P.A., Oparil, S., Carter, B.L., et al. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association 311 (17): 1809
Mahajan, R. (2014). Joint National Committee 8 report: How it differs from JNC 7. International Journal of Applied Basic Medical Research 4 (2): 61
Noonan, M. E. & Ginder, S. (2014) Mortality in Local Jails and State Prisons, 2000-2012- Statistical Tables. Bureau of Justice Statistics. Retrieved July 1 at http://www.bjs.gov/content/pub/pdf/mljsp0012st.pdf
Townsend, T., & Anderson, P. (2015). What goes up must come down: Hypertension and the JNC-8 guidelines. American Nurse Today 10 (6)
Wang, E.A., Pletcher, M., Lin, F., et al. (2009). Incarceration, incident hypertension, and access to health care. Archives of Internal Medicine 169 (7): 687
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