Home Monitoring Blood Pressure Project Proposal
Hypertension in the elderly affects approximately one billion people worldwide. It is the most common modifiable risk factor for conditions such as atherosclerosis, stroke, heart failure, atrial fibrillation, diabetes mellitus, sudden cardiac death, acute aortic syndromes, chronic kidney disease, and may cause death and disability in patients of all ages. Hypertension death rates increased twenty five percent from 1995 to 2005, and the actual number of deaths rose by fifty six percent, in part reflecting increasing numbers of older Americans and a high prevalence of hypertension at older age. (AHA, 2011) In 2009, the total direct and indirect costs attributable to hypertension were estimated to be seventy three point four billion. Our population is aging and hypertension among elderly patients over sixty five years of age is increasing in prevalence. Approximately thirty four million Americans are currently over sixty five years of age, thirteen percent of the United States population; this number is expected to reach seventy five million by 2040, representing an increased twenty percent of the United States population. Individuals over eighty five years of age are the largest growing subset in the United States and there have been dramatic improvements in life expectancy in older adults (AHA, 2011). The primary care health issues of an elderly person with coronary artery disease is particularly prevalent in our society and is an issue that needs more attention. High blood pressure causes many problems within the person's body and as people age, the chances of these problems occurring may increase especially if the person has suffered from high blood pressure for many years. The severity of hypertension increases remarkably with age. Hypertension is a major source of morbidity and mortality (Gibson, 2009). Preventing future problems with high blood pressure depends upon regular monitoring and taking the prescribed medicine as directed. The treatment of hypertension can differ among individuals. This yields the question as to whether home monitored blood pressure versus office blood pressure benefits the elderly patients in their treatment. We should treat hypertension in the elderly in order to reduce their risk of cardiovascular events and their mortality rates. The purpose of this paper is to discover the design of an evidence-based practice project that studies the different approaches to hypertension among the elderly patients and to observe if this design is best for the individual.
PICOT Question
There are several steps in evidence-based practice to form the research question which includes: forming the research question, searching for the literature for evidence to answer the question, combining the evidence with research that has already been preformed, implementing the change from the evidence, evaluating and then the results. In order to utilize the PICOT question you have to format one which stands for patient population, intervention or issues of interest, comparison, outcome and timeframe (Melnyk & Fineout-Overholt, 2011). The type of question used for the proposed project will be prevention and is stated as follows: "Among the elderly patients with coronary artery disease and hypertension, will monitoring blood pressure at home, in addition to routine blood pressure taken during an office visit, improve blood pressure management?" PICO (T) components.
P- The population would be an elderly patient.
The importance of the project is primary care treatment for elderly patients with coronary artery disease and risk factors such as hypertension. The focus would be on home monitored high blood pressure versus routine office visits. Many people with hypertension do not have easy access to be seen by their primary care physician or nurse practitioner. The focus on this population could bring some needed information to the forefront of the primary care nurse practitioner's practice.
I- The intervention or issue would be home monitored blood pressure.
Measuring blood pressure at home and keeping a record of the measurements will show the patient and the doctor how much their blood pressure changes during the day. The patient and their doctor can use this as a record of measurement to see how well the patients medicine is managing to control the high blood pressure. A good way for them to take part in managing their health and recognize changes early is to have the patient to take their blood pressure.
C- The comparison would be elderly patients getting only routine office blood pressures measured.
Patients that daily monitor their blood pressure versus patients that do not monitor their blood pressure until they go for an office visit or check up. The patient's blood pressure should be 130/80 or less for it not to be considered pre-hypertension or stage one hypertension. The attempt will be to cite studies which show how monitoring your blood pressure at home versus at the doctor's office will be beneficial.
O- The outcome would be; how could elderly patients with coronary artery disease, who monitor blood pressure at home versus having blood pressure taken during routine office visits, provide a decrease risk for hypertension?
The patient will be able to keep a running log of their blood pressure and manage the hypertension with the doctor for better treatment. Evaluating proper monitoring of the patient's blood pressure and treatment will allow the nurse practitioner to discover if the treatment is useful in lowering hypertension in the person.
T- The long term management: For this evidence-based practice project, this will allow an extended time frame for examining elderly patients having home monitored blood pressure versus having blood pressure monitored at the office.
Proposed Project
The primary purpose of the project is to research home monitored blood pressure versus office monitored blood pressure for treatment options with patients who have hypertension, in order to decrease unforeseen outcomes. Interest in the care and treatment for the elderly with coronary artery disease and risk factors, such as hypertension, would be the reason to focus on monitoring high blood pressure at home versus monitoring during routine office visits. The project will evaluate the intervention used to treat elderly patients with hypertension. The comparison would be the elderly patient having their blood pressure taken only during a routine office visit versus the patient daily monitoring their blood pressure at home. Although high blood pressure usually cannot be cured in most cases, it can be prevented and controlled (Schroeder, 2008). In evaluating, monitoring and treating the patient's blood pressure, the nurse practitioner can discover if the treatment is useful in lowering hypertension within the person. In treating the elderly for hypertension, it is necessary to consider their history/physical and other medical conditions. Hypertension is one of the most prevalent chronic diseases for which treatment is available, however, most elderly patients with hypertension are untreated. There are no symptoms, but it is often talked about as the "silent killer" (Jaana, 2007). There may be no symptoms but people may be affected by high blood pressure and may experience dizziness, palpitations, sweating and headaches. These issues need more attention among the elderly patients because high blood pressure has significant risk factors like coronary artery disease, peripheral vascular disease, diabetes mellitus and chronic kidney disease. The elderly are prone for strokes to occur due to complications with high blood pressure. The primary objective of this evidence-based practice project is to evaluate whether the use of self-measured blood pressure monitoring influences the outcome of the elderly with hypertension and to what extent can the change in outcomes be to using self-monitoring devices alone or using self-measured blood pressure plus additional support or attention. The intention of this project is to inform one’s decision making as to whether to encourage the use of self-measured blood pressure monitoring alone or with additional support.
Hypertension in the elderly affects approximately one billion people worldwide. It is the most common modifiable risk factor for conditions such as atherosclerosis, stroke, heart failure, atrial fibrillation, diabetes mellitus, sudden cardiac death, acute aortic syndromes, chronic kidney disease, and may cause death and disability in patients of all ages. Hypertension death rates increased twenty five percent from 1995 to 2005, and the actual number of deaths rose by fifty six percent, in part reflecting increasing numbers of older Americans and a high prevalence of hypertension at older age. (AHA, 2011) In 2009, the total direct and indirect costs attributable to hypertension were estimated to be seventy three point four billion. Our population is aging and hypertension among elderly patients over sixty five years of age is increasing in prevalence. Approximately thirty four million Americans are currently over sixty five years of age, thirteen percent of the United States population; this number is expected to reach seventy five million by 2040, representing an increased twenty percent of the United States population. Individuals over eighty five years of age are the largest growing subset in the United States and there have been dramatic improvements in life expectancy in older adults (AHA, 2011). The primary care health issues of an elderly person with coronary artery disease is particularly prevalent in our society and is an issue that needs more attention. High blood pressure causes many problems within the person's body and as people age, the chances of these problems occurring may increase especially if the person has suffered from high blood pressure for many years. The severity of hypertension increases remarkably with age. Hypertension is a major source of morbidity and mortality (Gibson, 2009). Preventing future problems with high blood pressure depends upon regular monitoring and taking the prescribed medicine as directed. The treatment of hypertension can differ among individuals. This yields the question as to whether home monitored blood pressure versus office blood pressure benefits the elderly patients in their treatment. We should treat hypertension in the elderly in order to reduce their risk of cardiovascular events and their mortality rates. The purpose of this paper is to discover the design of an evidence-based practice project that studies the different approaches to hypertension among the elderly patients and to observe if this design is best for the individual.
PICOT Question
There are several steps in evidence-based practice to form the research question which includes: forming the research question, searching for the literature for evidence to answer the question, combining the evidence with research that has already been preformed, implementing the change from the evidence, evaluating and then the results. In order to utilize the PICOT question you have to format one which stands for patient population, intervention or issues of interest, comparison, outcome and timeframe (Melnyk & Fineout-Overholt, 2011). The type of question used for the proposed project will be prevention and is stated as follows: "Among the elderly patients with coronary artery disease and hypertension, will monitoring blood pressure at home, in addition to routine blood pressure taken during an office visit, improve blood pressure management?" PICO (T) components.
P- The population would be an elderly patient.
The importance of the project is primary care treatment for elderly patients with coronary artery disease and risk factors such as hypertension. The focus would be on home monitored high blood pressure versus routine office visits. Many people with hypertension do not have easy access to be seen by their primary care physician or nurse practitioner. The focus on this population could bring some needed information to the forefront of the primary care nurse practitioner's practice.
I- The intervention or issue would be home monitored blood pressure.
Measuring blood pressure at home and keeping a record of the measurements will show the patient and the doctor how much their blood pressure changes during the day. The patient and their doctor can use this as a record of measurement to see how well the patients medicine is managing to control the high blood pressure. A good way for them to take part in managing their health and recognize changes early is to have the patient to take their blood pressure.
C- The comparison would be elderly patients getting only routine office blood pressures measured.
Patients that daily monitor their blood pressure versus patients that do not monitor their blood pressure until they go for an office visit or check up. The patient's blood pressure should be 130/80 or less for it not to be considered pre-hypertension or stage one hypertension. The attempt will be to cite studies which show how monitoring your blood pressure at home versus at the doctor's office will be beneficial.
O- The outcome would be; how could elderly patients with coronary artery disease, who monitor blood pressure at home versus having blood pressure taken during routine office visits, provide a decrease risk for hypertension?
The patient will be able to keep a running log of their blood pressure and manage the hypertension with the doctor for better treatment. Evaluating proper monitoring of the patient's blood pressure and treatment will allow the nurse practitioner to discover if the treatment is useful in lowering hypertension in the person.
T- The long term management: For this evidence-based practice project, this will allow an extended time frame for examining elderly patients having home monitored blood pressure versus having blood pressure monitored at the office.
Proposed Project
The primary purpose of the project is to research home monitored blood pressure versus office monitored blood pressure for treatment options with patients who have hypertension, in order to decrease unforeseen outcomes. Interest in the care and treatment for the elderly with coronary artery disease and risk factors, such as hypertension, would be the reason to focus on monitoring high blood pressure at home versus monitoring during routine office visits. The project will evaluate the intervention used to treat elderly patients with hypertension. The comparison would be the elderly patient having their blood pressure taken only during a routine office visit versus the patient daily monitoring their blood pressure at home. Although high blood pressure usually cannot be cured in most cases, it can be prevented and controlled (Schroeder, 2008). In evaluating, monitoring and treating the patient's blood pressure, the nurse practitioner can discover if the treatment is useful in lowering hypertension within the person. In treating the elderly for hypertension, it is necessary to consider their history/physical and other medical conditions. Hypertension is one of the most prevalent chronic diseases for which treatment is available, however, most elderly patients with hypertension are untreated. There are no symptoms, but it is often talked about as the "silent killer" (Jaana, 2007). There may be no symptoms but people may be affected by high blood pressure and may experience dizziness, palpitations, sweating and headaches. These issues need more attention among the elderly patients because high blood pressure has significant risk factors like coronary artery disease, peripheral vascular disease, diabetes mellitus and chronic kidney disease. The elderly are prone for strokes to occur due to complications with high blood pressure. The primary objective of this evidence-based practice project is to evaluate whether the use of self-measured blood pressure monitoring influences the outcome of the elderly with hypertension and to what extent can the change in outcomes be to using self-monitoring devices alone or using self-measured blood pressure plus additional support or attention. The intention of this project is to inform one’s decision making as to whether to encourage the use of self-measured blood pressure monitoring alone or with additional support.
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