What is the template for a nursing visit focused on hypertension (high blood pressure) management?

Nursing Visit Template for Blood Pressure Management

A structured nursing visit for hypertension management should systematically address blood pressure measurement, medication adherence assessment, lifestyle modification counseling, and care coordination using a team-based approach with clear documentation and follow-up scheduling. 1

Pre-Visit Preparation

• Review electronic health record for previous BP readings, current medications, missed appointments, and laboratory results to identify undiagnosed or undertreated hypertension 1
• Confirm appointment using computer-based reminders or telephone contact to reduce no-shows 1
• Prepare patient education materials tailored to individual needs and cultural background 1

Blood Pressure Measurement Protocol

• Use validated automated BP device with appropriate cuff size for the patient 2
• Obtain multiple readings (at least 2-3 measurements) during the visit, with the patient seated quietly for 5 minutes before measurement 2
• Review home BP monitoring data if patient is self-monitoring (goal: <135/85 mmHg for home readings) 1, 2, 3
• Document all readings in the electronic health record with time and patient position 1

Medication Assessment

• Verify current antihypertensive regimen including drug names, doses, and frequency 1
• Assess medication adherence by asking specific questions about missed doses, barriers to taking medications, and use of pill organizers 1, 4, 5
• Identify adverse drug effects through direct questioning about dizziness, fatigue, cough, ankle swelling, or other symptoms 1
• Review medication costs and financial barriers, connecting patients to assistance programs if needed 1
• Simplify regimen when possible by discussing once-daily dosing and single-pill combinations with the physician 1

Lifestyle Modification Counseling

Focus on seven major areas with specific, measurable goals: 1

• Dietary sodium restriction to <1500 mg/day with practical strategies for reading labels and cooking 2
• Weight management with gradual sustained weight loss goals if BMI ≥30 kg/m² 1
• Physical activity recommendations for regular exercise with specific weekly targets 1
• Alcohol consumption assessment and moderation counseling 1
• Smoking cessation support and referral to cessation programs 1
• DASH or Mediterranean diet adoption with increased fruit and vegetable intake 2
• Stress management techniques and adequate sleep 1

Risk Factor and Comorbidity Assessment

• Screen for stroke risk factors particularly in women: atrial fibrillation (use CHA2DS2-VASc score if present), oral contraceptive use, hormone replacement therapy, migraine with aura, obesity 1
• Assess pregnancy history in women for previous preeclampsia or pregnancy-induced hypertension 1
• Review diabetes status and target BP <130/80 mmHg if diabetic 2
• Identify target organ damage through review of recent laboratory results (renal function, proteinuria) and cardiac assessment 1

Patient Education and Empowerment

• Explain hypertension terminology clarifying that "hypertension" and "high blood pressure" are interchangeable and do not indicate anxiety 1
• Discuss treatment goals with target office BP <130/80 mmHg for most patients 2
• Emphasize chronicity of hypertension requiring lifelong management 1
• Address patient beliefs about medications, exploring concerns about necessity and side effects using motivational interviewing 1
• Provide self-monitoring education on proper technique with validated home BP devices 1
• Incorporate treatment into daily routines such as taking medications with tooth brushing 1

Care Coordination and Team-Based Approach

• Collaborate with physician on medication adjustments based on home BP readings and treatment algorithms 1, 4
• Refer to specialists when indicated: dietitian for intensive nutrition counseling, pharmacist for medication review, social worker for financial assistance 1
• Engage family members with patient permission to support medication adherence and lifestyle changes 1
• Connect to community resources including faith-based organizations, walking groups, and hypertension support programs 1

Documentation Requirements

• Record all BP measurements with date, time, and patient position 1
• Document medication changes including rationale and patient education provided 4
• Note adherence assessment and barriers identified 1, 5
• Track lifestyle modification progress with specific measurable outcomes 1, 5
• Update problem list and care plan in electronic health record 1

Follow-Up Planning

• Schedule next appointment before patient leaves, with frequency based on BP control: 1, 2
  • Monthly visits until target BP achieved
  • Every 3-6 months once BP controlled
  • More frequent visits for patients with nonadherence or organ damage 1
• Arrange home BP monitoring with instructions to submit readings weekly or before next visit 4, 3
• Set up telehealth monitoring if available, using smartphone applications or telephone-based transmission systems 1
• Provide written action plan with specific BP targets and when to contact the clinic 1
• Generate appointment reminders through electronic health record system 1

Quality Improvement Monitoring

• Track BP control rates using patient registries to identify undertreated patients 1
• Monitor appointment adherence and follow up on missed visits promptly 1
• Review medication intensification rates to ensure appropriate treatment escalation 4, 3
• Assess patient satisfaction and barriers to care 5