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DNP 805 Case Report: Health Care Informatics

DNP 805 Case Report: Health Care Informatics

The integration of technology in healthcare provision is an important milestone in the disease management process, especially for acute and chronic conditions like hypertension. High blood pressure or hypertension is a global health problem that affects millions and causes over 7 million deaths each year according to data from the World Health Organization (WHO) (Dadlani et al., 2019). The American Heart Association (AHA) observes that over 100 million Americans suffer from this acute condition. The AHA defines hypertension as a constant high force exerted on blood vessels as blood pushes against the arterial walls during pumping by the heart (AHA, 2018). Different factors like exercise, anxiety, and positioning impact blood pressure (BP) readings. While hypertension can be diagnosed and treated in primary care settings, it is essential to attain the correct BP reading to help providers make appropriate treatment decisions. Using technology aids providers in attaining the right interventions for hypertension. White coat hypertension is a condition whereby a normotensive patient encounters increased BP in clinical situations and is one of the factors that influence proper diagnosis and treatment of the disease in primary settings (Greenland, 2019).  The development of the Ambulatory Blood Pressure Monitoring (ABPM) device in 1992 was meant to address this phenomenon. However, the use and its design have evolved with time by leveraging technology to suit emerging patient needs and providers’ perspectives. The purpose of this paper is to describe how technology can be used to address a clinical problem of hypertension.

Synthesis of the Literature

The 24-hour ABPM is a non-invasive BP monitoring approach recommended by health organizations in the world for diagnosing hypertension. Studies show that the ABPM BP readings are lower by 15mmHg compared to clinical measurements. The device assists in the identification of pointers or risk factors that predispose people to heart conditions by measuring the BP even when patients are sleeping. Blood pressure drops by between 10% and 20% when one sleeps (Zhu et al., 2021). However, some individuals do not encounter the drop and instead develop nocturnal hypertension that increases one’s susceptibility to cardiovascular conditions and even death. A study by Banegas et al. (2018) explores the link between clinical blood pressure and the 24-hour ABPM with various causes of mortality associated with a cardiovascular condition in primary care clinics. The study concludes that ABPM can predict causes of cardiovascular deaths than clinical BP readings. The study also identified white coat hypertension and masked hypertension as significant risk factors for mortality for individuals with high blood pressure. Imperatively, experts and stakeholders in healthcare recommend the use of ABPM to confirm a hypertension diagnosis because of its ability to detect the condition even at night and offer accurate readings than the clinical care ones.

Description of the Case

During an annual primary care physician visit, Ashford’s blood pressure was 165/77. Mr. Ashford does not have any medical history of hypertension and has never received treatment for the condition. Mr. Ashford was issued with a BP monitor and asked to check his BP two times a day, and record them on a log. He was scheduled for a follow-up clinic in 2 weeks and should come with the BP log. The patient returned after 2 weeks to the facility with the BP log where the systolic BP ranged 131-163 mm Hg. His diastolic BP ranged from 65-85. Mr. Ashford never recorded the data and time and the activities he performed before the measuring of his BP. The patient failed to take his BP measurements on certain days.

The patient encounters several problems that include inability to comply with the requirements to record his BP, monitoring his BP only twice a day despite potential exacerbations, and lack of sufficient information on how to manage his condition. These problems reduce the ability of the patient to keep track of his glycemic control levels. The barriers to care include limited interaction with his provider, insufficient information, and self-management practices that can enhance overall care.

Description of Technology

Ambulatory BP monitoring allows providers and patients and their families to obtain out-of-office BP reading based on established intervals, in most cases, 15 to 30 minutes over 24 hours. The US Preventive Services Task Force recommends the use of ABPM devices as a better method by providers to predict long-term cardiovascular disease outcomes (Kario, 2021). The ABPM is an automated compact device with uses oscillometric techniques to obtain BP readings. The monitor is attached to a belt that patients wear around their waist and connected to a sphygmomanometer cuff with a tube. The monitor is programmed to check BP after and determine intervals, usually 15 to 30 minutes over the 24 hours. The device works whether the patient is asleep or awake with no interruptions. Patients can do their normal activities while having the device but should rest their arms and avoid vigorous actions and motions when the cuff inflates (Greenland, 2019).The patients should also keep a log of their activities while with every BP reading. The readings are linked to a computer after 24 hours and are analyzed by a provider to make effective care decisions for patients, especially helping them to avoid potential cardiovascular attacks.

Using ABPM to Solve Clinical Problem

ABPM offers the most effective way of measuring and recording hypertension data for patients with the condition. The device leverages technology to offer a reliable way to diagnose high blood pressure instead of using office readings that may not provide accurate measures. In this case, Mr. Ashford can use the ABPM device to measure and record the various readings of his blood pressure. The log used does not offer comprehensive data about the time of the day when he took his BP readings. The BP measuring based on the case is only done twice a day yet the ABPM device records after every 30 minutes (Kario, 2021). The data provided by Mr. Ashford does not include his readings while asleep at night. Further, the patient forgot to take and record his blood pressure on particular days.

The patient and provider will check the BP as scheduled whether Mr. Ashford is asleep or not. Using the ABPM monitoring technology, all the patient needs to do is wear the device and it records at the predetermined intervals. The monitor will automatically check Mr. Ashford’s BP based on the set schedule and will be affected by his sleep (Banegas et al., 2018). The availability of multiple data is critical for providers to make better decisions. The providers can also use the ABPM technology to diagnose white coat hypertension among patients with elevated BP during clinic visits while receiving treatment for the condition.

Summary Integrating the Christian Worldview

High blood pressure is one of the main causes of cardiovascular disease and requires effective diagnosis and subsequent treatment interventions to reduce morbidities and mortality. Through the use of technological devices like the ABPM, healthcare providers can enhance the accuracy of hypertension diagnosis and reduce the cost of care to patients and the industry while improving patient outcomes (Dadlani et al., 2019). Providers cannot rely on clinical blood pressure readings and measurements alone since they can be influenced by several factors like white coat hypertension.

The Christian worldview seeks the development and use of interventions that enhance the quality of life and provides benefits to patients without any discrimination and bias. The proposed solution seeks better interventions to prevent millions of death that occur due to hypertension. The Christian worldview focuses on the provision of overall good to the majority to ensure that they lead better lives. The ABPM offers a more accurate BP reading as it measures hypertensive conditions over 24 hours (Zhu et al., 2021).The technology allows providers to get data that they can review and make better decisions in treatment interventions.

Conclusion

The case report focuses on hypertension as a clinical problem and the use of ABPM technology to manage and appropriately treat the disease. The paper describes the use of the technology to address Hypertension, especially white coat hypertension. ABPM remains an effective and reliable recommended method for diagnosing hypertension in primary care settings. Providers should use this technology to enhance patient care outcomes and prevent potential risks associated with hypertension among the affected patients.

References

American Heart Association (AHA) (2018). More than 100 million Americans have high blood

pressure,AHA says. https://www.heart.org/en/news/2018/05/01/more-than-100-million-americans-have-high-blood-pressure-aha-says

Banegas, J. R., Ruilope, L. M., Alejandro de la Sierra, Vinyoles, E., Gorostidi, M., Cruz, J. J.,

Williams, B. (2018). Relationship between the clinic and ambulatory blood pressure

measurements and mortality. The New England Journal of Medicine, 378(16).

https://doi.org/10.1056/NEJMoa1712231

Dadlani, A., Madan, K., & Sawhney, J. P. S. (2019). Ambulatory blood pressure monitoring in

clinical practice. Indian heart journal, 71(1), 91-97. https://doi.org/10.1016/j.ihj.2018.11.015

Greenland, P. (2019). Effective use of ambulatory blood pressure monitoring. JAMA, 322(5),

420-421. https://doi.org/10.1001/jama.2019.10123

Kario, K. (2021). Home blood pressure monitoring: current status and new developments.

American journal of hypertension, 34(8), 783-794. https://doi.org/10.1093/ajh/hpab017

Zhu, H., Zheng, H., Liu, X., Mai, W., & Huang, Y. (2020). Clinical applications for out-of-office

blood pressure monitoring. Therapeutic advances in chronic disease, 11, 2040622320901660. https://doi.org/10.1177/2040622320901660

 

 

 

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