Hypertension: Home Monitoring and Patient Education

to drive healthcare to a more patient-centered focus

- appropriateness of testing
- ability to accurately conduct the test and interpret results
- potential interference with test results

BP > 130/80

medication adherence

arm and wrist

"white coat syndrome", assess efficacy of meds outside clinic; improves adherence

mostly accurate and reliable; light, portable; good eyesight and hearing required

becoming more accurate with advancing technology, more accurate

40%

80-100%

- bladder width 40% of circumference of arm
- bladder covers 80-100% of circumference of arm

falsely high BP

falsely low BP

- keep a log of readings
- if monitoring therapy, take reading every morning
- watch for changes with medication changes
- avoid tobacco, caffeine, PSE
- do not self-adjust meds
- contact PCP if elevated results

- memory to store readings
- input meals/insulin administration

used to pierce skin to obtain blood sample
can use with lancing device

smaller

no

400-600 mg/dL; after that "error" or "high" - see PCP

- blood sugar too high to be read
- sample too small
- temperature error
- wrong or expired strip

- wash hands
- wipe finger with alcohol wipe and allow to dry
- set hand below heart for 30-60 sec
- place test strip in glucometer
- lance finger
- apply blood drop to test strip and wait for reading

upper arm, thigh, calf, fleshy parts of hand

- variation in glucose concentration throughout body
- rapid changes in glucose

- possible hypoglycemic episode
- history of hypoglycemic unawareness
- site results don't agree with how you feel

every 3 months

purple; don't open red until ready to use

<70 mg/dL

shakiness, sweating, sudden hunger, tachycardia, confusion

instruct pt with hypoglycemia to take 15-20g of glucose and recheck glucose in 15 minutes

elevated cholesterol levels; contributes to atherosclerotic heart disease

complete lipid panel every 5 years after age 20

total cholesterol, LDL-C, HDL-C, triglycerides

help monitor the efficacy and adherence to diet, exercise, and medication plans; must be fasting for 9h

excessive bleeding from finger stick

- avoid high doses of vitamin C
- wash hands thoroughly
- read instructions
- do not excessively milk finger

total cholesterol >200 mg/dL
HDL-C <40
triglycerides >150

first FDA approved screening for HIV-1 and HIV-2
saliva-based

20-40 minutes (inconclusive after 40 minutes)

at least 3 months after exposure

- need referral for confirmatory test
- counseling available from manufacturer
- counsel on avoiding behaviors that may infect others

if positive, link to care

trophoblastic cells

human chorionic gonadotropic hormone
causes corpus lutteur to continue to produce progesterone and estrogen while the placenta develops

hCG

hCG

1-2 weeks after fertilization

when used 1 week after the first day of the missed period

99%

33%

- miscarriage or birth in past 8 weeks
- Profasi (chorionic gonadotropin for injection)
- ovarian cysts

- preformed on or before first day of missed period
- waxed cup used for urine collection
- refrigerated urine
- diluted urine (test in morning)

in the morning (urine less diluted)

hold by thumb grip with absorbent tip in the urine stream for 5-10 seconds
read results after 3 minutes

not pregnant

pregnant

vertical line in control window

not pregnant

pregnant

assume pregnant and contact PCP/obstetrician
discuss teratogenic medications with PCP

review testing procedure and ensure proper technique
test again in 1 week if menstruation has not begun

medical inability to conceive after 1 year

24-48 hours after ovulation
24 hours after LH surge

basal thermometer or urine ovulation prediction test

detect luteinizing hormone (LH) surge

urine ovulation test
begin using 2-4 days before ovulation in the morning

not ovulating; test again at same time next day

ovulating; have intercourse in next 48h

- fertility medications (clomiphene)
- PCOS
- menopause
- pregnancy, breastfeeding
- discontinuation of oral contraceptives
- impaired liver or kidney function
- tetracyclines

low-level, casual use

long-term use

urine and hair

self-contained unit with no handling of urine; fill with urine and wait 5 minutes

mail in 90-120 strands, cut close to scalp
results in 5 days after receipt

anything containing codeine

sertraline

propranolol

need confirmation test; seek services of drug rehab program

tests for colorectal cancer

3rd

colon damage; cancer; internal bleeding; hemorrhoids

pts over 50 with history or family history of colorectal cancer, women with history of breast or reproductive cancer, or benign intestinal polyps

a colonoscopy

blue

- medications that cause bleeding (NSAIDs)
- hemorrhoids or menstrual period
- red meat
- foods high in vitamin C
- foods that discolor stool
- chemicals in toilet

- female
- pregnancy
- diabetes
- urinary stones or obstructions
- history of UTIs

- early detection of infection
- confirmation that infection has been cured with antibiotics

- detects nitrites
- detects nitrites and leukocyte esterase

gram negative bacteria reduce nitrates to nitrites in urine

after some urine has passed, hold under stream for 1-2 seconds, then lay flat to dry for 1-2 minutes and compare to chart on bottle

phenazopyridine and menstruation

vegetarian diet, tetracycline, and vitamin C

- test in morning, avoid interference meds/food, do not touch sensor pad
- refer if positive test or if negative, but symptoms persist