Category: Hypertension

Background

Hypertension is a severe medical condition in which the force of blood against the artery walls is too high. It is usually defined as high blood pressure above 140/90 mmHg and severe if above 180/120mmHg. It is caused by smoking, overweight, salt in the diet, stress, old age, and genetics. Additionally, some chronic conditions like kidney, diabetes, hormonal balance, and high cholesterol. Such conditions make the patient very vulnerable and in danger since they can cause side effects. Common signs and symptoms are severe headaches, fatigue, chest pain, difficulty breathing, and shortness of breath. It can be lowered through regular exercise, consumption of low sodium, limited alcohol and stress, and eating a balanced diet. This paper discusses a pharmacology case study of a patient with a 14-year history of pressure and possible borderline diabetes—other previews on other alternative therapies and critical point questions associated with it.

H.P has various conditions such as stage 3 chronic kidney disease (CKD), left ventricular hypertrophy (LVH), and high blood pressure putting him at increased risk of cardiovascular complications. LVH suggests s thickened hearts left the pumping chamber, and the heart may not be pumping efficiently. Hypertension and CKD are interconnected such that uncontrolled hypertension can lead to the damaging of the kidney, which further increases the pressure (Ku et al., 2019). High blood pressure control reduces the risks of cardiovascular complications and mortality. Therefore, alternative options are applied to treat the patient considering his pressure goal. Reducing the amount of salt intake in the diet is one of the behaviors to be adopted. Treatment can be done by angiotensin-converting enzyme inhibitors and diuretic therapy (Ku et al., 2019). Monitoring pressure at home with automated devices should be used, and patients trained on how to do it. Two readings should be done per day, and the progress monitored. Water pills to be taken to initiate the kidney to make more urine eliminate extra fluid and water.

Additional Info Needed to Treat the Patient

The patient recorded an increase in body weight which is risky. Therefore, weight loss is essential to help him manage his conditions. Weight loss can reduce BP by 5 mm Hg for every 5-kg weight loss. Bariatric surgery may be another option for patients who may find it hard to manage weight (Ku et al., 2019) manually. The renal denervation process is essential, and a measure of eGFRs (>45 mL/min/1.73 mACE 2) indicates a reduction of BP. The availability of concurrent albuminuria (albumin excretion > 300 mg/d) shows risks of CKD (Ku et al., 2019). 50% of patients with CKD are said to be taking two to three different types of drugs; hence an alternative medication can be taken (Ku et al., 2019). Some of the medicines that may be useful are bumetanide, metoprolol, hydralazine, and clonidine.

Desired Treatment Outcomes

Blood pressure reduction to <140/90mmHg is one of the outcomes expected. An improvement in the patient’s diet and regular physical exercise are anticipated. Exercise helps in avoiding extra calories, which are dangerous when they build up in the body (Gardiner et al., 2017). Weight loss may indicate a reduction in CKD since its implication at first was hazardous. A positive reaction to the prescribed drugs is another outcome that is expected. Trying new drugs may be accompanied by severe side effects which are not fit for the patients.

Acupuncture is a system of complementary medicine where needles are inserted in the skin at specific points along the lines of energy used in the treatment of physical and mental conditions. It’s a cleansing and balancing of the whole body as the symptoms pass, and one begins to feel better. During the process, the body is cleansed, and there is the elimination of toxins and poisonous wastes which build up in the bloodstream. Some of the side effects of acupuncture may include fainting, dizziness, bleeding, soreness, and nerve damage.

Work of Acupuncture According to Traditional Chinese Culture

Acupuncture’s oldest texts on Chines medical learning began back over 2000 years ago. Since then, it has developed following the earlier procedures (Kim & Song, 2019). It was commonly practiced in small clinics, and no formal training existed. However, knowledge and skills were transferred through apprenticeship among family members. The CTM has undergone various stages of struggle, foundation, and growth (Shahrajabian et al., 2020). A diversity of medical ingredients was used where the majority of which are plants that are not threatened. Acupuncturists, especially those who follow the traditional Chinese medication, mainly focused on the flow of qi (energy) through the body. They believed that energy disruptions create imbalances in the body’s energy leading to illnesses (Cheung et al., 2021). Needless which touch, acupuncture points are inserted through the body. The body has hundreds of acupoints in the body with 14 major energy carrier channels. The needles stimulate the body’s system to rebalance the body, react to a symptom or illness and release the body’s natural painkillers such as endorphins that control nerve impulses.

The first step followed was making an appointment with the acupuncturist and discussing the condition caused. After that, an examination was conducted to the areas of the body that may react to acupuncture. The tongue, pulse, behavior, and smell are looked into, and the patient might also be asked questions on the type of feeling they experience. Factors such as environmental changes and tragic life events are believed to alter the body’s average balance. The tongue is examined as people are considered to bite the tongue part, representing an unhealthy part of the body. Needles were tapped into acupuncture points into the skin throughout the body. The needles used are tiny and inserted at various depths, and allowed to stay for a few minutes or more than 20 minutes. Later, the acupuncturist manipulates the yang, yang, qi, and blood through various techniques like massage, herbs, and needles (Cheung et al., 2021). The multiple changes in the body are then monitored for any improvement.

Acupuncture in the USA and Illnesses Effectively Treated by the Procedure

In the USA, the commonly used acupuncture is electricity acupuncture (electro-acupuncture). This is due to the advanced technology that combines ancient needling techniques with electricity (Zhu, 2018). This needling can treat many nervous system disorders, including stroke. The primary use of acupuncture is the treatment to restore the normal functioning of the body. Acupuncture treats various illnesses like Parkinson’s Disease in Patients with Depression. It is one of the most common killer diseases around the globe. According to research conducted in PD patients, 61% indicated a decreased depression after acupuncture (Huang et al., 2020). This suggests that it lowers the effects of PD in patients with depression.

Diseases of the muscles, bones, and joints like sprains and headaches. Nervous system illnesses like stroke, anxiety, and other nervous disorders. Acupuncture has evolved as a better method for treating chronic lower back pain (cLBP), which causes discomfort (Yu et al., 2018). The modulation effects of acupuncture are examined and treated. Qualified doctors can prescribe drugs to help ease the pain experienced to lead a comfortable life.

Infertility cases among women and men are also resolved by the acupuncture method. Couples who might find it hard to conceive need to visit a doctor and examine to determine possible problems. The challenge might be the man who may be having poor quality of sperm or a low sperm count. The woman might be affected by infections or cannot produce the female gamete. The disabling of the flow of energy by the stagnancy syndrome impacts semen quality and gynecological diseases, which can be (Zhu et al., 2018). When successfully done, fertility is restored among couples who have failed to conceive. This is due to improving the quality of the sperms and ovaries balancing the endocrine system and hormones.

Dangerous Metals in Traditional Ayurvedic Medications

Ayurvedic medication emphasizes sound health and prevention and treatment of diseases. However, some Ayurveda products contain heavy metals such as lead, mercury, aluminum, and arsenic (Mikulski et al., 2017). This is due to the belief that they possess possible healing benefits. Small amounts of lead are believed to calm the stomach. On the other hand, arsenic may also be used to treat some types of body cancers. The greatest menace of lead in the human body is irreversible brain damage. Higher levels can lead to damage of the kidney and nervous systems of both adults and children. Very higher levels can lead to death and unconsciousness.

Aluminum also causes lung problems leading to difficulty in breathing. Nervous systems can be affected, causing difficulty in voluntary and involuntary actions. Brain disorders leading to abnormal behavior in humans and flawed reasoning and memory (Mikulski et al., 2017). The bones become weak, and cancers develop, affecting even the marrow, critical in survival. Inorganic forms of arsenic are highly carcinogenic and cause cancer of the liver, bladder, skin, and lungs. Mercury causes neurological and behavioral disorders, including tremors and memory loss. Lack of sleep occurs and emotional instability where one experiences torture of the mind. Frequents headaches are experienced, which lasts for a longer time.

Yoga Components in the USA

Yoga exercise is used to foster harmony in the environment, mind, and body. The components of yoga are movement, breathing, meditation, and yogic philosophy (Danhauer et al., 2017). Breathing is an essential thing in our daily life. It enables the circulation of oxygen into the body and deoxygenated blood outside the body. Movements include a change in position from one place to another. It helps evade predators and seek protection. From an anatomical perspective, moving different body parts creates extension, flexion, internal and external rotation. Attention on mediation and focus on a particular activity are maintained hence increasing productivity. It helps to keep the mind sharp and relieve stress and anxiety, which strengths the immune system.

Biofeedback

Biofeedback is a technique that involves the use of auditory and visual feedback to administer involuntary body functions. They include blood pressure, blood flow, and heartbeats. Sensors are connected to various body parts and connected to a device known as electromyography. The body measurements, temperature, heartbeats, muscle tension, blood flow, and skin changes are detected (Roach et al., 2018). It works very effectively when one is in a state of visual realities (Gradl et al., 2018). This refers to being relaxed to avoid worry or fear as they may create a false implication from the readings taken.

Illnesses Treated by Biofeedback

Biofeedback is commonly known to treat illnesses such as coronary artery disease, pediatric migraine, fibromyalgia, stress conditions, low back pain (Haines & Bowles, 2017), anxiety, and migraine. Costs of treating back pain are huge, causing a significant burden to society and individuals or by the government through subsidizing the treatment cost. Approaches such as spinal surgery can also be applied but are expensive (Yu et al., 2018). The risk factors are age and sex, where the older are at high risk of getting the disease. As one ages, the chances of getting sick become elevated due to lower immunity. Men are said to be at a higher risk of the disease compared to men. It can also be historically transmitted through genes from one person to another.

Fibromyalgia is triggered by a stressful event and cases of injuries and illnesses. Common symptoms are dizziness, feeling either too hot or cold, anxiety (Zafar et al., 2018), and depression. Non-pharmacological therapy like physical exercise, aerobic exercise, massage, yoga, and cognitive behavior therapy effectively manage the disease (Mehra et al., 2019). Anxiety and depression among children and adolescents are some of the common psychological problems. Therefore, the biofeedback technique is critical in dealing with such issues (Thabrew et al., 2018). Pediatric migraine is among the top six most disabling diseases in the world (Mollen et al., 2019). Finding possible remedies could positively change social change through increased productivity and participation (Mollen et al., 2019). Biofeedback helps in controlling pain impulses hence controlling the headaches. Parents should be responsible for guiding their children and provide remedies for migraines, such as avoiding stress. This might enable the children to open up and expose their problems, and they can be assisted.

Chiropractic Therapy

Chiropractors are people who treat conditions related to the body structure and aims at relieving pain. Chiropractic is concerned with the diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system and the side effects of these disorders on the function of the nervous system (de Luca et al., 2021). It may lead to conditions like low back pain, tension headaches, and shoulder pain. Was referred by the chiropractor to another healthcare practitioner, whether imaging was ordered or performed, and how payment for the visit was made was recorded. Chiropractors also consider asking the patients questions concerning the type of food eaten. This is to enable them to come out with a better plan on how to handle them. Some actions such as smoking might also be present, so there is a need to consider it. The general lifestyle adopted and possibilities of other conditions or disorders which cannot be noticed by observation.

Differences Between Osteopathic and Chiropractic Therapy

Osteopathic aims to improve health across all the body systems, while chiropractic primarily focuses on the spine, joints, and muscles. Osteopathic is drug-free and non-invasive (Bordoni & Escher, 2021). Whereas in osteopathic, there are drug prescriptions. While assessing the patient, chiropractors rely more on diagnostic equipment like x-rays and MRI scans to examine the current shape of the spine. At the same time, osteopaths use manual techniques like palpation in analyzing the patient.

References

Bordoni, B., & Escher, A. R., Jr (2021). Osteopathic principles: The inspiration of every science is its change. Cureus, 13(1), e12478.

Cheung, H., Doughty, H., Hinsley, A., Hsu, E., Lee, T. M., Milner‐Gulland, E. J., Possingham, H. P., & Biggs, D. (2021). Understanding traditional Chinese medicine to strengthen conservation outcomes. People and Nature, 3(1), 115-128.

Danhauer, S. C., Addington, E. L., Sohl, S. J., Chaoul, A., & Cohen, L. (2017). Review of yoga therapy during cancer treatment. Supportive Care in Cancer, 25(4), 1357-1372.

de Luca, K., Hogg-Johnson, S., Funabashi, M., Mior, S., & French, S. D. (2021). The profile of older adults seeking chiropractic care: A secondary analysis. BMC Geriatrics, 21(1), 1-12.

Gardiner, F. W., Nwose, E. U., Bwititi, P. T., Crockett, J., & Wang, L. (2017). Services aimed at achieving desirable clinical outcomes in patients with chronic kidney disease and diabetes mellitus: A narrative review. SAGE Open Medicine, 5.

Gradl, S., Wirth, M., Zillig, T., & Eskofier, B. M. (2018, March). Visualization of heart activity in virtual reality: A biofeedback application using wearable sensors. In 2018 IEEE 15th International Conference on Wearable and Implantable Body Sensor Networks (BSN) (pp. 152-155). IEEE.

Haines, T., & Bowles, K. A. (2017). Cost-effectiveness of using a motion-sensor biofeedback treatment approach for the management of sub-acute or chronic low back pain: Economic evaluation alongside a randomised trial. BMC Musculoskeletal Disorders, 18(1), 1-10.

Huang, C. H., Lin, M. C., & Hsieh, C. L. (2020). Acupuncture treatment reduces incidence of Parkinson’s disease in patients with depression: A population-based retrospective cohort study in Taiwan. Frontiers in Aging Neuroscience, 12, 444.

Kim, I., & Song, S. (2019). Blood pressure measurement in patients with chronic kidney disease: From clinical trial to clinical practice. Kidney Research and Clinical Practice, 38(2), 138-140.

Ku, E., Lee, B. J., Wei, J., & Weir, M. R. (2019). Hypertension in CKD: Core curriculum 2019. American Journal of Kidney Diseases, 74(1), 120-131.

Mehra, A., Souhan, A., & Kumari, V. (2019). Is biofeedback the last resort for fibromyalgia: A case report and review of Literature. Int J Psychol Sci, 1, 6-8.

Mikulski, M. A., Wichman, M. D., Simmons, D. L., Pham, A. N., Clottey, V., & Fuortes, L. J. (2017). Toxic metals in ayurvedic preparations from a public health lead poisoning cluster investigation. International Journal of Occupational and Environmental Health, 23(3), 187-192.

Mollen, C., Henien, M., Jacobs, L., & Myers, S. (2019). Parent perceptions on transfers to pediatric emergency departments and the role of telemedicine. Pediatric Emergency Care, 35(3), 180-184.

Shahrajabian, M. H., Sun, W., & Cheng, Q. (2020). Climate change, acupuncture and traditional Chinese herbal medicines. Pharmacognosy Communications, 10(1).

Thabrew, H., Ruppeldt, P., & Sollers, J. J. (2018). Systematic review of biofeedback interventions for addressing anxiety and depression in children and adolescents with long-term physical conditions. Applied Psychophysiology and Biofeedback, 43(3), 179-192.

Yu, L. C., Lin, I. M., Fan, S. Y., Chien, C. L., & Lin, T. H. (2018). One-year cardiovascular prognosis of the randomized, controlled, short-term heart rate variability biofeedback among patients with coronary artery disease. International Journal of Behavioral Medicine, 25(3), 271-282.

Yu, S., Ortiz, A., Gollub, R. L., Wilson, G., Gerber, J., Park, J., Huang, Y., Shen, W., Suk-Tak Chan., Wasan, AD., Edwars, R.R., Napadow, V., Kaptchuk, T.J., Mikulski, M. A., Wichman, M. D., Simmons, D. L., Pham, A. N., Clottey, V., & Fuortes, L. J. (2017). Toxic metals in ayurvedic preparations from a public health lead poisoning cluster investigation. International Journal of Occupational and Environmental Health, 23(3), 187-192.

Zhu, J., Arsovska, B., & Kozovska, K. (2018). Acupuncture treatment for fertility. Open Access Macedonian Journal of Medical Sciences, 6(9), 1685.

Zhu, J. (2018). Through a century: Traditional Chinese medicine since 1912.Chinese Medicine and Culture, 1(1), 5.

Zafar, M. A., Ahmed, B., Al Rihawi, R., & Gutierrez-Osuna, R. (2018). Gaming away stress: Using biofeedback games to learn paced breathing.IEEE Transactions on Affective Computing, 11(3), 519-531. Web.

The study of the ways in which help can be provided to patients with high blood pressure is of particular importance. This is due to the fact that this problem can affect any person, regardless of age or position. Thus, this work examines the effectiveness of the methods proposed by the United State Department of Health to combat the disease. In particular, attention will be paid to how patients with hypertension seeking care at an outpatient clinic in New York State can additionally be used with current practice to impact the systolic and diastolic blood pressures over an 8-weeks period.

Several valuable sources have been identified to gain a complete understanding of the research problem. Hence, the United State Department of Health provides a valuable document called “Physical Activity Guidelines for Americans.” In it, the authors emphasize that “adults gain most of the health benefits when they do the equivalent of 150 to 300 minutes of moderate-intensity aerobic physical activity each week” (United State Department of Health, 2018, p. 56). Thus, physical activity and lifestyle changes can significantly improve patient performance (American Heart Association, 2018; Saco‐Ledo et al., 2020). In addition, further research shows that “aerobic exercise added to optimized medical therapy reduces blood pressure in patients with low responsiveness to drug treatment” (Lopes, et al., 2021, p. 1317). Thus, activity can contribute to improving the treatment of people.

In conclusion, this work set out to consider the relationship between hypertension in patients and physical activity. Thus, the study of literary sources provided a large amount of data about the problem. It is noted that moderate and permanent applications will help improve the functioning of all organs and systems of the human body. At the same time, it is worth remembering that training should be planned in accordance with the needs and characteristics of the patient.

References

American Heart Association. (2018). American heart association recommendations for physical activity in adults and kids. Heart. Web.

Lopes, S., Mesquita-Bastos, J., Garcia, C., Bertoquini, S., Ribau, V., Teixeira, M., Ribeiro, I. P., Melo, J. B., Oliveira, J., Figueiredo, D., Guimarães, G. V., Pescatello, L. S., Polonia, J., Alves, A. J., & Ribeiro, F. (2021). Effect of exercise training on ambulatory blood pressure among patients with resistant hypertension: A randomized clinical trial.JAMA Cardiology, 6(11), 1317–1323. Web.

Saco‐Ledo, G., Valenzuela, P. L., Ruiz‐Hurtado, G., Ruilope, L. M., & Lucia, A. (2020). Exercise reduces ambulatory blood pressure in patients with hypertension: A systematic review and meta‐analysis of randomized controlled trials.Journal of the American Heart Association, 9(24). Web.

U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans. Health. Web.

Article #1

The article by Moran et al. (2022) examines the impact of hypertension control programs on vulnerable population groups in developing countries. The research was funded by a non-profit health organization (Resolve to Save Lives), and each author contributed to the study. The intended audience primarily includes healthcare professionals who operate in the examined countries, such as India, Bangladesh, and several other low-income countries. The article was received from the National Library of Medicine (NIH), demonstrating the credibility of the source. The research is relevant because there are growing concerns about the accessibility of heart-related drugs in developing countries, and people with hypertension do not have sufficient finances to address their health complications. The authors examine the various possibilities of improving accessibility in these regions by analyzing the effectiveness of hypertension control programs. Ultimately, the research might contribute to solving the identified problem in developing countries.

Article #2

The second article is by Rovesti et al. (2018), and it explores a broader subject – the concept of health and illness in contemporary societies. This research is a collaboration of multiple authors, primarily from notable universities in Italy, India, and Germany. Similar to the first article, the paper was received from the National Library of Medicine (NIH). The intended audience is broad – the report is written in a publicist and easy-to-understand language. The article is relevant to the topic of Society, Disease, and Illness because it directly examines the mentioned concepts. The authors discuss how healthcare is dependent on the current state of society, economics, and other external factors. Moreover, they emphasize the relevance of the research by stating that a deeper understanding of these concepts can help improve healthcare services in the future. Ultimately, they conclude that healthcare is directly related to multiple external factors, and it is crucial to study it in combination with other sciences and cultural considerations.

References

Moran, A. E., Farrell, M., Cazabon, D., Sahoo, S. K., Mugrditchian, D., Pidugu, A., Chivardi, C., Walbaum, M., Alemayehu, S., Isaranuwatchai, W., Ankurawaranon, C., Choudhury, S., Pickersgill, S., Watkins, D., Husain, M., Rao, K., Matsushita, K., Marklund, M., Hutchinson, B., Nugent, R., Kostova, D., & Garg, R. (2022). Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low-and middle-income countries. Pan American Journal of Public Health, 46, 1-10.

Rovesti, M., Fioranelli, M., Petrelli, P., Satolli, F., Roccia, M. G., Gianfaldoni, S., Tchernev, G., Wollina, U., Lotti, J., Feliciani, C., & Lotti, T. (2018). Health and illness in history, science and society. Open Access Macedonian Journal of Medical Sciences, 6(1), 163-165.

Ahmed, Z., Kumar, V., Kamal, Achakzai, A., Khatri, A., & Khushk, S. (2021). Frequency of hypertension and diabetes mellitus in patients undergoing coronary artery bypasses grafting surgery. Annals of the Romanian Society for Cell Biology, 25(6), 914–924.

The article suggests that individuals with hypertension are at a higher risk of developing short-term and long-term complications following a coronary artery bypass grafting surgery. For the purposes of this quantitative study, 196 participants aged 18 to 65 with no previous history of cardiac surgery were recruited. The participants with a history of hypertension and diabetes underwent elective coronary artery bypass, with their condition being monitored after the procedure. During the study, the demographic data of the participants and their medical histories were collected and analyzed using SPSS version-21 statistics software. The authors conclude that hypertension is the primary risk factor for developing cardiovascular disease and is positively correlated with long-term and short-term postoperative complications. In particular, it was noted that male patients are more likely to be hypertensive and, therefore, are at higher risk of complications. The article on the prevalence of hypertension in patients undergoing coronary artery bypass grafting surgery can provide needed background information on the risks of surgery and the need for postoperative hypertension management.

Dymek, J., Gołda, A., Polak, W., Lisowski, B., & Skowron, A. (2019). Effect of education for hypertensive patients with correctly performed self-blood pressure monitoring (SBPM).Pharmacy, 7(3), 1–12. Web.

The study under consideration aims to examine the effect of patient education on hypertension management. Specifically, the impact of pharmacist-led education on the patients’ knowledge and ability to maintain blood pressure within normal parameters was evaluated. The participants were required to measure their blood pressure for 20 consecutive workdays, followed by an individualized training session with a pharmacist, who further educated patients on self-blood pressure monitoring. In addition, the knowledge of participants on hypertension and blood pressure measuring was assessed through three tests. The first test was offered to the participants before observed blood pressure measurements, the second took place after the 20 successive days of self-blood pressure monitoring, and the third occurred six months after the personal education sessions. The authors conclude that educating patients with hypertension on independent blood pressure monitoring is highly effective and beneficial as it translates into a decreased frequency of measurement errors. The study can meaningfully contribute to the proposed research as it demonstrates the advantages of education on maintaining blood pressure within the normal range post coronary artery bypass surgery.

Kim, J., Park, J., Lee, J., Min, J. J., Lee, S., Lee, Y., Kim, W. S., Song, S., Yeo, J. H., & Cho, H. (2020). Comparative efficacy of angiotensin converting enzyme inhibitors and angiotensin receptor blockers after coronary artery bypass grafting.Scientific Reports, 10, 1–7. Web.

This quantitative research study emphasizes the importance of secondary interventions following coronary artery bypass grafting surgery. In particular, the study compares the effect of angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors in reducing blood pressure in patients during the postoperative period. The overall sample included 5456 participants who underwent bypass surgery, with 1198 patients prescribed antihypertensive medication. The data on antihypertensive medication prescribed to patients and their clinical outcomes was collected using Clinical Data Warehouse Darwin-C. The authors evaluated whether the patients experienced any major adverse cardiovascular and cerebrovascular events following the surgery and analyzed the differences between patients prescribed ARBs and ACE inhibitors. It was concluded that patients given ARBs for management of hypertension following coronary artery bypass grafting surgery experienced better protective effects than persons prescribed ACE inhibitors. The study contributes to the proposed research as it examines the impact of antihypertensive drugs on patients who underwent coronary bypass surgery and can inform the study on postoperative blood pressure management.

Maslakpak, M. H., Rezaei, B., & Parizad, N. (2018). Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial.Cogent Medicine, 5(1), 1–13. Web.

The research study discusses the effect of family involvement on patient education concerning hypertension management. The authors carried out a single-blind randomized, parallel-group, controlled trial in order to estimate the impact of family participation in hypertension education sessions offered by healthcare facilities. One hundred participants were divided into the control group, patient-oriented, family-oriented, and mixed groups receiving education on blood pressure management and monitoring. The researchers measured the patients’ adherence to medication, low sodium diet, and medical appointments before and following the education intervention. The study shows that family involvement in patient education is positively correlated with better antihypertensive drug and physician appointments adherence as well as observance of a healthy diet. The authors note that separate patient education and family members training on hypertension management are effective. Nevertheless, education sessions carried out in the presence of both patients with hypertension and their family members were found to be more effective. The study can inform the proposed research as it illuminates the effectiveness of client education on hypertension management and can be invaluable for patients following coronary artery bypass surgery.

Song, T., Liu, F., Deng, N., Qian, S., Cui, T., Guan, Y., Arnolda, L., Zhang, Z., & Yu, P. (2020). A comprehensive 6A framework for improving patient self-management of hypertension using mHealth services: Qualitative thematic analysis.Journal of Medical Internet Research, 23(6), 1-15. Web.

The qualitative study assesses patient experiences with the 6A framework for improving hypertension management. The 6A framework (access, assessment, assistance, awareness, ability, and activation) defines the mechanisms offered to patients utilizing mHealth services for monitoring and maintaining blood pressure within the normal parameters. These services provide patients with educational information on hypertension and blood pressure measuring as well as reminders on when to measure blood pressure and automatic feedback on results. Overall, the researchers conducted in-depth, semi-structured interviews with 22 patients with hypertension using mHealth services. The interviews show that most patients are content with mHealth service for hypertension management. In particular, the assistance function that gives patients access to educational materials and self-management reminders was highly praised. The authors conclude that the employment of mHealth services for hypertension management improves patients’ self-management ability and leads to better health outcomes. This study contributes to a better understanding of patient behaviors and adherence to blood pressure monitoring and medication outside the hospital. Therefore, it can inform the proposed research study on how to educate patients and support them in antihypertensive drugs adherence after coronary artery bypass surgery.

Research Synthesis

Overall, based on these quantitative and qualitative studies, it can be argued that education on hypertension management is critical for patients undergoing coronary artery bypass grafting surgery. The studies indicate that the majority of persons that need the surgery have issues with high blood pressure and require additional medication such as ARBs and ACE inhibitors to manage hypertension during the postoperative period. It can also be concluded that education on the management of hypertension results in better adherence to medication and timely blood pressure monitoring. In addition, research articles indicate that patients have a positive experience with educational materials pertinent to their condition and mHealth services. The literature gathered for the review can grant a better understanding of patient experience with education on hypertension management following bypass surgery. Moreover, the selected literature helps comprehend the efficiency of different antihypertensive drugs such as ARBs and ACE inhibitors on patients following surgery. Nevertheless, seeking additional information on what prevents patients from adhering to the prescribed blood pressure medication after an operation would be helpful.

References

Ahmed, Z., Kumar, V., Kamal, Achakzai, A., Khatri, A., & Khushk, S. (2021). Frequency of hypertension and diabetes mellitus in patients undergoing coronary artery bypasses grafting surgery. Annals of the Romanian Society for Cell Biology, 25(6), 914–924.

Dymek, J., Gołda, A., Polak, W., Lisowski, B., & Skowron, A. (2019). Effect of education for hypertensive patients with correctly performed self-blood pressure monitoring (SBPM).Pharmacy, 7(3), 1–12.

Kim, J., Park, J., Lee, J., Min, J. J., Lee, S., Lee, Y., Kim, W. S., Song, S., Yeo, J. H., & Cho, H. (2020). Comparative efficacy of angiotensin converting enzyme inhibitors and angiotensin receptor blockers after coronary artery bypass grafting.Scientific Reports, 10, 1–7.

Maslakpak, M. H., Rezaei, B., & Parizad, N. (2018). Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial.Cogent Medicine, 5(1), 1–13.

Song, T., Liu, F., Deng, N., Qian, S., Cui, T., Guan, Y., Arnolda, L., Zhang, Z., & Yu, P. (2020). A comprehensive 6a framework for improving patient self-management of hypertension using mHealth services: Qualitative thematic analysis.Journal of Medical Internet Research, 23(6), 1-15.

The aim of this paper is to create awareness through education about hypertension, which is common among adults. Some of the issues that will be covered include etiology, signs and symptoms, at-risk population, prognosis, diagnostic procedures, treatment protocols as well as pharmacological treatments.

Definition

Hypertension refers to the blood pressure (BP) that is above 140/90 – it becomes severe when the pressure is above 180/120. Hypertension is diagnosed in individuals when, in two consecutive days, their systolic BP is ≥140 mmHg and/or the diastolic BP is ≥90 mmHg. In simpler terms, Blood pressure occurs when the force of blood between the arteries and the wall is constantly high (DeGuire et al., 2019). Elevated BP is when systolic is 120 to 129 mm Hg and diastolic is 80 ­– normal BP is 120/80 mm Hg and below.

Etiology

It is important to note that most cases of hypertension are categorized as essential hypertension. Research shows that an increase in salt intake is a major cause of hypertension (Oh et al., 2020). One of the widely described factors for the development of essential hypertension is the “genetic ability to salt response” (Oh et al., 2020, p. 5). Oh et al. (2020) further added that about 60 percent of patients tend to be salt-sensitive and, as such, may develop hypertension. Genetic to salt response means that anything that is above the required amount– increases the blood pressure. In other words, an increase in the intake of salt is directly proportional to hypertension.

Causes of Hypertension

It is imperative to note that hypertension develops over time. It may occur as a result of unhealthy lifestyle choices such as lack of physical activity. In addition to this, other health conditions, such as diabetes and obesity, may increase the risk of developing high blood pressure. Diet and lifestyle are regarded as two of the main contributors to essential hypertension. Secondary hypertension is established when a direct cause of high blood is identified. The most common causes of secondary hypertension are kidney disease and tumors – adrenal glands secret excess hormones.

Signs and Symptoms

Hypertension is regarded as one of the most unpredictable health conditions because it is not easy to diagnose – some people may not even know they have it. According to DeGuire et al. (2019), a third of the population with high blood pressure is not aware of the illness – it does not have “any symptoms unless it is very severe” (p. 15). This explains why healthcare professionals recommend regular check-ups. In fact, those who have a relative with this condition are advised to monitor their BP at home.

At Risk Population(s)

The at-risk population for hypertension varies with sex and age. Adults are the most affected population – about 23 percent of adults Americans above 50 live with hypertension (Rab et al., 2020, p. 597). As for women, 75 percent of those above 75 years have hypertension (Rab et al., 2020). However, of men aged 75 years, 64 percent of them suffer from hypertension (Rab et al., 2020, p. 598). African Americans tend to experience hypertension at an earlier age. The last at-risk population for consideration is pregnant women.

Prognosis

The prognosis of hypertension largely depends on how well it is managed and controlled. For those patients who follow a prescribed diet and assigned physical activities, they will be able to control it (Rabi et al. (2020). For example, patients should follow a strict and healthy lifestyle pattern comprising up to 30 minutes of daily exercise, intake of a low-salt diet, and taking prescribed medication daily. Prognosis depends on several features such as level of blood pressure, presence of target-organ changes, co-existing risk factors, and age at presentation.

Diagnosis of High Blood Pressure

The diagnostic process of high blood pressure requires regular check-ups. The healthcare provider will examine the patient by asking them a set of questions about their medical history and possible symptoms. The provider will use a stethoscope to listen to the heartbeat. Similarly, a cuff that is placed around the arm will also aid with checking blood pressure (refer to the diagram in the slide). It is important to ensure it fits well for accurate reading. The cuff, as elucidated by DeGuire et al. (2019), “is inflated using a small hand pump or a machine” (p. 15). During the initial visit, the care provider will measure blood pressure in both to find out if there are any variations – a higher reading will be used in the subsequent checking.

Tests

Once diagnosed with high blood pressure, the healthcare provider may recommend several tests to determine a cause. The first test is ambulatory monitoring, which is a longer test performed to check blood pressure (Zhang et al., 2021). The second test is lab tests, which target blood and urine to check for possible conditions that can cause or increase the severity of the condition. The last test is an electrocardiogram (ECG or EKG), which is used to measure how fast or slow the heart is beating and associated electrical activity.

Treatment Protocols

In an effort to treat hypertension, the care provider will recommend non-pharmacological and lifestyle management. This is necessary for individuals with elevated BPs regardless of gender, age, and cardiovascular-related risks. Education should contain detailed instructions on weight, salt intake, and regular exercise (Valenzuela et al., 2021). Weight management is helpful if obesity is present. Weight reduction tends to lower systolic blood pressure by up to 20mmHg. Smoking management is necessary to prevent the development of cardiovascular conditions. Lastly, lifestyle changes are necessary as they decrease the chances of developing high BP.

Pharmacological Treatments

The type of medication used to treat hypertension depends largely on the severity of the blood pressure. According to Rabi et al. (2020), many healthcare providers recommend a combination of two or more drugs to effectively manage the condition. Before one starts taking any medication, it is important to have well-established goals, such as reducing BP. Those above 65 and living with other diseases, such as diabetes and chronic kidney are advised to aim for a BP lower than 130/80 mmHg (Rabi et al., 2020). The recommended pharmacological treatment options are angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), and diuretics.

Support Systems

Maintaining a healthy diet that is low in sodium and saturated fats and taking medication as prescribed require having a support system. It is important for patients with hypertension to have a team that will help with planning healthy meals, preparing the right food and drink, and, at the same time, encouraging them to remain on track with their goals. Therefore, having a support system comprising health professionals from different disciplines helps a lot with accomplishing the set goals. The system may include primary care providers, nurses, pharmacists, and social workers who use their skills to help patients.

Prevention

It is imperative to note that by preventing high blood pressure, one essentially lowers the risk of developing other complications such as stroke and heart disease. This presentation recommends the following healthy living habits in an effort to prevent high blood pressure. Firstly, individuals should strive to eat healthy diets such as plenty of fresh fruits and vegetables, which maintain BP to normal. Secondly, patients should strive to maintain a healthy weight, which helps reduce the risk of developing hypertension. One way of determining weight is by calculating the body mass index once weight and height are known (Unger et al., 2020). Lastly, patients should constantly take part in physical exercises, which helps a lot with maintaining a healthy weight. Physical Activity Guidelines for Americans website is a good place to start.

References

DeGuire, J., Clarke, J., Rouleau, K., Roy, J., & Bushnik, T. (2019). Blood pressure and hypertension. Health Report, 30(2), 14-21. Web.

Oh, G. C., & Cho, H. J. (2020). Blood pressure and heart failure. Clinical Hypertension, 26(1), 1-8. Web.

Rabi, D. M., McBrien, K. A., Sapir-Pichhadze, R., Nakhla, M., Ahmed, S. B., Dumanski, S. M., & Daskalopoulou, S. S. (2020). Hypertension Canada’s 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Canadian Journal of Cardiology, 36(5), 596-624. Web.

Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357. Web.

Valenzuela, P. L., Carrera-Bastos, P., Gálvez, B. G., Ruiz-Hurtado, G., Ordovas, J. M., Ruilope, L. M., & Lucia, A. (2021). Lifestyle interventions for the prevention and treatment of hypertension. Nature Reviews Cardiology, 18(4), 251-275. Web.

Zhang, W., Zhang, S., Deng, Y., Wu, S., Ren, J., Sun, G., & Cai, J. (2021). Trial of intensive blood-pressure control in older patients with hypertension. New England Journal of Medicine, 385(14), 1268-1279. Web.

Introduction

Hypertension is a huge socio-economic problem in the modern world. It occupies a leading place in the structure of mortality and disability in economically developed countries, as well as in developing countries. In Europe, about 3 million people die from hypertension every year, and in the USA, there are about 1 million of patients with this illness (ihi.org, 2017). Hypertension affects people of working age, which influences the economic and social condition of the country. In connection with the current situation, the purpose of this paper is to analyze the system of prevention and treatment of hypertension both at the state level and at the level of the practical health service. Quality and sustainability changes in the field of cardiology will have a beneficial effect not only on the treatment of patients with pre-existing pathology, but also on the early detection of healthy patients with one or more risk factors and on the planning of preventive measures aimed at their elimination.

Revision & Synthesis

In the first part of the study, the main types of hypertensions were identified, as well as the currently existing quality and safety measures. Among the concepts already used, one can single out the idea of three barriers and three facilitators. The issues of virtual medicine are touched upon, the topic of which will also be continued in this work. Further in Part 1 it is dwelled on the development of preventive measures to maintain heart health. The concept of prevention of hypertension is also key in the second part of the work. Its main ideas are promoting physical activity and assessing risk factors, which will be integrated into the proposed evidence-based and safety program.

Proposed Evidence-Based Quality & Safety Program

The concept of risk factors, developed in the 60s, has become the scientific basis for the prevention of diseases of the circulatory system (ihi.org, 2017). With the accumulation of scientific data, the concept of risk factors has developed and to date has been supplemented with the following provisions, which are actively used in quality and safety programs (Kleinpell, 2021). Risk began to be considered as a continuous characteristic, and quantitative methods for assessing individual risk and risk stratification were created. The concept of risk implies the active promotion of physical activity to prevent hypertension. A systematic review of the results of clinical studies indicates that by changing the lifestyle, it is possible to significantly reduce the mortality from diseases of the circulatory system both in patients and in the general population (Barone Gibbs et al., 2021). Strengthening preventive activity in healthcare related to promoting and encouraging the desire of the population for a healthy lifestyle is also an important component of the quality and safety program.

It is clinically proven that the evidence-based quality and safety program to address the issue from Part 1 (hypertension) significantly increases the positive outcome for patients. The main risk factors assessed in the first part of the program are smoking and drinking alcohol and fatty foods, as well as a sedentary lifestyle (Brantley & Chipps, 2021). When risk factors are eliminated, according to the second part of the evidence-based quality and safety program, the number of deaths decreases (Brantley & Chipps, 2021). When patients quit smoking, the negative outcome possibility falls by 50%, with sufficient physical activity — by 30%, with moderate alcohol intake — by 15%, and with a change in diet — by 40% (Carey et al., 2018).

My proposed design is to digitalize the assessment of risk factors and promote a healthy lifestyle. It has several significant advantages over the currently existing system. The partial transfer of the quality and safety program to a digital format implies an increase in both the quality and accessibility of medical care. In the conditions of a tense financial situation, a large territory, limited resources and a changing demographic situation, new technological solutions are required, which is the digital transformation of existing processes (Kleinpell, 2021). Digitalization of risk factors assessment and prevention of a healthy lifestyle will give patients the opportunity to monitor their health, actively participate in the collection of medical data, and the choice of the attending physician or treatment strategy.

Potential Obstacles & Solutions for Overcoming

An increase in the number of errors associated with the use of telemedicine technologies in the provision of medical care is considered as the main potential obstacle. As a way to overcome it, the restriction of types of remote medical care can act. Secondly, many scientists note a sharp increase in the risks associated with the protection of information (ihi.org, 2017). These threats exist today, but they are on a smaller scale, localized within one medical organization. The way to overcome this obstacle is to teach information security in universities as a separate discipline and at a high level. This will allow implementing numerous organizational, software and hardware solutions to protect patient information from leakage.

Stakeholders

Stakeholders within the selected healthcare entity with whom I may need to collaborate are patients, chief physicians, advanced nurse practitioners and software developers. The role of patients is in testing applications developed for them to assess risk factors and early diagnosis of hypertension. They should also provide feedback on the work of applications aimed at forming a healthy lifestyle. The role of patients is to make complaints, wishes and suggestions regarding various aspects of digitalization of medical processes. Developing feedbacks will allow to find out what can be improved for a more comfortable use of the developed applications. Constructive and specific comments from customers will be useful for continuous improvement and further popularization of the virtual quality and safety program.

The role of software developers in the implementation of the proposed program is to develop an application that will act as an intermediary between doctors and patients. They will also need to ensure the safety of personal patients in order to prevent their leakage. Software developers are responsible for each of the six stages of application development (Carey et al., 2018). Among them are the design of an idea, strategy development, design work, direct development, market entry and monitoring of the situation. Programmers will carry out strategic planning in the form of drawing up a roadmap for a mobile application. Then they will carry out the path from the minimum viable product (MVP) to getting into the use of patients and doctors (Brantley & Chipps, 2021). At the same time, it is necessary to take into account the functionality of the application, the possible wishes of the audience and the following updates. Software developers will also be responsible for providing technical support and answering patients’ questions regarding the operation of the application.

Among stakeholders, it is also necessary to designate a specific group of advanced nurse practitioners. Since the digitalization of medicine in this case is connected precisely with the safety program regarding hypertension, they have a special responsibility. Telemedicine does not make it possible to completely abandon face-to-face interaction with nurses. However, with the help of technology, advanced nurse practitioners can perform an initial examination. At a remote reception, they can collect anamnesis, prescribe the necessary tests, and decipher them (Kleinpell, 2021). Then advanced nurse practitioners will also have to work with patient data and regular monitoring of medical indicators. Most often, users of remote medical care prefer to chat with a doctor. Therefore, advanced nurse practitioners are responsible for collecting patient indicators and providing them with full-fledged medical care.

Leaders that are needed are the chief physician doctors who will act as a link between patients, advanced nurse practitioners and developers and technical support. The chief physicians will manage the changes in accordance with the plan defining the activities of stakeholders. Moreover, it is the chief physician who will organize the work of a team of advanced nurse practitioners to provide timely and high-quality medical and medicinal care to the population. They will also ensure the organization of medical and preventive, administrative, economic and financial activities related to the operation of the application (Carey et al., 2018). The chief physicians will analyze the activities and, based on the assessment of the performance of the application and doctors, take the necessary measures to improve the existing forms and methods. They will also monitor compliance with the requirements of the internal labor regulations, safety and labor protection.

Change Management Theory

A change management theory I will use to support the implementation of my quality and safety program is the ADKAR management model. It was developed by Prosci Change CEO Jeff Hiatt; at the center of this concept are the employees who are affected by the changes (ihi.org, 2017). ADKAR is a set of five stages that each of the advanced nurse practitioners must pass sequentially. Among these stages are Awareness, Desire, Knowledge, Ability and Reinforcement (Bekemeier et al., 2021). To evaluate the results, the chief physician should use a scale from one to five (Beaussier et al., 2020). If an employee scores three points or less at one of the stages, they should improve their result, and only then can they move on to the next step.

Evidence of the effectiveness of using the ADKAR management model within the program I designed is the potential reduction of resistance to change among employees. Often, the introduction of new technologies is associated with difficulties for employees, and they perceive changes negatively (Bekemeier et al., 2021). Unwillingness to master new technologies, disguised as inability, is often practiced. The ADKAR management model focuses on developing doctors’ desire to support and participate in changes. With the use of this model, one can be sure that the changes will be successful, since staff will be motivated to contribute to innovations (Barone Gibbs et al., 2021). For this reason, advanced nurse practitioners will not resist the development of new technologies and will be able to master the work with the application.

Expected Outcomes

The expected outcomes of the implementation of my proposed quality and safety program are increasing the availability of cardiology medicine. In the future, this includes the use of remote-type medical equipment: this is equipment for receiving and sending data to doctors. With the help of specialized software for a smartphone or computer, anyone will be able to track risk factors, correct them, as well as send information about their condition and get advice remotely. These are just some of the possibilities of using machine-to-machine interaction technologies (Kleinpell, 2021). Among the outcomes of the introduction of telemedicine networks is the solution of the most important social tasks. First of all, it is the provision of high-quality cardiological services to healthcare institutions, regardless of their location (Arija et al., 2018). It also includes monitoring and counseling during and after complex surgical interventions, and general monitoring of risk factors and the state of cardiovascular health.

There are different ways to ensure sustainability of the expected outcomes. They include raising the level of the material and technical base and laboratory, functional and instrumental diagnostics. Moreover, for the interest of advanced nurse practitioners, it is necessary to raise their wages, which will act as a guarantee of a constant high quality of medical care to the population. Management courses for chief physicians should also be conducted regularly to ensure more effective communication between patients and doctors (ihi.org, 2017). To ensure sustainability of the expected outcomes, continuous education of advanced nurse practitioners should also be provided, developing both professional knowledge and skills of working with new technologies.

Conclusion

This paper contributes to the rationale for the development of telemedicine, emphasizing its use in the field of cardiology. The new quality and safety program for the prevention and treatment of diseases of the cardiovascular system transforms the existing concept of risk factors and a healthy lifestyle. It will be based on new remote forms of interaction between the attending physician and the consultant physician, the medical worker and the patient. Telemedicine will be cost-effective only if it becomes a queuing system at the state level. Modern innovative development of national healthcare is impossible without a comprehensive combination of traditional clinical methods and modern info communication technologies quality and safety program. The introduction of digitalization, aimed at improving the management system in healthcare, will significantly increase the number of positive outcomes.

References

Arija, V., Villalobos, F., Pedret, R., Vinuesa, A., Jovani, D., Pascual, G., & Basora, J. (2018). Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: Randomized clinical trial.Health and Quality of Life Outcomes, 16, 1-11. Web.

Barone Gibbs, B., Hivert, M. F., Jerome, G. J., Kraus, W. E., Rosenkranz, S. K., Schorr, E. N., Spartano, N. L., Lobelo, F., & American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology (2021). Physical activity as a critical component of first-line treatment for elevated blood pressure or cholesterol: Who, what, and how?: A scientific statement from the American Heart Association.Hypertension, 78(2), 26–37. Web.

Beaussier, A., Demeritt, D., Griffiths, A., & Rothstein, H. (2020). Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality. Health Policy, 124(5), 501-510.

Bekemeier, B., Kuehnert, P., Zahner, S. J., Johnson, K. H., Kaneshiro, J., & Swider, S. M. (2021). A critical gap: Advanced practice nurses focused on the public’s health. Nursing Outlook.

Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and control of hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology, 72(11), 1278–1293.

Kleinpell, R. M. (2021). Outcome assessment in advanced practice nursing (5th ed.). Springer Publishing Company.

Nelson-Brantley, H. V., & Chipps, E. (2021). Implementation science and nursing leadership: Improving the adoption and sustainability of evidence-based practice. JONA: The Journal of Nursing Administration, 51(5), 237-239.

ihi.org. (2017). QI 202: Addressing small problems to build safer, more reliable systems. Web.

The article summarized in the section is Hypertension pharmacological treatment in adults: A World Health Organization guideline executive summary by Al-Makki et al., retrieved from Web. The article presents hypertension as a significant cause of cardiovascular disease and deaths globally, especially in middle and low-income countries. It provides new treatment guidelines for hypertension advanced by the World Health Organization Handbook for Guideline Development (Al-Makki et al., 2022). It presents research findings per the Grading of Recommendations, Assessment, Development, and Evaluations. The recommendations from the research are relevant to accurately diagnosing adults with lifestyle modification counseling.

There is a need to better lower blood pressure other than the usual safe, cost-effective, and well-tolerated therapies. Nonpregnant adults with hypertension should manage hypertension by initiating pharmacological therapy and BP treatment targets, utilizing healthcare workers, and creating intervals for follow-up visits (Al-Makki et al., 2022). The recommendations offer information for dual therapy, single-pill combinations, treatment algorithms, dual therapy, and monotherapy in managing hypertension. The balance between anticipated beneficial and undesirable effects, underlying evidence of cost-effectiveness and resource requirements, acceptability, health equity, treatment feasibility, and patient values and preferences dictate the guidelines.

Hypertension significantly influences the risk of all major cardiovascular events like peripheral vascular disease, sudden cardiac death, heart failure, and stroke. Significant breakthroughs in our understanding of its pathophysiology have helped highlight the disease’s complex origins involving the dysregulation of several homeostatic systems that influence blood pressure and the progression of end-organ damage associated with hypertension (Al-Makki et al., 2022). Growing evidence reveals that the pathophysiology of hypertension is caused by complicated interactions between environmental and genetic factors, resulting in varied illness risks and onset ages in the general population.

The first point to share from the article is its recommendation for combination therapy. Single-pill combination is recommended alongside therapy as initial treatment for adults with hypertension that require pharmacological treatment to improve persistence and adherence. Additionally, there are three classes from which to pick Antihypertensive medication; long-acting dihydropyridine calcium channel blockers, diuretics, and angiotensin-receptor blockers. However, one needs to conduct health economic analyses to quantify budget implications and the cost-effectiveness of implementing combination therapy instead of monotherapy.

Secondly, other risk factors for cardiovascular disease must be identified and treated correctly in all persons with hypertension to reduce total cardiovascular risk. In the lack of a calibrated equation for the local population, the choice should be based on the available resources and the acceptability and feasibility of the cardiovascular disease risk prediction tools (Al-Makki et al., 2022). However, in the incidence that assessing CVD risk may inhibit the timely beginning of hypertension medication, it should be delayed and incorporated as a follow-up measure.

Lastly, intensive treatment for selected patients complicates things for health workers. For example, emphasizing team-based care in low-resource situations necessitates straightforward and protocolized care (Al-Makki et al., 2022). Intensive therapy for some patients complicates treatment protocols and may result in decision overload, particularly for health providers with less expertise. However, despite being able to receive pharmacological treatment from nonphysician professionals like nurses and pharmacists, the WHO advises conditions like specific management protocols, proper training, and prescription authority (Al-Makki et al., 2022). Patients are more satisfied when they perceive their care comes from well-qualified as well as competent staff.

Adopting the guidelines has significant social implications because better treatment enhances hypertension control and helps lessen long-standing inequity. The guideline’s objective is to promote the adoption of a uniform strategy for the pharmacological management and treatment of hypertension, which will improve the global hypertension control rate. Managing blood pressure will lessen health disparities since preventing cardiovascular events lowers mortality rates.

Reference

Al-Makki, A., DiPette, D., Whelton, P. K., Murad, M. H., Mustafa, R. A., Acharya, S.,… & Khan, T. (2022). Hypertension pharmacological treatment in adults: A World Health Organization guideline executive summary. Hypertension, 79(1), 293-301. Web.

Introduction

In high blood pressure, a common illness, the blood consistently presses too hard against the artery, putting internal organs in danger of serious problems. The strength of the heart to pump blood and the arteries’ stiffness affect an individual’s blood pressure. Combinations of variables, such as artery constriction and greater cardiac output, lead to hypertension. Millimeters of mercury (mm Hg) are the reference standard for measuring blood pressure.

Currently, hypertension is considered a significant health risk due to its impact on the global population. It affects millions of people in the US, many of whom also have unmanageable high blood pressure (Centers for Disease Control and Prevention, 2020). Hypertension increases the risk of heart disease, hemorrhage, heart failure, and death. The likelihood of developing these problems can be considerably decreased by managing blood pressure and maintaining it within normal ranges. Only around 25% of those with hypertension have it under control, according to the CDC (2020). A complicated interaction between a person’s lifestyle, environment, and inherent genetic elements causes hypertension.

The decline in death rates from heart disease and stroke in industrialized nations is primarily due to advances in detection and treatment research.

Treatment for hypertension is relatively uncommon, and its prevalence is associated with low control rates. Pharmacological therapies have dramatically lowered the risk of cardiovascular morbidity and death (Correa et al., 2018). The risk and regularity of cardiovascular events associated with therapy for hypertension have a significant impact on their family and friends. Although strokes can happen to anybody, they are more common among the senior population. Medical professionals, the healthcare system, and the methods used to treat hypertensive patients all have a role to play in solving the hypertension puzzle. Regrettably, a lack of adequate control of hypertension may be the consequence of both the ineptitude of the hospital staff and the noncompliance of the patient with regard to their prescription.

This issue fascinates me in particular since, in my capacity as a registered nurse, I frequently encounter patients in my unit who have been diagnosed with hypertension. Compared to younger generations, the incidence is significantly higher in older persons aged 54 and beyond (Abu et al., 2020). The individual who will be the focus of this evaluation is Mr. Koome, an African American adult who is 70 years old and was diagnosed with hypertension a decade ago. His history of substance misuse, including alcoholism, obesity, stroke, chronic cigarette smoking, and coronary artery disease, substantially impacts the quality of his life.

During the diagnosing process, Mr. Koome received information on hypertension; nevertheless, he has not followed the advice provided to him. He acknowledges that there are occasions when he does not always check his blood pressure before taking medicine and that there are also instances when he forgets to take his prescription. This examination aims to explore strategies for improving the patient’s health, study data from published research that has been subjected to peer review, and suggest nursing practices and regulatory frameworks that might have a beneficial influence on the patient’s health.

Analyzing Evidence Related to the Problem

The most successful methods, supported by data, for treating hypertension and perhaps curing the condition include making changes to one’s lifestyle and taking prescribed drugs as directed. The patient’s motivation, as well as demographic characteristics such as educational status, patient income, age, self-efficacy, and co-morbidity, all have a role in whether or not the patient adheres to the advised adjustments in lifestyle (Abul et al., 2020). Other characteristics include a knowledge of the condition, having a supportive social network, being overweight, smoking, drinking alcohol, and leading a sedentary lifestyle. Enhancements to institutions, such as forming interdisciplinary teams with counseling expertise, are required to carry out modification operations successfully. The capacity of hypertension patients to adapt to lifestyle changes should be improved via the development of programs by medical institutions, and healthcare staff should be provided with enough understanding about lifestyle modifications to assist hypertension patients.

For a treatment plan to be successful and evidence-based, it is necessary for it to comply with specific criteria when choosing data sources. One of these requirements is the exclusive use of research that other experts have evaluated that is kept up-to-date and relevant. It is essential to the process of doing research that relies on strong evidence to have the papers involved examined by other experts on the subject. In order to collect information necessary for this research on hypertension, medical databases such as Cinahl and PubMed were utilized. To locate pertinent findings, a comprehensive search on hypertension and nursing practice standards was carried out utilizing sources published during the last several years. It is advisable always to avoid relying on sources of data that are not reputable, such as non-peer-reviewed papers or those that are outdated.

The effects of treatments on hypertension have been demonstrated via studies. Adler (2019) states that the hypertension improvement programs implemented in a community helped improve the condition and hypertension management. Patients were constantly reminded of their medication schedule, weekly visits, and other health-related matters via short message service (SMS) applications (SMS). Seventy percent of patients had successfully managed their hypertension when the hypertension improvement program was launched (Adler, 2019). With the use of incentives, the program is more likely to keep most of its participants engaged for the scheduled monitoring duration.

Nurses may influence their patients’ present and future via policy work. Through lobbying, they are able to use their political expertise to affect decision-making and associated problems, which in turn improves outcomes, prevents disease and decreases hospital readmissions. Nursing theories and conceptual frameworks empower nurses with new ways of looking at their patients and their professional duties (Araki, 2019). Such efforts can help the practitioner provide better care for hypertensive patients and direct any necessary action.

As per the information presented in the analysis of the above articles, it is of the utmost importance to determine and treat all of the relevant risk factors for hypertension, make adjustments to our way of life, and start the first pharmacological therapy to treat hypertension properly. Equally as essential as interacting with patients on their terms and gauging how well they comprehend and feel about their illness are meeting patients where they are.

State Board of Nursing Practice and Governmental Policies

The Nurse Practice Act defines and regulates the scope of practice for registered nurses; therefore, familiarity with this law is essential for the nursing profession. The nursing boards in each state are responsible for ensuring that nursing regulations are followed. To ensure that nurses everywhere are competent and qualified to do their jobs, each state has enacted its Nurse Practice Act, which may be found here. Guidelines for nurses controlling hypertension can be found in nursing practice standards and government legislation (Spector et al., 2018). Patients’ results and general well-being have been considerably improved because of the recommendations.

Sustainable, low-cost, and successful interventions and policies have been adopted at the state and municipal levels to combat the problem of hypertension. Any nursing care given to a patient must be carried out in accordance with the law (Spector et al., 2018). The Board of Nursing and its Nurse Practice Standards play a crucial role in regulating the nursing profession. Due to the benefits of the Nursing and Midwifery Board’s strict regulations, RNs may treat their clients and conduct themselves confidently. RNs should be conscious that they are responsible for providing safe, legal care, and following all applicable ethical standards. High-quality nursing care for Mr. Koome depends on nurses adhering to state nursing practice standards, which has implications for the inclusion of non-maleficence and autonomy in the planning of his care.

Leadership Methods that Boost Outcomes

Nurses play a crucial role in improving health outcomes, expanding access to treatment, and easing the burden on healthcare systems. According to Araki. (2019), patients with hypertension benefit from nurses’ efforts to educate them, coordinate their care, and take the lead in implementing leadership techniques. One of the most successful methods of hypertension management is individualized care based on each patient’s specific needs (Araki, 2019). For Mr. Koome to get the finest care possible and see an improvement in his results, a more all-encompassing strategy is necessary. The patient’s primary care physician, cardiologist, and other specialists can work together effectively in a multidisciplinary approach. The numerous doctors and nurses working on this case can coordinate and communicate more effectively in order to use an interdisciplinary approach to patient care (Araki, 2019). The benefits of coordinated care are lower the risk of the patient receiving fragmented care, reducing hospitalizations and unnecessary medical treatment, increasing adherence to medical treatment, and eventually increasing the quality of care.

The patient’s blood pressure will be kept within normal range using a multidisciplinary approach I will execute to change management. Experts in hypertension are necessary for determining the cause of treatment resistance. If no etiological therapies are available, multidisciplinary interventions should be considered by nurses, pharmacists, nutritionists, physiotherapists, social workers, psychologists, and public health experts. When conventional and alternative methods of determining blood pressure are insufficient, they should be examined as an additional option. I will make sure patients get their meds on time, take them correctly, and learn to take charge of their health.

Conclusion

Age-related hypertension is a significant health issue that disproportionately impacts the elderly. Mr. Koome, a male patient, was evaluated since he had been diagnosed with hypertension and had not been following medical instructions. Mr. Koome’s hypertension treatment strategy should be determined using the most accurate and up-to-date medical evidence available in order to get the most remarkable potential outcomes for his health. There are greater outcomes and less medical disarray for hypertension patients treated by multidisciplinary teams. Each nurse must abide by the rules for nursing practice that are in force in their state at the time of practice. When taken collectively, these elements can aid hypertensives in improving their health and well-being while mitigating the severity of the disease’s negative effects.

References

Abu, H., Aboumatar, H., Carson, K. A., Goldberg, R., & Cooper, L. A. (2018). Hypertension knowledge, heart-healthy lifestyle practices and medication adherence among adults with hypertension. European Journal for Person-Centered Healthcare, 6(1), 108.

Adler, A., Laar, A., Prieto-Merino, D., Der, R., Mangortey, D., Dirks, R., & Perel, P. (2019). Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? BMJ, 9(4).

Araki, M. (2019). Patient-centered care and professional nursing practices. Journal of Biomedical Research and Clinical Investigation, 1(1), 1004.

Center for Disease Control and Prevention. (2020). High Blood Pressure. Web.

Correa, A., Rochlani, Y., Khan, M. H., & Aronow, W. S. (2018). Pharmacological management of hypertension in the elderly and frail populations. Expert Review of Clinical Pharmacology, 11(8), 805-817.

Spector, N., Hooper, J. I., Silvestre, J., & Qian, H. (2018). Board of Nursing approval of registered nurse education programs. Journal of Nursing Regulation, 8(4), 22-31.

The tactics of treating patients with hypertension are determined individually and are aimed at improving the quality of life, eliminating the symptoms of the disease. It should be noted that a similar therapeutic approach is currently used in the treatment of all cardiovascular diseases: the strategy is to improve survival and to eliminate the symptoms. However, it is important to note that in order to design an appropriate and effective intervention strategy, many different aspects need to be considered. IHI Open School’s (2020) Module 202 specifically reflects on how to address arising small issues within the complex system of healthcare. The module discusses the importance to seek the experience of other massive industries in implementing changes, and that it could not be expected from the system to work perfectly from the very start. Moreover, it also addresses small potential errors that may lead to failure in the long perspective if not resolved properly. The module emphasizes the importance of designing strategies to avoid or correct such issues in complex systems, which is imperative when implementing an intervention.

A prerequisite for managing a patient with any degree of risk is persistent and intensive non-drug correction of lifestyle and habits. Non-pharmacological methods of treatment of hypertension help to reduce blood pressure and the need for antihypertensive drugs, as well as increase their effectiveness. Leading a healthier life allows for the correction of risk factors and primary prevention of hypertension in patients with high or normal blood pressure. Williams et al. (2018) specifically state that “many patients with hypertension will require drug therapy, but lifestyle interventions are important because they can delay the need for drug treatment or complement it” (p. 315). Among the most important non-drug interventions, physical activity is considered rather effective and beneficial for all aspects of one’s health.

Regular exercise may be beneficial both for the prevention and treatment of hypertension and for reducing cardiovascular risk and mortality. Even a small reduction in blood pressure levels can be enough to significantly reduce the risk of heart disease and stroke, and studies show that physical activity is effective for this purpose. American Heath Association considers the amount of 90 minutes per week of moderate exercise an optimum for managing arterial hypertension, and encourages patients to employ this strategy. However, in order to be as effective as possible, this intervention plan requires clinical improvement – through changes in population’s attitude towards heart diseases and lifestyle.

Physical inactivity in middle and older age often leads to the aggravation of arterial hypertension, as well as the manifestation of comorbidities such as diabetes mellitus, hemorrhoids, and varicose. To improve the 90-minutes intervention strategy of AHA, it should be made a priority to educate not only the patients, but the population as well on the consequences of immobility. A widespread change can only be achieved through joined efforts of healthcare professionals, state, and community itself. Free seminars, courses, and counseling should be offered to people as a means of helping them establish a healthier lifestyle. It is necessary to offer the population guidelines on how to work out at home and at work, and how to implement physical activity into everyday life. Community should additionally engage in the process: for example, offering specific free activities for elderly and disabled population as the most vulnerable groups.

The U.S.’ universal healthcare paradigm could be rather effective in achieving widespread change with the 90-minutes-per-week intervention plan. Decentralized approach that this concept employs would allow to address population groups in a more specific, targeted ways, and tailor the care to the needs of particular community. According to Zieff et al. (2020), “universal healthcare can address the growing chronic disease crisis and mitigating its economic costs, reduce the vast health disparities in the population, and increase opportunities for preventive health initiatives” (p. 583). State programs can develop their own, small and specialized intervention strategies to ensure the population’s needs are met to the fullest. Community nurses will play the main role there: it is now known that the entire healthcare system, as well as the quality of medical care, largely depends on the work of nurses. The evidence from Hanžek’s (2018) study state that “nursing discharge summaries emphasize the role of the nurse in cost-effective planning and nursing care” (p. 51). Community health nurses will definitely hold a specific place in the whole intervention plan, as they provide the majority of the care.

If the community nurses will be employed as the main change force for this intervention, the health outcomes could improve significantly. Bekemeier et al. (2021) emphasize “the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues” (p. 865). The patient needs are the priority for the community center nurses, as the patients attend these centers primarily to get help with their problem. Such needs may include psychological, medical or social help, and nurses provide assistance for all of them.

In case of arterial hypertension, patients need support and compassion as they struggle to accept the diagnosis and learn to live with it in a productive and comfortable way – community nurses’ competence is of extreme importance here. Moreover, the community nurses also design and present educational campaigns and care actions to the community – which is a priority in the case of arterial hypertension. According to Hartzler et al. (2018), “health education typically targeted specific issues, such as cancer screening or self-management of a chronic illness” (p. 241). This could contribute to the overall level of hypertension-related awareness in society and assist the population in switching to a healthier lifestyle.

References

Bekemeier, B., Kuehnert, P., Zahner, S. J., Johnson, K. H., Kaneshiro, J., & Swider, S. M. (2021). A critical gap: Advanced practice nurses focused on the public’s health. Nursing Outlook, 69(5), 865–874.

Hanžek, K. (2017). Attitudes and opinions of community health nurses on nursing discharge summaries and cooperation with hospital nurses. Croatian Nursing Journal, 1(1), 51–59.

Hartzler, A. L., Tuzzio, L., Hsu, C., & Wagner, E. H. (2018). Roles and functions of community health workers in primary care. The Annals of Family Medicine, 16(3), 240–245.

Institute for Healthcare Improvement Open School. (2020). IHI Open School online courses: Course summary sheets. Boston; Institute for Healthcare Improvement.

Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D., Coca, A., De Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S., Kreutz, R., Laurent, S., … Desormais, I. (2018). 2018 practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Pressure, 27(6), 314–340.

Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A healthy debate. Medicina, 56(11), 580.

Abstract

PPHN condition results from failure to attain a smooth transition “from fetal to extrauterine pulmonary circulation after birth”. Diagnosis of this condition can be done through various ways including; physical examinations, looking at the history, undertaking laboratory tests, using chest x-ray, undertaking hyperoxia test, and echocardiogram.

The signs and symptoms include; tachypnea or rapid breathing, increased heart beat rate, respiratory distress which may include signs like grunting and flaring nostrils, and cyanosis even at the time the infant is being given extra oxygen to help it in breathing and having heart murmur among others.

In this paper, there has also been describing of the causes, treatment, and outcomes of PPHN condition and the role of the respiratory therapist in dealing with this condition.

Introduction

PPHN condition is an outcome of failure to attain a smooth transition “from fetal to extrauterine pulmonary circulation after birth” (Bartle, Patole & Rao, 2010, p.845). In most cases, pulmonary circulation experiences a noticeable drop from a high-resistance condition in the utero to a “low-resistance circuit”, within a very short period of time after birth (Mago, 2012, p.30).

Such reduction in the “pulmonary vascular resistance” or what is simply referred to as PVR, gives room for the lungs to turn out to be a gas exchange body organ (Kraemer, Krijger, Reiss, Rottier, Sluiter & Tibboel, 2011, p.245).

This paper is going to look at the “Persistent Pulmonary Hypertension of the Newborn” condition in much detail. The paper will discuss the diagnosis of this condition, its signs and symptoms, the population affected, causes, treatment, outcomes, and the role of the respiratory therapist. The last section of the paper will present a summary of the discussion.

Diagnosis

The diagnosis of the “Persistent Pulmonary Hypertension of the Newborn” condition can be confirmed by echocardiography which gives demonstration of the “right-to-left shunt with normal anatomy” (Bartle, Patole & Rao, 2010, p.845).

There is suspicion of PPHN in the newborn children who shows liability in the progressive cyanosis oxygenation condition in the initial twelve to twenty four hours of the child’s life; and in other occasions, after the first good oxygenation period.

Establishing of diagnosis is carried out from the physical examinations, the history of the patient, “laboratory tests, chest x-ray, pre-ductal and post-ductal blood gases, hyperoxia test, and echocardiogram” (Natarajan, Ostrea, Uy, & Villanueva-Uy, 2006, p.181).

Revelation is made of either a term infant or post-term infant by the history with a perinatal asphyxia’s history or predisposing factors like persistent membrane rapturing, “oligohydramnios, maternal group B streptococcal colonization, maternal smoking, and antenatal use of NSAIDS” (Natarajan et al., 2006, p.181).

The purpose of the physical examination is to help reveal the intermittent or progressive cyanosis, the variable levels of the respiratory distress and an intimately “split second heart” (Natarajan et al., 2006, p.181). There may be an audible murmur within the tricuspid or pulmonary region or sometimes in mitral area.

Systematic BP maybe at the normal level or there may be exhibition of sigs of the congestive heart failure as well as low blood pressure or BP. Moreover, there may be saturations of differential oxygen with either the upper or the lower extremities resulting from deoxygenated blood shunting via ductus arteriosus (Natarajan et al., 2006, p.181).

On the other hand, considering the x-ray method, this is found to be non-specific. This may be either normal or there may be mild or moderate “parenchymal lung disease” (Natarajan et al., 2006, p.181).

This form of diagnosis is mostly important in diagnosing the cause of acute deterioration among the affected children suffering from the PPHN-related conditions like; pulmonary hemorrhage among others (Nakwan, Nakwan & Wannaro, 2011, p.311).

Diagnosing PPHN by applying echocardiographic diagnosis is carried out on the basis of demonstrating high pressures of the pulmonary artery that are usually higher than the systemic pressures, and a “right-to-left shunt” via the foramen oval and ductus arteriosus.

Indicators that suggest higher levels of the pressure in the pulmonary artery are; prolonged time interval of the ventricular systole and a short “pulmonary flow velocity ratio” (Natarajan et al., 2006, p.181). A prolonged “left ventricular systolic” interval of time indicates ventricular dysfunction.

Failing of the acceleration of “systolic blood flow” between the major pulmonary artery and the minor peripheral artery on the Doppler also indicates ductal shunt. Conversely, echocardiogram might be normal and “the right-to-left shunt across the ductus arteriosus or foramen may not be seen depending on the level of the pulmonary artery pressure at the time of examination” (Natarajan et al., 2006, pp.181-182).

Signs and Symptoms

The signs and symptoms for the PPHN condition include; tachypnea or rapid breathing, increased heart beat rate, respiratory distress which may include signs like grunting and flaring nostrils, and cyanosis even at the time the infant is being given extra oxygen to help it in breathing (Natarajan et al., 2006, p.181).

On some occasions when the infant is being examined for PPHN, the physician may be able to hear an abnormal heart sound or what is called a “heart murmur” (Natarajan et al., 2006, p.181).

Affected Population

Some sections of the population are affected by PPHN, and this basically depends on the risk factors to which they may be exposed.

For instance, Cornfield & Delaney (2012, p.18) present a report that in a well-considered, case-control trial carried out in the U.S Army population, it was found out that babies that were delivered through cesarean section were at about five times increased risk of developing the condition of PPHN in comparison with a control population that is well-matched demographically.

As on one hand this study encompassed nearly twelve thousand infants, it is only 20 of them that were found to have developed the PPHN condition (Cornfield & Delaney, 2012, p.18). In the study, choramnionitis as well deliberated a considerably higher risk of the PPHN (Cornfield & Delaney, 2012, p.18).

The idea that imply that Cesarean section delivery leads to having increased risk of developing PPHN is offered support to by data that was obtained from a study conducted previously in which the delivery mode, maternal race, and “high maternal body mass index each increased the likelihood of PPHN” (Cornfield & Delaney, 2012, p.18).

It is also found that the risk of any woman delivering a baby that is affected by PPHN within the overall population is found to be approximately two babies among every one thousand live births (Cornfield & Delaney, 2012, p.18).

Causes

It has been found that in otherwise fit newborn, “the cause of PPHN is usually unknown” (Cornfield & Delaney, 2012, p.16). Among the researchers, there are those who hold a belief that stress among mothers while they are carrying babies in their wombs, linked to particular pregnancy complications may raise the level of the risk of having the PPHN condition.

The occurrence of PPHN may take place with particular congenital conditions or diseases of babies that have some effects on the lungs (Weijerman, Van Furth, Van der Mooren, Van Weissenbruch, Rammeloo, Broers, & Gemke, 2010, p.1195).

The PPHN condition has as well been associated with such health conditions as hypoglycemia, anemia, birth asphyxia and severe pneumonia. Such conditions may lead to high BP within the blood vessels that subsequently, leads to the lungs to rise to the level where the blood of the infant goes on passing by lungs after delivery.

In most cases, these conditions are found to be reversible and are also normally temporary. Some particular congenital conditions which contribute towards having incomplete development of the lungs may as well be linked to PPHN (Cornfield & Delaney, 2012, p.17).

Treatment

Maintaining sufficient oxygenation is the fundamental objective in PPHN management and mechanical ventilation is among treatment modalities that can be applied to realize this objective (Goissen, Ghyselen, Tourneux, Krim, Storme, Bou, & Maingourd, 2008, p.437-438).

Among the very early strategies within the conventional ventilator therapy was the hyperventilation to raise the level of the blood PH, facilitate the reversing of ductal shunting and inducting pulmonary vasodilatation. In comparing hyperventilation with alkali infusion, it was found out that hyperventilation brought down the level the “extracorporeal membrane oxygenation” risk (Oden & Cheifetz, 2005, p.105).

But on the other hand, from some study findings, it has been established that hyperventilation as well as “metabolic and respiratory alkanosis” induction in PPHN treatment, have not improved the clinical outcome to a significant level and have been linked to “adverse neurologic sequelae” (Natarajan et al., 2006, p.183).

On the other hand, pulmonary vasodilation using a number of drugs has undergone evaluation for PPHN treatment, but there has been no recommendation of any, apart from NO (Nassi, Daniotti, Agostiniani, Lombardi, Favilli, & Donzelli., 2010, p.104).

Some special cases of adenosine infusion have indicated improved oxygenation but have some adverse effects of “bradycardia, hypotension, and prolonged breeding time, which have precluded its clinical use” (Natarajan et al., 2006, p.183).

Initially, there was utilizing of tolazoline as a “vasolidilating, α-adrenergic blocking agent” (Natarajan et al., 2006, p.183). However, it facilitates inducing of histamine release and brings in adverse effects like having higher levels of gastric secretions as well as bleeding. It also leads to frequent occurrence of oliguria and systematic hypotension.

On the other hand, “Extracorporeal membrane oxygenation” (ECMO) is found to be a final therapy mode among infants that has reversible cardiac or respiratory failure at a time the rest of non-invasive measures have not succeeded. This method is an improved cardiopulmonary bypass which makes sure that there is sufficient delivery of oxygen and gas exchange among the PPHN patients having or not having cardiac support.

In this manner, the innate organs of the patient are rested to ensure facilitation of repair as well as to evade barotrauma and also volutrauma of the management of mechanical ventilation. Apart from PPHN, ECMO has as well been employed in “meconium aspiration syndrome, CDH, and cardiac anomalies” (Natarajan et al., 2006, p.184).

Basing on the fact that ECMO is an invasive method, this method or procedure is reserved for the young children that are receiving maximum “ventilatory support” and the ones that meet Barlett standards, which is suggestive of at least eighty percent risk of incurring death.

In the course of the last ten years or so, there has been a decline in the frequency of the utilization of ECMO technique because of the coming up of alternative techniques like inhaled NO or iNO (Natarajan et al., 2006, p.184).

Inhaled nitric oxide or (iNO) is a technique that has been identified to be safe and very effective treatment method for PPHN in the near-term as well as term newborns (Fashaw, Hale, Lee, Rosenberg, Vaver, Waas, & Werner, 2010, p.27; Hosono, Ohno, Kimoto, Shimizu, Takahashi, & Harada, 2009, p.79).

It has also been found out that using iNO has contributed to 3.4 percent more lives saved and a six percent rise in “average utility gained per infant (Lorch, Cnaan & Barnhart, 2004, p.417). Moreover, utilization of this technique has helped to bring improvement in oxygenation and also in decreasing the need for having ECMO among term newborns having PPHN (Kinsella & Abman, 1998,p.28).

In the current day, there has been extending of iNO utilization to the pre-term infants as being a rescue therapy among the infants having respiratory failure in spite of “surfactant replacement therapy”, and also more prevalent utilization among the infants who are less sick in an effort to bring down the level of frequency of the “chronic lung disease of the premature” (Fashaw et al., 2010, p.127).

While the use of this technique becomes more and more prevalent, it remains vital to go on evaluating short-term as well as long-term outcomes for the infants (Walsh-Sukys & Tyson, 2000, p.20).

Outcomes

The follow-up studies that were conducted previously about the infants who underwent treatment using iNO as “neonates have not found a short-term increase in medical, neurodevelopmental or behavioral problems when compared historically or concurrently with infants treated conventionally or with ECMO” (Fashaw et al., 2010, p.127).

A number of studies of young children of up to the age of 2 years, who received treatment using iNO as neonates have been somehow encouraging concerning short-term “developmental outcomes” (Fashaw et al., 2010, p.127).

In addition, the interviews conducted among parents that had children aged slightly above four years, that underwent treatment using iNO for PPHN, did not give out any findings of having increased neurologic, pulmonary, cognitive, “behavioral or neurosensory outcomes in infants treated with iNO when compared to those managed without iNO” (Fashaw et al., 2010, p.129).

Even if neurodevelopmental disabilities are given different definitions depending on the study being carried out, there has been reporting of these disabilities in between ten to thirty percent of the infants having no differences pointed out where comparison was made between the infants that received treatment with iNO and a control population that received treatment for PPHN.

Such numbers were as well comparable to those infants that received treatment with ECMO “followed out to 7 years of age” (Fashaw et al., 2010, p.129).

Therefore, outcomes for the infants treated as being neonates for “Persistent Pulmonary Hypertension of the Newborn” tends not to be related to the “specifics of individual intensive care treatment regimens, rather to events clinically associated with PPHN such as prenatal asphyxia” (Fashaw et al., 2010, p.129).

In general terms, the children that receive treatment with iNO have the same outcomes as those that receive treatment with ECMO and those that are treated with the conventional ways for the Persistent Pulmonary Hypertension of the Newborn.

The Role of the Respiratory Therapist

The respiratory therapist may be requested to offer supplemental oxygen and may also offer supplemental pressure to any patient who may be grunting in order to relieve the patient from some of the breathing hardships. The respiratory therapist can give this through either the nasal CPAP or through any other more appropriate means.

The therapist is then supposed to watch the infant (patient) closely for any symptoms of tiring. By making any observation of any sign of tiring, it may now become essential to apply more interventions. It is quite imperative for the therapist to watch closely this kind of patient.

The respiratory rate as well as the oxygen saturation of the patient has to be constantly monitored. In case there is any deterioration in the patient, quick intervention must take place (Tibballs & Chow, 2002, p.399).

Summary/ Conclusion

PPHN condition results from failure to attain a smooth transition “from fetal to extrauterine pulmonary circulation after birth”. The diagnosis of this condition can be carried by undertaking physical examinations, looking at the history, undertaking laboratory tests, using chest x-ray, undertaking hyperoxia test, and echocardiogram.

The signs and symptoms for the PPHN condition include; tachypnea or rapid breathing, increased heart beat rate, respiratory distress which may include signs like grunting and flaring nostrils, and cyanosis even at the time the infant is being given extra oxygen to help it in breathing and having heart murmur among others.

It is believed that PPHN is brought about by stress among mothers while they are carrying babies in their wombs, linked to particular pregnancy complications which may raise the level of the risk of having the PPHN condition. Moreover, the occurrence of PPHN may take place with particular congenital conditions or diseases of babies that have some effects on the lungs.

Considering treatment, maintaining sufficient oxygenation is the main goal in PPHN management and mechanical ventilation is among treatment modalities that can be applied to achieve the goal. ECMO has been found to be a final therapy mode among infants that has reversible cardiac or respiratory failure at a time the rest of non-invasive measures have not been successful.

The technique is an improvement of the cardiopulmonary bypass which makes sure that there is sufficient delivery of oxygen and gas exchange among the PPHN patients having or not having cardiac support. But on the other, in the last few year, there has been a decline in the frequency of the utilization of ECMO technique because of the coming up of alternative techniques like inhaled NO or iNO.

This new technique has been found to be very safe and very effective for treating PPHN in the near-term as well as term newborns. It has also been found out that using iNO has contributed to 3.4 percent more lives saved.

Moreover, utilization of this technique has helped to bring improvement in oxygenation and also in decreasing the need for having ECMO among term newborns having PPHN.

The respiratory therapist can play an important role of offering supplemental oxygen as well as providing supplemental pressure to any patient who may be grunting in order to relieve the patient from some of the breathing problems. The therapists also closely watches the patient in order to help carry out any interventions when need arises.

References

Bartle, D., Patole, S., & Rao, S. (2010). Current and future therapeutic options for persistent pulmonary hypertension in the newborn. Expert Review of Cardiovascular Therapy, 8(6), 845-873.

Cornfield, D., & Delaney, C. (2012). Risk factors for persistent pulmonary hypertension of the newborn. Pulmonary Circulation, 2(1), 15-23.

Fashaw, L., Hale, K., Lee, N. R., Rosenberg, A. A., Vaver, K. N., Waas, N., & Werner, D. (2010). School-age outcomes of newborns treated for persistent pulmonary hypertension. Journal of Perinatology, 30(2), 127-139.

Goissen, C. C., Ghyselen, L. L., Tourneux, P. P., Krim, G. G., Storme, L. L., Bou, P. P., & Maingourd, Y. Y. (2008). Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan. European Journal Of Pediatrics, 167(4), 437-440

Hosono, S., Ohno, T., Kimoto, H., Shimizu, M., Takahashi, S., & Harada, K. (2009). Developmental outcomes in persistent pulmonary hypertension treated with nitric oxide therapy. Pediatrics International, 51(1), 79-83.

Kinsella, J. P., & Abman, S. H. (1998). Inhaled nitric oxide and high frequency oscillatory ventilation in persistent pulmonary hypertension of the newborn. European Journal Of Pediatrics. Supplement, 157S28-S30.

Kraemer, U., Krijger, R. D., Reiss, I., Rottier, R. J., Sluiter, I., & Tibboel, D. (2011). Vascular abnormalities in human newborns with pulmonary hypertension. Expert Review of Respiratory Medicine, 5(2), 245-264.

Lorch, S. A., Cnaan, A., & Barnhart, K. (2004). Cost-Effectiveness of Inhaled Nitric Oxide for the Management of Persistent Pulmonary Hypertension of the Newborn. Pediatrics, 114(2), 417-426.

Mago, R. (2012, August). Antidepressants and persistent pulmonary hypertension of the newborn. Psychiatric Times, 29(8), 30.

Nakwan, N., Nakwan, N., & Wannaro, J. (2011). Predicting mortality in infants with persistent pulmonary hypertension of the newborn with the score for neonatal acute physiology-version II (SNAP-II) in Thai neonates. Journal of Perinatal Medicine, 39(3), 311-321.

Nassi, N. N., Daniotti, M. M., Agostiniani, S. S., Lombardi, E. E., Favilli, S. S., & Donzelli, G. P. (2010). Sildenafil as ‘first line therapy’ in pulmonary persistent hypertension of the newborn?. Journal Of Maternal-Fetal & Neonatal Medicine, 23(1),104-105.

Natarajan, G., Ostrea, E. M., Jr., Uy, H. G., & Villanueva-Uy, E. T. (2006). Persistent pulmonary hypertension of the newborn: pathogenesis, etiology, and management. Pediatric Drugs, 8(3), 179-188.

Oden, J., & Cheifetz, I. M. (2005). Neonatal Thyrotoxicosis and Persistent Pulmonary Hypertension Necessitating Extracorporeal Life Support. Pediatrics, 115(1), 105-108.

Tibballs, J., & Chow, C. (2002). Incidence of alveolar capillary dysplasia in severe idiopathic persistent pulmonary hypertension of the newborn. Journal Of Paediatrics & Child Health, 38(4), 397-400

Walsh-Sukys, M. C., & Tyson, J. E. (2000). Persistent Pulmonary Hypertension of the Newborn in the Era Before Nitric Oxide: Practice Pediatrics, 105(1), 14.

Weijerman, M., Van Furth, A., Van der Mooren, M., Van Weissenbruch, M. M., Rammeloo, L., Broers, C. M., & Gemke, R. J. (2010). Prevalence of congenital heart defects and persistent pulmonary hypertension of the neonate with Down syndrome. European Journal Of Pediatrics, 169(10), 1195-1199.