NURS FPX 4030 Assessment 3 PICO(T) Questions And An Evidence Based Approach

1. According to Al-Makki et al. (2021), hypertensive patients who have already undergone lifestyle modification counseling should receive medication therapy. The patients must have a confirmed diagnosis of hypertension with BP exceeding 140/90 mmHg. Moreover, the first line of drugs should be from any class of thiazide, angiotensin enzyme inhibitor or angiotensin receptor block, and long-acting dihydropyridine calcium channel blocker. This resource is the most credible as it is relevant to hypertension and authorized by WHO and AHA journals. Moreover, the study was published in 2021 within the last five years publications.
2. Another study supports the non-pharmacological treatment of hypertension and prehypertension through a Dietary Approach to Stop Hypertension (DASH), physical exercise, interventions to lose weight, and stress management strategies. Integrating lifestyle modifications with less salt intake, eating fruits and vegetables, increased physical activities such as walking and running, and reducing weight can lead to balanced blood pressure (Fu et al., 2020). This source is also credible as it is recently published, supported by the AHA journal, and relevant to hypertension. 
3. According to Oliveros and colleagues (2019), a hypertension management strategy must consider multiple factors, such as complex medical comorbidities, degree of frailty, and psychosocial factors. Non-pharmacological interventions should be encouraged to prevent hypertension and as an adjuvant therapy to mitigate antihypertensive needs. Moreover, pharmacological interventions are necessary for older patients with hypertension who show a negligible decrease in blood pressure levels with lifestyle modification alone.

Decision-Making on PICO Question Using Findings

Considering the findings from evidence-based research data, the decision derived is that prehypertensive patients should first be guided towards non-pharmacological interventions, such as the DASH diet and lifestyle modifications, before considering pharmacological therapy. However, hypertensive patients with BP exceeding 140/90mmHg or with comorbidities are advised to follow physicians’ initial antihypertensive medication. Hypertension can be well regulated by adjuvant therapy of lifestyle modifications and antihypertensive drugs. Nurses must provide patient-centered care tailored to the health needs of hypertensive patients based on the frailty degree, comorbidities, and relevant psychosocial factors. 

Conclusion

As a chronic health issue, hypertension requires intricate management and long-term care. To implement the best evidence-based care strategy, nurses must look for credible data on hypertension. For this purpose, nurses can use the PICO(T) approach to make the right decisions. Here, the PICO question is whether hypertensive patients have regulated blood pressure via pharmacological therapy or lifestyle modifications. The right decision was based on relevant findings, including lifestyle modification for pre-hypertensives and pharmacological or adjuvant therapy for older people with hypertension and comorbidities.  All the findings are based on CRAAP criteria and offer credible solutions.

References 

Al-Makki, A., DiPette, D., Whelton, P. K., Murad, M. H., Mustafa, R. A., Acharya, S., Beheiry, H. M., Champagne, B., Connell, K., Cooney, M. T., Ezeigwe, N., Gaziano, T. A., Gidio, A., Lopez-Jaramillo, P., Khan, U. I., Kumarapeli, V., Moran, A. E., Silwimba, M. M., Rayner, B., & Sukonthasan, A. (2021).

Hypertension pharmacological treatment in adults: A world health organization guideline executive summary. Hypertension, 79(1). https://doi.org/10.1161/hypertensionaha.121.18192 

Fu, J., Liu, Y., Zhang, L., Zhou, L., Li, D., Quan, H., Zhu, L., Hu, F., Li, X., Meng, S., Yan, R., Zhao, S., Onwuka, J. U., Yang, B., Sun, D., & Zhao, Y. (2020). Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. Journal of the American Heart Association, 9(19). https://doi.org/10.1161/jaha.120.016804