Understanding Your Blood Pressure

Your blood pressure is expressed in two numbers- one number on top and one on the bottom. The top number, better known as the systolic blood pressure, is the amount of pressure in your arteries when the heart contracts to push blood out to the rest of the body. The bottom number, or diastolic blood pressure, is the amount of pressure in your arteries when the heart is at rest. Together, these numbers are used to determine the health of your heart. The “mmHg” after the fraction means millimeters of mercury- the unit used to measure blood pressure.

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*A diagnosis of high blood pressure must be confirmed with a medical professional. A doctor should also evaluate any unusually low blood pressure readings.

Depending on your blood pressure, you’ll fall into one of the categories above. Those with pre-hypertension are likely to develop high blood pressure unless lifestyle changes are made to control it. In Stage 1 Hypertension, doctors will likely prescribe lifestyle changes and consider adding blood pressure medication. With Stage 2 Hypertension, doctors will typically prescribe blood pressure medications and lifestyle changes.

*From the American Heart Association, if your BP is 180/110 mmHg or higher and you are NOT experiencing symptoms such as chest pain, shortness of breath, back pain, numbness/weakness, changes in vision or difficulty speaking, wait about five minutes and take it again. If the reading is still at or above that level, call 911 and get help immediately.*

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Eat This, Not That: Homemade Veggie Pizza

If you’re anything like me (or human), you probably love pizza and can tear through one with little assistance. In the words of Joey Tribbiani, “What’s not to like?”…. Bread? good! Sauce? good! Cheese? gooooood!

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I’ve got some bad news… you might want to sit down for this. Pizza is horrible for you. That is, unless you choose the right options. A 12″ cheese pizza from Domino’s has 1,760 calories, 60 grams of total fat, 3,600 mg of sodium, 216 grams of carbohydrates, and 64 grams of protein.

In comparison, making your pizza at home allows you to choose exactly what you want to include on your pie, healthy and fresh toppings, and it’s pretty fun as far as cooking goes! The 12″ pizza you’ll see below has approximately 1,466 calories, 44 grams of total fat, 2,400 mg of sodium, 58 grams of carbohydrates, and 63 grams of protein. Here’s a look at how this breaks down per slice:

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Instead of ordering delivery pizza the next time you’re with family or friends, pick a few different toppings  and make it right in the comfort of your own kitchen. Below, I’ll walk you through the steps I take when I make my own pizza’s. You might love or hate the toppings I use, but you can add whatever you’d like to yours, which is the great part of making your own pizza.

  1. Pick toppings. I went with broccoli, Brussels sprouts, and onion for mine. You could go any way- peppers, spinach, olive, mushroom, etc. If you want to add meat, try picking a low sodium option like ground turkey or chicken as opposed to sausage or bacon.
  2. Pre-cook toppings. After selecting your toppings, chop them up and throw them in a pan on medium heat with olive oil.  This helps remove the moisture in the vegetables so that the crust doesn’t get soggy as it bakes. Cook the vegetables until they are tender- this time will vary.

3. Prepare the crust. Before adding anything, brush the crust with a thin coat of olive oil. I used Boboli’s 12″ 100% Whole Wheat- choose whichever crust you prefer, but the nutritional information will vary.

4. Add on toppings. Spread on the pizza sauce and add your toppings and cheese. I used Rao’s Homemade Pizza Sauce and Galani’s Fresh Mozzarella. Again, different sauces or cheeses will vary in nutritional info, so be sure to check the label.

5. Bake the pizza. Cook time will vary based on the crust, so follow directions on the package. This pizza baked for 10 minutes on 450ºF and came out looking divine, if I must say so myself.

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Thanks for reading! Let me know what some of your favorite pizza toppings are in the comments below. Enjoy!

Understanding Your BMI

Body Mass index (BMI) is a measurement often used to determine an individuals overall health. BMI is determined by dividing a person’s weight (in kilograms) by their height (in meters) squared. For example, if I’m 5′ 10″ and weigh 175 lbs, this would be 79.4 kilograms and 1.78 meters. If I plugged these numbers into the equation, it would look like this:

BMI isn’t the perfect screening tool because it does not actually measure body fat or actual health- this information requires further assessment by a healthcare provider. Individuals with extra muscle mass such as athletes may be perfectly healthy, but have a high BMI because muscle is not accounted for. From the example above, a BMI of 25.06 would be considered overweight, but there are other factors to consider. A 5′ 10″ individual could weigh 175 lbs with 30% body fat or weigh the same 175 lbs and have 10% body fat. Two individuals with very different health statuses, but the same BMI.

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Infographic from everydayhealth.com

Overweight or obese individuals are at increased risk for high blood pressure (hypertension), high cholesterol, type 2 diabetes, heart disease, stroke, sleep apnea, depression, and some cancers (endometrial, breast, colon, liver).

  1. https://www.cdc.gov/healthyweight/effects/index.html

How to Stay up to Date With Research

Ever since I began nursing school, the importance of understanding and utilizing research was made clear. Now, as I continue my education in pursuit of my Doctor of Nursing Practice degree, the emphasis on research is even more profound! We all know it is important to keep up to date and apply evidence to our practice, but who has time for that?!

Regardless of where you are in your career, nursing student or experienced nurse, you probably find yourself short on free time- I know I do. I remember the eye rolls when a professor would suggest a book or article just published to read in our “spare time”. Yes, between writing 20 page care plans, cramming for exams, and sleeping 4 hours a night, I will read it eventually (but, probably not).

So, why all the fuss about research? Well, evidence-based practice is an essential part of improving quality of care, patient outcomes, and decreasing healthcare costs. In 2001, the Institute of Medicine published guidelines stating that decision making in healthcare should be based on evidence. The goal was that by 2020, 90% of clinical decisions would be supported by evidence.

Not surprising, although no less disappointing, we are still far behind. Also not surprising, one of the greatest barriers to health care professionals reading research articles is time. It has been reported that a healthcare provider would have to read at least 19 articles every single day in order to stay current on the latest advancements¹.

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That’s ridiculous if you ask me (or anyone else)… So, how is it that you can stay up to date while not quitting your day job to read 19 articles a day? There are several systems available providing updates on the latest research, so you don’t have to go snooping for it. The following three resources are all ones that I use and have had great experiences with.

  1. EvidenceAlerts is a free, email, evidence update service offered through a collaboration with DynaMed Plus and McMaster University in Hamilton, ON. You can determine which areas you want to receive updates in to weed out subjects you either aren’t interested in or don’t apply to your field. You can also select how frequently you want to receive updates. The updates are not full articles, but a quick synopsis of the studies and results. Each synopsis offers several comments from clinical raters, which can be pretty blunt and are actually my favorite part of the updates!
  2. AHRQ Evidence-Based Practice Email Updates is another great way to stay up to date on the latest advancements in healthcare. The Agency for Healthcare Research and Quality (AHRQ) developed this free system to assist health care providers and organizations in their efforts to improve quality or care. Similar to EvidenceAlerts, there is a wide spectrum of topics to choose from, so it’s best to narrow it to what areas you want updates on. You can also choose between weekly or daily updates. To be honest, this is pretty similar to EvidenceAlerts, so you’ll have to look around and see what you like best! I receive updates from both and have never received the same articles, so I’d recommend both if you’re really interested in a topic.
  3. The last system I want to mention is the one I’ve been using the longest- MedScape e-newsletters. This is different from the other two because in addition to weekly medical news and featured stories, you also receive news about medical conferences and continuing education (CE) opportunities through quizzes and case they send you. Again, you can filter out what areas you don’t want updates on. Some of the recent updates I received from their MedPulse service were related to Alex Wubbels’ arrest for refusing to draw blood from her unconscious patient and the controversy surrounding President Trump rescinding DACA. This is a good way to receive updates on research and hot topics in the medical community.

Hopefully one or all of these services will benefit your practice and make reviewing research a less time consuming part of your schedule! I really do recommend subscribing to all three services, but whatever you choose, good luck and don’t lose your spirit of inquiry!

¹Straus, S. E., Glasizou, P., Richardson, W. S., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and teach it (4th ed.). Edinburgh, London: Churchill Livingstone Elsevier.

 

 

“The Salty Six”: Where Your Sodium is Coming From

Before jumping in, last week I wrote about sodium’s effects on the heart. Now I’d like to take a better look at where all this sodium is coming from! “The Salty Six” includes the top six sources of sodium in diets of U.S. adults and children. Let’s take a look at each and some examples that may be surprising!

Bread and Rolls

Pepperidge Farm’s “Original White” bread contains 75 mg of sodium per slice, while their “100% Natural Whole Wheat” bread contains 105 mg per slice. Even though each serving may not seem high, this is only one slice and sodium intake from foods like bread can add up throughout the day. Check the labels on your bread, rolls, and bagels to find lower sodium options.

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Cold Cuts and Cured Meats

Only 2 oz. (about 6 thin slices) of Boar’s Head’s oven roasted turkey breast contains 360 mg of sodium. Both their black forest ham and oven roasted chicken breast contain 440 mg of sodium in 2 oz. Try cutting lunch meats out of your diet, but if you must, look for lower-sodium options and, as with anything, eat in moderation.

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Sandwiches

This is technically a combination of the first two foods, but think about the amount of sodium you end up with both together. A sandwich or burger can contain more than 100% of your sodium for the day with just one item- not even including the side of fries or chips most would probably get.

A 6″ Italian BMT from Subway has a minimum of 1400 mg of sodium. Eat fresh right? Nope. That’s just a 6″ also- a 12″ cold cut combo has a whopping 2,530 mg of sodium. Even a foot-long veggie delight has almost 1,000 mg of sodium!

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A burger king whopper has 810 mg of sodium. Add in the 570 mg of sodium from a small fry and you have a salt-bomb ready to explode.

Pizza

One slice of a pepperoni pizza from Pizza Hut has 620 mg of sodium. A slice of regular cheese contains 560 mg of sodium. The sodium content will vary largely by what toppings are added on top. If you must have pizza, try to limit the cheese and keep the toppings to just vegetables. A 4-ounce slice of a basic margarita pizza made with whole-grain crust, olive oil, red tomato, and low-fat mozzarella has 90 calories and 60 mg of sodium.

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Soup

This one is probably surprising for a lot of you. One can of soup can range from 100 to 940 mg of sodium! Check the labels to look around for lower sodium options. One cup of Campbell’s chicken noodle soup contains 890 mg of sodium- over 1/3rd of your recommended daily intake. In comparison, Progresso’s reduced sodium chicken noodle soup contains 470 mg of sodium. For you sushi/chinese food fans, that miso soup has almost 1,000 mg of sodium in just one cup, so avoid that completely.

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Chicken

The sodium content of chicken will vary depending on the cut and method of preparation. One skinless, unseasoned chicken breast has only 77 mg of sodium. Marinating chicken can up the sodium content to around 500 mg per breast. Taking it one step further- a fried chicken breast from KFC has 1,130 mg of sodium. Chicken can be a nutritious, heart-healthy option, so choose how you prepare it wisely!

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This list isn’t all encompassing and there are certainly more salty foods out there. My guilty pleasure is Chipotle, but if you think that burrito or salad is healthy because of all the fresh ingredients check out this page on their website and see how your order stack up:

https://www.chipotle.com/nutrition-calculator

The order I would typically get has 2,230 mg of sodium (holy s**t)… Let me know what yours is in the comments below or anything else on this list that may have surprised you!

 

Why Sodium is Deadly and How I’m Fighting Back

Sodium is a mineral essential for the body to function. We get sodium from the foods and drinks we consume. If you take in too much sodium, it pulls extra water into your blood vessels increasing the total volume of blood. With more blood flowing through the vessels, blood pressure increases.

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Picture a garden hose turned on just enough to have a steady stream. Now you grab onto the knob and turn it all the way to the left (this symbolizes a meal high in sodium). More water being forced through the hose, the pressure increases, and the water shoots out much faster. This is the same thing happening with your blood vessels!

Overtime, the increased pressure can overstretch or injure the blood vessel walls and tire out the heart by forcing it to work harder to pump blood through the body leading to high blood pressure and possibly a heart attack, stroke, and/or heart failure. High blood pressure is often known as the silent killer because there are rarely symptoms and it is a major risk factor for heart disease- the No. 1 killer worldwide.

The Centers for Disease Control and Prevention (CDC) recommend that Americans consume less than 2,300 milligrams (mg) of sodium per day. For at risk groups like those with hypertension or a family history of heart disease, hypertension, or stroke, it is recommended to take in less than 1,500 mg of sodium per day. Based on these guidelines, the vast majority of adults eat more sodium than they should—an average of more than 3,400 mg each day. It’s no surprise that 90% of American adults are expected to develop high blood pressure over their lifetimes.

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So where is all this sodium coming from? Hint: it’s not the salt shaker. Actually, approximately 77% of the sodium we consume is from packaged, prepared, and restaurant foods. Around 12% of our sodium intake occurs naturally in food and the other 10% is from the salt shaker.

If all this is news to you, you aren’t alone! I exercise often- running, hiking, weight lifting- and always felt that I ate pretty healthy, but for some reason my blood pressure was typically on the higher side. I know based on my family history that I’m at high risk for hypertension and heart disease, so this always concerned me.

I figured I could workout more to fight back against my blood pressure, but never really saw any improvement. It wasn’t until I started doing some research and looking at my eating habits that I realized how high my sodium intake was. I rarely eat fast food or food items that are thought of as “salty” but even a lot of vegan/gluten-free things are high in sodium!

So, what am I doing about it? I’ve started keeping track of my sodium intake throughout the day to be sure not to exceed 1,500 mg. It’s been almost a week and I’ve stayed below this goal every day! I’ve also been cooking all my meals and eating a lot more fruit and vegetables to satisfy my hunger in a heart-healthy way. When I had my vital signs taken at my doctor’s office yesterday, my blood pressure was down to 127/87. This is still slightly high, but I’m committed to lowering this number even more.


Here’s my challenge for you: Keep track of what you’re eating for the next few days and note the sodium content. Use the notes section in your phone, a notebook, or journal to keep it organized. If you can’t find the sodium content on the package, use a website like fatsecret.com. Then, come back and let me know in the comments below what your sodium intake was!

Cardiac Rhythm Series: First Degree AV Block

In first degree AV block, the sinoatrial (SA) impulse is delayed longer than normal at the AV node before being transmitted to the ventricles causing a prolonged PR interval1, 2. As a reminder, the PR interval represents the time needed for an electrical impulse to travel from the SA node throughout the cardiac conduction system to the Purkinje fibers2.

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Characteristics: P waves present and uniform with one per QRS, PR interval greater than 0.2 seconds and consistent, QRS less than 0.12 seconds, regular rate and rhythm.

First degree AV block has a number of possible causes:

  • AV node ischemia: The AV node’s blood supply comes from the right coronary artery in 90% of individuals and the left circumflex coronary artery in the remaining 10%2, 3.
  • Enhanced vagal tone: Well-trained athletes can develop first-degree AV block due to an increased vagal tone3.
  • Acute myocardial infarction: First-degree AV block occurs in just under 15% of patients with acute MI (particularly of the inferior wall) admitted to coronary care units3.
  • Drugs: Digoxin, amiodarone, beta-blockers, and calcium-channel blockers increase the refractory time of the AV node which slows conduction. These drugs are not completely contraindicated, but their use increases the risk of developing a higher degree of AV block3.
  • Infective endocarditis or rheumatic fever2, 3.

“If the R is far from the P, then you have a first degree.”

First degree AV block is typically considered benign and usually does not progress to higher degrees of AV block2. If asymptomatic, no treatment is needed2. The patient should be monitored for progression to higher degrees of AV block2.

  1. Bojar, R. M. (2016). Manual of perioperative care in adult cardiac surgery (5th ed.). West Sussex, UK: Wiley-Blackwell
  2. University of Maryland Medical Center Office of Clinical Practice and Professional Development. (2014). Introduction to cardiac rhythm interpretation (6th ed.).
  3. http://emedicine.medscape.com/article/161829-overview#a4

For the next post of this series, click here: second degree AV block, Mobitz type I (Wenckebach).