Wellness Protocol: Blood Pressure Control

PHILOSOPHY:   To utilize the client's commitment to make positive behavior or health changes to control blood pressure. Designed to address the client's individual needs and increase the chances for success.

ASSUMPTIONS:   The following plan was designed for those with primary or essential hypertension, rather than those with secondary hypertension. High is defined as sustained systolic >140mm. Hg. and/or diastolic>90.

FORMAT:   The client and the counselor will spend time together on an agreed-upon schedule to work on problems, to reinforce positive changes, and to provide periodic assessment, including blood pressure monitoring.

Session I. Get acquainted with client.

1. Weigh the client, take blood pressure readings, and record on wallet card. Ascertain current diagnostic and treatment information, and complete standard follow-up form.



2. Review with the client why high readings are a cause for concern, and refer back to physician if readings are high.



3. Have the client list all prescription and over the counter medications being taken and the number of times per day/week each drug is taken.



• Is the client taking medication(s) as prescribed?



• Is the client seeing his/her physician as requested?



4. Explain to the client that he/she should be seen again by the wellness counselor to review a list of things which he/she can do to assist in lowering blood pressure or to help his/her medication work more effectively.



5. Make an appointment for the next visit, within 7 to 10 days, or after the client's next physician visit.

1. Confirm physician's diagnosis



2. Weigh the client, take blood pressure readings, and complete follow-up form.



3. Discuss any problems the client may be experiencing with his/her treatment regimen and explore possible solutions. Work on one problem at a time.



• Problems may include: not understanding the doctor's advice, not remembering to take medication or get prescription filled, treatment side effects, etc.



• Solutions may include: notes on calendar or other areas of the home, having another person remind client, pill boxes, keeping a supply at work, etc.



4. Make an appointment for the next visit, no sooner than 7 to 10 days.

1. Weigh the client, take blood pressure readings, and complete follow-up form.



2. If problems were found with the client's treatment regimen during Session II, review any progress made. If other problems still exist, continue with problem-solving methods.



3. Introduce the three non-pharmacological treatments listed below.



4. Weight Control (if client is overweight)



• Utilize Guided Self-Help Materials for Weight Loss, or refer client to a formal weight loss program.



5. Alcohol Restriction



• Alcohol can be a cause of hypertension:
  - for men: when one has 3 or more drinks per day or drinks daily
  - for women and older persons: when one has 2 or more drinks per day or drinks daily.



• Alcohol is high in calories.



• Remind the client that one drink is:
  1½ oz. shot = 12 oz. beer = 4 oz. wine



• Alcohol intake should be reduced to 2 drinks/day.



6. Sodium Restriction



• Sodium intake should be limited to ²/₃ gm/day (or as prescribed by physician)



7. Make an appointment for the next visit, no sooner than 7 to 10 days.

1. Sessions will follow as needed, focusing on:



• Topics selected by the client



• Problems the client may be experiencing with his/her treatment regimen.



2. Monitoring and assisting clients to make positive changes should be an on-going process.

Materials Needed:

• Follow-up form (developed by the University of Michigan Worker Health Program)
• Wallet card (developed by the University of Michigan Worker Health Program)
• Questionnaire
• Recent handouts related to blood pressure, medications and following a treatment regime, nutrition, and dietary salt.