HEP 454 Module 2 Writing Assignment Program Rationale

Needs assessment

Health problem

Blood pressure taken before and after dialysis does not agree well with those reported outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of better predictive value than blood pressure recorded right before and after dialysis remains incompletely known. More than seventy percent of dialysis patients have hypertension, and only around twenty percent of those with hypertension have sufficient management of their blood pressure (BP). Peritoneal dialysis (PD) patients are no different, and the reported prevalence of hypertension ranges from around 30 to more than 90 percent. Variability in the definitions and tools used to diagnose hypertension is largely to blame. Using various definitions of hypertension, epidemiological studies in Mississippi found that 72% to 88% of all individuals investigated had increased BP (Ashby et al., 2019). Patients with high blood pressure were more likely to be on antihypertensive medication, but only 30 to 50 percent of those patients had their blood pressure under control in those trials. When patients begin dialysis for kidney failure, they are almost universally on blood pressure-lowering medicines. Although many of them have too much fluid in their systems, frequent dialysis may help lower blood pressure if a patient has that fluid removed. Despite this, roughly 60 percent of hemodialysis patients and 30 percent of patients on peritoneal dialysis (PD) still require medication for high blood pressure.

Patients on hemodialysis often have three treatments a week. Before dialysis, the patient’s weight and extra fluid usually increase and decrease the following dialysis. Blood pressure is highest before hemodialysis and drops to its lowest after that, as you might expect (Heerspink et al., 2009). After hemodialysis, low blood pressure is a common symptom. The side effects are cramps, dizziness, lightheadedness, nausea, and vomiting. Hemodialysis patients who get treatment every day, like those who get hemodialysis at home, had less high blood pressure than those who didn’t (HHD). Most patients undergoing more frequent hemodialysis at home have normal blood pressure and do not require blood pressure medications.

Risk factors

To maintain healthy blood pressure, it is necessary to properly control a person’s fluid intake. Leg cramps, nausea, and lightheadedness are all signs that your body lacks fluid, which can lower your blood pressure. Many signs of having too much fluid in your body, such as swollen ankles or a tight chest. Each patient can benefit from establishing a goal weight for themselves each day. There may be an excess of fluid if the patient’s weight and blood pressure are high (Zhang et al., 2019). A lack of fluid can cause dehydration in underweight patients or have low blood pressure. Dextrose, a type of sugar, can be changed in PD dialysate exchanges with the help of a doctor and a nurse trained in peritoneal dialysis. Keeping fluids out and blood pressure down can be accomplished by limiting your daily salt and beverage intake.

Hypertension affects a large percentage of people undergoing peritoneal dialysis. It is possible to have both high and low blood pressure, and both of these conditions can lead to heart disease, strokes, and early death. Using peritoneal dialysis regularly makes it possible to maintain a healthy blood pressure level without using any other medications (Müller et al., 2020). With correct hydration management and appropriate remedies, blood pressure can be kept under control.

Priority population

The priority population for Gulfport Quality Improvement Initiative is adults aged between 25 years and 40 years undergoing dialysis. According to the national kidney foundation, patients in stages 4-5 need more care and treatment because the stage is critical and should be handled carefully to help the patient cope with the situation (Stern et al., 2014). The majority of the patients suffering from high blood pressure are between 25 and 30. Patients in this age bracket take many things for granted and do not follow the correct procedure for dialysis to avoid having high blood pressure issues. It is advised that adults watch what they eat, the amount of salt intake, and eat healthy food to avoid becoming obese. Obesity is one of the reasons that causes high blood pressure in dialysis patients. If they eat healthily and follow the procedure for the treatment, it is easy to manage the high blood pressure that affects them.

People on hemodialysis can keep an eye on their blood pressure at home or while they are out and about. This is a better way to keep an eye on their blood pressure than to keep an eye on their dialysate blood pressure. Even though blood pressure is routinely measured in dialysis treatment facilities, some parts of the current measurement method may be deficient. Patients with chronic kidney disease (CKD) who have increased blood pressure (hypertension) can now use various new diagnostic and treatment options. A guideline for the dialysis population has not yet been developed to address this critical issue while the KIDGO recommendations are being reviewed.

Other similar programs

As part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) recommends that persons with CKD utilize whatever therapy is necessary to keep their blood pressure under 130/80.

To lower blood pressure, the NHLBI suggests five dietary and lifestyle modifications. Those with high blood pressure, whether prehypertension or hypertension, need to maintain a healthy body weight close to a typical person. They also encourage patients to eat enough fresh fruits and vegetables, whole grains, and low-fat dairy products to achieve optimal health.

Keeping their daily sodium consumption to no more than 2000mg also help in keeping them in the dialysis program and management of blood pressure becomes easier. Therefore they encourage these patience to try and consume less sodium. They should also reduce their use of frozen meals and fast-food establishments and instead eat more fresh foods. Eating reash foods reduces the risk of consuming something that can increase high blood pressure and adding more salt to the body.

Patients are also encouraged by the NHLB to look at nutrition labels on packaged items to see how much sodium is in a serving. You may keep track of your sodium intake by keeping a sodium diary. They should also maintain a regular exercise schedule, aiming for 30 minutes of brisk activity five days a week (walking, bicycling, or swimming). Lastly, they should not overindulge in alcoholic beverages. As far as men are concerned, they should limit themselves to no more than two alcoholic beverages every day. Women should consume only one serving a day since they are more sensitive to the effects of alcohol due to the differences in the breakdown of food in the body.

The heart disease and stroke prevention program’s objective is to prevent, manage, and reduce the risk factors associated with heart disease and stroke by implementing health system interventions to improve effective delivery of care, community-clinical linkages to support prevention and management of high blood pressure and diabetes, and collecting and analyzing data to guide work.

Their priorities include promoting reporting of blood pressure and A1C measures; and initiating activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure. They also promote awareness of high blood pressure among patients. They increase the implementation of quality improvement processes in health systems and team-based care in health systems. They also increase the use of health-care extenders to support self-management of high blood pressure.

References

Ashby, D., Borman, N., Burton, J., Corbett, R., Davenport, A., Farrington, K., Flowers, K., Fotheringham, J., Andrea Fox, R. N., Franklin, G., Gardiner, C., Martin Gerrish, R. N., Greenwood, S., Hothi, D., Khares, A., Koufaki, P., Levy, J., Lindley, E., MacDonald, J., … Wilkie, M. (2019). Renal Association Clinical Practice Guideline on Haemodialysis. In BMC Nephrology (Vol. 20, Issue 1). https://doi.org/10.1186/s12882-019-1527-3

Heerspink, H. J. L., Ninomiya, T., Zoungas, S., de Zeeuw, D., Grobbee, D. E., Jardine, M. J., Gallagher, M., Roberts, M. A., Cass, A., Neal, B., & Perkovic, V. (2009). Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. The Lancet, 373(9668). https://doi.org/10.1016/S0140-6736(09)60212-9

Müller, M., Schönfeld, C. L., Grammer, T., Krane, V., Drechsler, C., Genser, B., Kohnen, T., Wanner, C., & März, W. (2020). Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-70998-9

Stern, A., Sachdeva, S., Kapoor, R., Singh, J., & Sachdeva, S. (2014). High blood pressure in dialysis patients: Cause, pathophysiology, influence on morbidity, mortality and management. In Journal of Clinical and Diagnostic Research (Vol. 8, Issue 6). https://doi.org/10.7860/JCDR/2014/8253.4471

Zhang, L., Wang, Y., Xiong, L., Luo, Y., Huang, Z., & Yi, B. (2019). Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: Evidence from a meta-analysis. BMC Nephrology, 20(1). https://doi.org/10.1186/s12882-019-1586-5