ASSESSMENT -History and risk factors -assess potential symptoms of target organ damage -angina, sob, altered speech,

headache, dizziness, balance problems, nosebleeds. Cardiovascular assessment: apical and peripheral pulse

Weight Loss Assessment question: Do you know your ideal body weight? Help the patient determine their ideal body weight by checking body mass index (BMI) and waist circumference. At the visit the patients height and weight can be measured, as part of the assessment you can identify what the patients BMI is and show them via a chart where they are in the classifications. BMI is determined by multiplying weight in pounds by 703 the dividing by height in inches. There are programs available for downloading onto a PDA (personal digital assistant) that have the automatic calculator and the classification tables to make this easier and take up less time in the process. BMI alone does not identify risk because weight from muscle or from water retention may overestimate body fat. Normal BMI should be between 18.5 and 24.9. Measure the patients waist circumference as part of the visit and document it in the record. Waist circumference is also a good measure of need for weight loss. Too much body fat in the abdomen increases risk of cardiovascular disease. For women a waist circumference of more than 35 inches and men greater than 40 inches is considered high. Weight loss of just ten pounds can lower blood pressure (Lowering Blood Pressure, 2003). If the patient falls into the overweight range stress the importance of losing weight slowly. Encourage patient to lose no more than to 2 pounds per week and a reasonable goal is 10 % of their current weight. One pound equals 3,500 calories so to lose one pound per week the patient will need to eat 500 calories less per day or burn 500 calories per day. Provide a handout the gives meal plan examples to aid the patients decision making. The best approach would be to eat less and be more physically active. Be careful to stress that serving sizes/amount is as important as what is eaten.

Physical Activity Assessment question: On a daily basis how much physical activity do you do? Moderate level physical activity on a daily basis will not only help with weight loss but can reduce blood pressure and the risk of cardiovascular disease. Moderate level activity thirty

minutes a day for most days of the week is recommended. To start the patient can even divide the thirty minutes into three ten-minute periods. Discuss with the patient simple things to try in the beginning ,use the stairs instead of the elevator, park you car at the far end of the parking lot in the morning. Give the patient the American Heart Association pamphlet Just Get Moving. (AHA, 2000). At a follow up visit discuss other examples of moderate level physical activity including: walking briskly, mowing the lawn, golf- walking to course, swimming with moderate effort, cycling at moderate speed of 10 miles per hour, general cleaning, home repair such as painting (Lowering Blood Pressure ,2003). Together with the patient, develop a plan for them to incorporate moderate activity into their daily routine so they gradually increase the time spent in physical activity to 60 minutes per day, everyday (Control your Risks, 2003). Give them a log to keep to document the activity and ask them to bring it to subsequent visits.

Avoid Excessive Alcohol Assessment question: What is your routine alcohol intake? Many studies suggest that small amounts of alcohol intake can reduce risks of cardiovascular disease. Drinking too much alcohol can raise blood pressure. Some studies say that drinking more than 3-4 ounces per day of 80 proof alcohol will raise blood pressure (Control your risk, 2003). Alcohol consumption should be limited to no more than 1-2 drinks per day. Remind the patient that if he/she is dieting alcohol is high in calories. Define for the patient what constitutes a drink: 12 ounces of beer (150 calories), 5 ounces of wine (100 calories), 1 ounces of 80 proof whiskey (100 calories ) ( Lowering Blood Pressure, 2003). Help the patient fit their alcohol intake into their diet plan.

Eat Heart Healthy Assessment questions: What is your sodium intake? Do you know what foods you eat regularly are high in sodium? Research shows that a healthy eating plan can not only help reduce weight but can lower the risk of developing high blood pressure and reduce already elevated pressure (Control your risk factors, 2003). A key to healthy eating is reducing sodium intake. In general we eat more sodium than we need on a daily basis. 2.4 grams of sodium is the most we should ingest in a day. That equals approximately one teaspoon of salt daily (Control your risk factors ,2003). Because sodium is found naturally in many products an important part of patient education is teaching the patient and family how to read labels to make good choices regarding the foods they include in their diet. Look for labels that indicate: sodium free, low sodium, light sodium, reduced sodium. Teach comparing labels, a good choice to use is frozen versus canned vegetables. Have the patient identify which is the better choice.

To help the patient plan an overall better diet. Consider teaching the DASH diet. Dietary Approches to Stop Hypertension (DASH) is from a clinical study that looked at the effects of nutrients in food on blood pressure. This study found that blood pressure was reduced by focusing on low saturated fat, total fat and cholesterol and adding foods rich in fruits, vegetables and low fat dairy products (Control your risk factors, 2003). Through discussion and example teach the patient that because the DASH diet is higher in fruits, vegetables and grain it is normal as you begin to have some bloating and diarrhea. A good way to avoid or minimize that would be to change gradually, i.e. add a vegetable or fruit serving at lunch or dinner. Spread out the servings throughout the day and add fruits as snacks. Treat meats as one part of the meal, try for two or more meatless meals per week (Lowering blood pressure, 2003). Provide the patient with information on calories, food substitutions, and foods that are rich in certain nutrients. There are many good dietary handouts that can reinforce this information. As the nurse you can choose one that meets the needs of your population. Being successful with dietary changes means an understanding of what it is you eat each day, so you can make the needed changes. Initially ask the patient to keep a diary of what they eat each day. This can provide a starting point for simple but successful dietary changes and can aid in the evaluation of their success. The caloric intake on the DASH plan can be easily altered so that the overall diet becomes more focused on healthy eating, but reduced caloric intake. An example that can be easily shared with patients can be found on http://www.nhlbi.nih.gov.