i “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF HYPERTENSIVE PATIENTS REGARDING DASH DIET AT SELECTED KUMBALAGUDU PHC AREA, BANGALORE.” By Mr. ARUN BABU Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of requirement for the degree of Master of Science in Nursing In Community Health Nursing Under the Guidance of Mrs. KATHYAYINI.N.B. M.Sc. (N), Assistant Professor, Department of Community Health Nursing. Kempegowda College of Nursing K.R.Road, V.V.Puram, Bangalore-560 004 2013
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i
“EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE OF HYPERTENSIVE
PATIENTS REGARDING DASH DIET AT SELECTED
KUMBALAGUDU PHC AREA, BANGALORE.”
By
Mr. ARUN BABU
Dissertation Submitted to the Rajiv Gandhi University of Health
Sciences, Bangalore, Karnataka.
In partial fulfillment of requirement for the degree of
Master of Science in Nursing
In
Community Health Nursing
Under the Guidance of
Mrs. KATHYAYINI.N.B. M.Sc. (N),
Assistant Professor,
Department of Community Health Nursing.
Kempegowda College of Nursing
K.R.Road, V.V.Puram, Bangalore-560 004
2013
ii
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “Effectiveness of structured
teaching programme on knowledge of hypertensive patients regarding DASH
diet at selected Kumbalagudu PHC area, Bangalore.”is a bonafide and genuine
research carried out by me under the guidance of Mrs.Kathyayini.N.B, M.Sc.
Nursing, Asst Professor, Department of Community Health Nursing, Kempegowda
College of Nursing, Bangalore-560 004.
Place: Bangalore. Signature of the Candidate
Date: 11-2- 2013 (Mr. Arun Babu)
iii
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled is “Effectiveness of structured
teaching programme on knowledge of hypertensive patients regarding DASH
diet at selected Kumbalagudu PHC area, Bangalore.”is a bonafide research done
by Mr. Arun Babu in partial fulfillment of the requirement for the degree of
Master of Science in Community Health Nursing.
Place: Bangalore. Signature of the Guide
Date: 11-2-2013 Mrs.Kathyayini.N.B. M.Sc. (N).
Asst. Professor,
Deparment of Community Health Nursing,
Kempegowda College of Nursing,
Bangalore-560004.
iv
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF
THE INSTITUTION
This is to certify that the dissertation entitled “Effectiveness of structured
teaching programme on knowledge of hypertensive patients regarding DASH
diet at selected Kumbalagudu PHC area, Bangalore” is a bonafide research done
by Mr. Arun Babu under the guidance of Mrs.Kathyayini.N.B. M.Sc(N).
Asst Professor, Department of Community Health Nursing, Kempegowda College
of Nursing, Bangalore-560 004.
Seal & Signature of the HOD Seal & Signature of the Principal
Mrs.V.T.LAKSHMAMMA. M.Sc(N) Mrs.V.T. LAKSHMAMMA
Professor and HOD, Principal, Head of the department,
Department of Community Health Nursing, Community Health Nursing,
Kempegowda College of Nursing, Kempegowda College of Nursing,
Bangalore-560 004. Bangalore-560 004.
Place: Bangalore. Place: Bangalore.
Date: 11-2- 2013. Date: 11-2- 2013
v
COPYRIGHT
Declaration by the Candidate
I hereby declare that Rajiv Gandhi University of Health Sciences, Karnataka,
shall have the rights to preserve, use and disseminate this dissertation/thesis in print
or electronic format for academic/research purpose.
Health is the level of functional or metabolic efficiency of a living being.
In general it is a condition of a person's mind and body, usually meaning to be free
from illness, injury or pain.1To maintain good health, health and nutrition are the two
things that go hand in hand. Nutrition is the basic requirement for all the organisms
and cells to stay alive and to support life. A healthy diet contains a balance of food
groups and all the nutrients necessary to promote good health. Hippocrates suggested,
“Let food be your medicine.” Proper nutrition leads to a healthier body. From the
conception, the construction of the body structure in the womb starts with the food
taken by the mother. On birth, breast feeding and then other forms of foods contribute
to the growth of the child. Healthy eating is the practice of making choices about what
and/or how much one eats with the intention of improving or maintaining good health.
Many common health problems can be prevented or alleviated with a diet. Common
health problems related to unhealthy diet are cardiovascular diseases, kidney related
diseases etc.2
Blood pressure is the pressure that the blood exerts against the blood vessel
walls as the heart pumps. Blood pressure rises with each heartbeat and falls when the
heart relaxes between beats but there is always a certain amount of pressure in the
arteries. That blood pressure comes from two physical forces. The heart creates one
force as it pumps blood into the arteries and through the circulatory system. The other
2
force comes from the arteries resisting the blood flow. A normal blood pressure
reading for an adult is: 120 / 80 mm of Hg.3
Hypertension is the condition of having high blood pressure, systolic pressure
above 140 mm Hg and diastolic above 90 mm Hg consistently for more than six
months. Blood pressure changes from minute to minute and is affected not only by
activity and rest, but also by temperature, diet, emotional state posture and
medications.2 High blood pressure adds to the workload of the heart and arteries. The
heart must pump harder and the arteries must carry blood that is moving under greater
pressure. If the blood pressure is too high, the heart has to work harder to pump which
would lead to organ damage and several illnesses such as heart attack, stroke, heart
failure, aneurysm, renal failure, vision loss.3
A critical step in preventing and treating high blood pressure is healthy
lifestyle. Lifestyle modification that effectively lower blood pressure are losing weight
if patients are over- weight or obese. Losing as few as 10 pounds( 4.5 kilograms) can
lower blood pressure.4
For people who are obese or high cholesterol levels, changes in diet (to a diet
rich in fruits, vegetables, and low- fat dairy products with reduced saturated and total
fat content) are important for reducing the risk of heart and blood pressure.5
The best and recommended hypertension diet plan is DASH. DASH is a
scientifically arrived high blood pressure diet which stands for Dietary Approaches to
Stop Hypertension (DASH). It is a diet that was developed by the United States
National Heart, Lung and Blood Institute (NHLBI). DASH is an effective health eating
plans which work to directly control hypertension; it also helps in weight loss. Obesity
can definitely lead someone to hypertension. Like sodium intake, obesity is directly
3
correlated with hypertension. Losing weight even in small measure can have dramatic
effects in lowering your blood pressure. Maintaining a healthy weight is an important
part of a healthy lifestyle. Foods that lower blood pressure are embedded in this eating
plan which is low in saturated fat, cholesterol and total fat. Fruits and vegetables that
lower blood pressure are included in DASH including fat-free or low-fat milk and milk
products. This diet for hypertension also includes fish, poultry and nuts as well as
whole grain products.6 Taking calcium, potassium, and magnesium supplements
instead of eating these foods does not have the same effect.7
A landmark study called DASH (Dietary Approaches to Stop Hypertension)
looked at the effects of an overall eating plan in adults with normal to high blood
pressure. Researchers found that in just eight weeks, people following the DASH diet
saw their blood pressure decrease. A subsequent study called DASH two looked at the
effect of following the DASH diet and restricting salt intake to 1500 mg per day.
Under the DASH two diet, people with hypertension had their blood pressure decrease
as much or more than any anti-hypertensive medication had been able to lower it.8
4
NEED FOR THE STUDY:
In present day scenario the magnitude of non communicable diseases (NCDs),
mainly cardiovascular diseases, cancers, diabetes and chronic respiratory diseases,
represents a leading threat to human health and development. These four diseases are
the world's biggest killers, causing an estimated 35 million deaths each year - 60% of
all deaths globally - with 80% in low- and middle income countries.9
Hypertension has become a major cause of morbidity and mortality worldwide
and it is now ranked third as a cause of disability-adjusted life years. The World Health
Report states that elevated blood pressure alone contributes to about 50% of
cardiovascular diseases (CVD) worldwide. Furthermore, the risk for CVD starts even
at upper limits of normal levels of blood pressure. Therefore it would be desirable to
achieve optimal or normal BP (below 130/80 mmHg) in the young and middle-aged.10
About 15 % - 37% of the adult population worldwide is affected with
hypertension. Pooling of epidemiological studies shows that hypertension is present in
25% urban and 10% rural subjects in India. On estimation, there are 31.5 million
hypertensive in the rural and 34 million in the urban population.11
According to the recent review on the global burden of hypertension, the
estimated prevalence of hypertension(in people aged 20 years and older) in India in
2000 was 20.6% among males and 20.9% among females and is projected to increase
to 22.9% and 23.6% respectively by 2025.12
Hypertension has both modifiable and non-modifiable risk factors, where in
diet is one among them through which hypertension can be effectively managed and
complications can be prevented.13
5
Complications of hypertension are vascular damage, coronary artery disease,
left ventricular hypertrophy; cerebral vascular involvement may produce stroke
Cerebral infarcts accounts for 80% of the strokes and transient ischemic attacks in
hypertensive persons.14
Life style modification strategies are recommended in the Joint National
Committee (JNC) 7 guidelines for the treatment and prevention of hypertension and
cardiovascular disease. The primary strategies discussed are proper nutrition through
the Dietary Approaches to Stop Hypertension (DASH) eating plan and sodium
restriction, weight reduction, increased physical activity and moderation of alcohol
consumption. Patients with hypertension have been shown to decrease their resting
blood pressure considerably by adopting one or more of these strategies.15
The DASH diet (Dietary Approaches to Stop Hypertension) is a diet promoted
by the National Heart, Lung, and Blood Institute (part of the National institute of
health (NIH), a United States government organization) to control hypertension. In
addition to its effect on blood pressure, it is considered a well-balanced approach to
eating for the general public. It is now recommended by the U.S. Department of
Agriculture (USDA) as an ideal eating plan for all Americans.16
The recent studies show that a diet rich in fruits, vegetables, whole grains, and
low fat dairy products and low in fat, refined carbohydrates, and sodium can lower
blood pressure either alone or in combination with other lifestyle changes. These
studies have greatly expanded our knowledge of non-pharmacologic interventions to
prevent and manage hypertension. They also underscore the need for diet and lifestyle
counseling in the primary care setting.17
6
Regarding optimal management of Indian hypertensive population according to
CUPS – Chennai Urban Population Study, prevalence of hypertension in men (22.8%)
and in women (19.7%) is still a dream by pharmacological measurement, because rule
of halves for hypertension states that half the people with high blood pressure are not
known, half of those known are not treated, and half of those treated are not controlled.
Thus, by this rule one out of eight patients is optimally treated by pharmacological
measurement. If lifestyle modifications are adopted as a primary prevention strategy in
Indian population, then many of the uncontrolled hypertension patients can be
optimally managed.18
From the above statistics it indicates that hypertension is a burning issue; need
to bring awareness among hypertensive patients. People even after diagnosed as
hypertensive, don’t pay attention upon their diet, which can result in more
complication and severity of disease. Hence, studies suggest that educating patients
regarding DASH diet is important and essential.
The investigator has come across with many cases of hypertension in rural
communities, Bangalore and observed lack of knowledge regarding DASH diet. The
various studies already conducted also suggest and support for further research on
DASH diet in prevention of hypertension. By keeping the above points in view, the
investigator rightly felt to impart knowledge on DASH diet for hypertensive patients
for effective management and prevention of complications of hypertension.
7
2. OBJECTIVES
This chapter deals with the statement of the problem, objectives of the study,
hypothesis, operational definitions and conceptual framework, which provide a frame
of reference.
STATEMENT OF THE PROBLEM
“Effectiveness of structured teaching programme on knowledge of hypertensive
patients regarding DASH diet at selected Kumbalagudu PHC area, Bangalore.”
OBJECTIVES OF THE STUDY
(i) To assess the level of knowledge of hypertensive patients regarding
DASH diet before the administration of structured teaching programme.
(ii) To assess the effectiveness of structured teaching programme on
knowledge of hypertensive patients regarding DASH diet.
(iii) To find the association between knowledge of hypertensive patients and
selected socio demographic variables.
HYPOTHESIS
H1: There is a significant difference between pre-test and post-test knowledge
scores of hypertensive patients regarding DASH diet.
H2: There is a significant association between knowledge scores of hypertensive
patients regarding DASH diet and selected ¸socio-demographic variables.
VARIABLES
Variable refers to a characteristic or attribute of a person or object that varies with in
the population understudy.
8
In this study two types of variables are considered, they are dependent variables and
independent variable.
Dependent variable:
The presumed effect is referred to as the dependent variable.
In this study, knowledge of hypertensive patients is the dependent variable.
Independent variable:
The presumed cause is referred to as the independent variable.
In this study structured teaching programme is the independent variable.
OPERATIONAL DEFINITIONS:
Effectiveness: It refers to gain in knowledge on DASH diet among hypertensive
patients determined by significant difference between pre-test and post-test knowledge
scores.
Structured teaching programme: It refers to systematically organized instructional
design developed to provide information for hypertensive patients regarding DASH
diet.
Knowledge: It refers to the response given by hypertensive patients regarding DASH
diet.
Hypertensive patients: It refers to people who have been diagnosed with high blood
pressure.
9
DASH diet: Dietary approaches to stop hypertension (DASH) diet refers to diet rich in
fruits, vegetables, whole grains and low-fat dairy foods which includes meat, fish, and
poultry and are limited in sugar-sweetened foods and beverages.
DELIMITATIONS OF STUDY: The study is delimited to hypertensive patients in
Kumbalagudu PHC area.
CONCEPTUAL FRAMEWORK
The conceptual framework plays several interrelated roles in the progress of
science. Their overall purpose is to make scientific findings meaningful and generalize
them. A conceptual framework deals with abstractions that are assembled by virtue of
relevance to a common phenomenon. This study is intended to assess the effectiveness
of structured teaching programme on knowledge regarding dietary approaches to stop
hypertension (DASH) among hypertensive patients in a selected Kumbalagudu PHC
area, Bangalore. The conceptual framework of the present study is based on General
System`s Theory which was introduced by Ludwig Von Bertalanffy (1968) with input,
process, output and feedback.
According to System`s Theory, a system is a group of elements that interact
with one another in order to achieve the goal. An individual is a system because he/she
receives input from the environment. This input when processed provides an output.
This system is cyclical in nature and continues to be so, as long as the input, process,
output and feedback keep interacting. If there are changes in any of the parts, there will
be changes in all the parts. Feedback from within the systems or from the environment
provides information, which helps the system to determine whether it meets its goal. In
the present study these concepts can be explained as follows.
10
Input:
The input consists of information, material or energy that enters the system.
Hypertensive patient is a system and has inputs within the system itself and acquired
from the environment. The inputs include learner’s background like age, sex, dietary
pattern, education, occupation, income, source of information and duration of
hypertension which may influence the knowledge of hypertensive patients regarding
DASH die. It refers to the action needed to accomplish the derived task to achieve the
desired output that is Effectiveness of structured teaching programme on knowledge
regarding dietary approaches to stop hypertension (DASH) among hypertensive
patients in a Kumbalgudu PHC area, Bangalore.
Process or through put:
1. Assessment of level of knowledge among hypertensive patients regarding dietary approaches to stop hypertension (DASH) using a structured questionnaires.
2. Administration of STP on knowledge regarding DASH diet.
3. Assessment of post-test level of knowledge by using same structured questionnaires.
Output:
Output is the behavioural response. Output response becomes feed back to the
system and environment. In the present study, output is the gain in knowledge scores.
This is achieved through a comparison between mean pre-test and post-test knowledge
scores of the subjects.
11
Feedback:
It is the process that provides information about the system’s output and its
redirection to input. Accordingly the higher knowledge score obtained by the
hypertensive patients indicates the effectiveness of structured teaching programme in
enhancing the knowledge of hypertensive patients regarding dietary approaches to stop
hypertension (DASH).
According to Ludwig Von Bertalanffy the system acts as a whole. Dysfunction
of a part causes system disturbances rather than loss of a single function. Whole
system can be resolved into an aggregation of feedback circuits such as input,
throughput and output. The feedback circuits help in the maintenance and
improvement of an intact system.
In this study, effectiveness of structured teaching programme is tested by inter
related elements such as input, throughput and output. From the feedback efficiency of
the input, such as structured teaching programme regarding DASH diet, will be
assessed. The process of teaching as throughput will be assessed in terms of its
effectiveness.
xii
(- - - - - - - Not included in the study)
Figure 1: Conceptual framework based on General System Theory by Von Bertalanffy (1968)
INPUT
Demographic and clinical variables such as,
• Age
• Sex
• Dietary pattern
• Education
• Occupation
• Income
• Source of information
• Duration of hypertension
THROUGH PUT
• Assessment of knowledge regarding DASH by using structured questionnaires.
• Administration of STP regarding DASH on the same day soon after the pre‐test and encouraging learning by samples. Post test using the same structured questionnaires on 8th day after the administration of STP.
OUT PUT
Analysis and interpretation of knowledge regarding DASH into 3 categories,
Adequate Moderately adequate Inadequate
Feed back
13
3. REVIEW OF LITERATURE
This chapter deals with the review of related literature.
The literature reviewed has been presented under the following categories:
1. Literature related to prevalence and risk factors of hypertension
2. Literature related to treatment and lifestyle modifications
3. Literature related to diet and blood pressure
4. Literature related to DASH diet
5. Literature related to knowledge and effectiveness of Structured Teaching
programme
1. Literature related to prevalence and risk factors of hypertension
A study was conducted on prevalence,awareness,control, and associations of
arterial hypertension in a Rural Central India Population with sample size of 4,711
subjects (ages 30+ years) undergoing an ophthalmic and medical examination. Results
shows that arterial hypertension was found in 1,041 (22.1%) subjects. Its prevalence was
associated with higher age (P < 0.001), higher body mass index (P < 0.001), body height
Pandav,Knowledge and perceptions about hypertension among neo-and settled-
migrants in Delhi, India, Volume:4, Issue:2, Publisher: World Heart Federation,
119-129.Available from:URL: www.me.ndeley.com.
48. Benjamine, Joice. “Effectiveness Of Planned Teaching Programme On Healthy
Life Style To Prevent Cardiovascular Diseases For Adolescents” Mangalore. 2006.
Available from: http://hdl.handle.net/123456789/3184.
49. Willis CE, Gaffney B, Yarnell JWG: Hypertension: what do people think? A
survey in Northern Ireland of public knowledge and attitudes concerning high
blood pressure, Health Education Journal, 01 December 2000, vol./is. 59/4(308-
314), 00178969.
50. Harrington J. Fitzgerald AP. Layte R. Lutomski J. Molcho M. Perry IJ.”
Sociodemographic, health and lifestyle predictors of poor diets”. Public Health
Nutr. 2011 Dec;14(12):2166-75. PMID:21729473
87
ANNEXURE-A
88
ANNEXURE-B
LETTER SEEKING EXPERT’S OPINION FOR THE CONTENT
Validity of the tool and Structured Teaching Programme
From,
Mr. Arun Babu
II year M.Sc Nursing,
Kempegowda College of Nursing,
Bangalore-560004.
To,
Forwarded through,
The Principal,
Kempegowda College of Nursing,
Bangalore- 560004.
Respected Sir/ Madam,
Sub: Requisition for expert opinion on content validity of the research tool.
I, Arun Babu, a post graduate student of Kempegowda College of Nursing, Bangalore, as
a partial fulfillment of the master degree in Community Health nursing of Rajiv Gandhi
university of medical sciences, Bangalore, have selected the below mentioned topic for the
dissertation.
89
Title of the project: “Effectiveness of Structured Teaching Programme on knowledge
regarding DASH diet among hypertensive patients at a selected Kumbalagudu PHC
area, Bangalore.”
Objectives:
(i) To assess the level of knowledge of hypertensive patients regarding DASH
diet before the administration of structured teaching programme.
(ii) To assess the effectiveness of structured teaching programme on
knowledge of hypertensive patients regarding DASH diet.
(iii) To find the association between knowledge of hypertensive patients and
selected socio demographic variables.
I kindly request you to validate my structured questionnaire for its appropriateness and
relevancy.
I am here with enclosing the copies of
a) Structured Questionnaire.
b) Criteria rating scale/ check list.
c) Blue print for reference.
d) Content validity certificate.
I kindly request you to go through the content and give your expert and valuable
suggestions in the columns given and mark ( ) if you agree.
90
Your expert opinion and kind cooperation will be highly appreciated and gratefully
acknowledged.
Thanking you in anticipation,
Yours faithfully,
Place: Bangalore
Date: (Mr. Arun Babu)
Signature of guide: Signature of principal:
91
ANNEXURE –C
CONTENT VALIDITY CERTIFICATE
This is to certify that the tool and Structured Questionnaire developed by Mr. Arun Babu
II year M.Sc Nursing student of Kempegowda College of Nursing, Bangalore (Affiliated
to Rajiv Gandhi University of Health Sciences) is validated by the undersigned and can
proceed to conduct the main study for dissertation entitled as “Effectiveness of
Structured Teaching Programme on knowledge regarding DASH diet among
hypertensive patients at a selected Kumbalagudu PHC area, Bangalore.”
Place:
Date:
(Name and Signature of the
expert with designation and
with seal of the institution)
92
ANNEXURE-C (1)
CRITERIA RATING SCALE FOR VALIDATING THE STRUCTURED
KNOWLEDGE QUESTIONNAIRE ON DASH DIET.
Respected Madam/Sir,
Kindly go through the content and place the tick mark (√) against the questionnaire
in the following columns ranging from very relevant to not relevant. When the question is
found to be not relevant and needs modification kindly give your valid opinion in the
remarks column. The structured questionnaire is presented in 2 parts.
Part I: Consists of 9 items related to the Demographic variable under the study.
Part II: It is designed to elicit information regarding DASH diet.
93
Part-I
Sl.No. Very
Relevant
Relevant Needs
Modification
Not
relevant
Remarks
1.
2.
3.
4.
5.
6
7.
8.
9.
Part-II
Structured knowledge questionnaire on Hypertension and DASH diet
Sl No
Very Relevant
Relevant Needs modification
Not relevant
Remarks
1.
2.
94
3.
4.
5.
6.
7.
8.
9.
10
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
95
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Suggestions if any:
Over all opinion of the validator:
Signature of the validator
Name and address of the validator
96
ANNEXURE D
LIST OF EXPERTS WHO VALIDATED THE TOOL AND STRUCTURED
TEACHING PROGRAMME
1. Mr. Sridhar M.Sc. (N)
Principal, HOD Medical surgical nursing
Fortis college of nursing
Bangalore.
7. Mr.Sibi Alexander
Head of the department
Medical Surgical Nursing
B.M.S Hospital Nursing college
Bangalore
2. Mr.Dinesh.S
Principal, Head of the department
Community Health Nursing
PadmashreeInstitute of Nursing
Bangalore
8. Mr. Gangaboraiah
Professor of Statistics
Kempegowda Institute of Medical
Science.
Bangalore-04
3. Mr.Prakash.H.D
Head of the department
Community Health Nursing
Governament college of Nursing
Bangalore
9. Dr.S.T.Yavagal.M.D,DM(Cardiology)
Professor& Head of the department
KIMS Bangalore
4. Mr.Prasanna Kumar.O
Lecturer & P.G.Guide
Department Community Health Nursing
Governament college of Nursing
Bangalore.
10. Dr.Keshav.H.K. M.B.B.S, M.D
Asst Professor Department of Medicine.
KIMS, Bangalore
97
5. Dr.Threessiamma.P.M. MSc(N),PhD
Associate Professor
Head of the department
Community Health Nursing
Fortis Institute of Nursing
Bangalore
11. Dr.Kavitha.D.S
Dietician
M.Sc Food & Nutrition
KIMS Bangalore
6. Mrs.Shani.E.Mathew
Head of the department
Community Health Nursing
Vydehi Institute of Nursing
Bangalore
12. P.M.Arulmozhi Baskaran
Head of the department
Community Health Nursing
Narayana Hrudayalaya college of Nursing
Bangalore
98
ANNEXURE – E
COPY OF THE CONSENT FORM
I am voluntarily willing to participate in the study conducted by Mr. Arun Babu on
“Effectiveness of Structured Teaching Programme on knowledge regarding DASH
diet among hypertensive patients at selected Kumbalagudu PHC area, Bangalore”. I
will also co-operate with the researcher in providing necessary information. I was
explained that the information provided would be kept confidential and used only for
above mentioned study purpose.
Signature of the Investigator Signature of the Participant
Date:
Place:
99
ANNEXURE – F
STRUCTURED KNOWLEDGE QUESTIONNAIRE
QUESTIONNARE:
A structured knowledge questionnaire to assess the knowledge of hypertensive
patients regarding DASH diet.
In the present study, questionnaire is designed to elicit the knowledge of
hypertensive patients regarding DASH diet. The participants are requested to respond
accurately to the questions. The information provided by the participant will be
exclusively utilized for the partial fulfillment of P.G. programme and the information will
be kept confidential.
The questionnaire is presented in two parts:
• Part I: Consists of 9 items related to the demographic variables under the study.
• Part II: It is designed to elicit the knowledge of hypertensive patients regarding
DASH diet. It consists of 34 items.
Part-I
SOCIO DEMOGRAPHIC DATA
Sample code ________________ Dear participant,
I would like you to answer following questions related to your socio- demographic data. Kindly respond as accurately as possible.
100
1. Age in years................................. 2. Gender a. Male [ ]
b. Female [ ] 3. Religion a. Hindu [ ]
b. Muslim [ ]
c. Christian [ ]
d. Any other specify……………. 4. Dietary pattern: a. Vegetarian diet [ ]
b. Mixed diet [ ] 5. Educational status ..................... 6. Occupation of the participant ................. 7. Family income per month (Rs).................. 8. Do you have source of information regarding importance of diet in hypertension: a. Yes/No......................
b. If Yes specify-----------
9. How long have you been diagnosed with hypertension? a. < 1 year [ ]
b. 1 - 3 years [ ]
c. 4 - 6 years [ ]
d. 6 years and above [ ]
101
Part-II INSTRUCTIONS: I Mr. Arun Babu, student of MSc nursing, would like to ask some information about Dietary Approaches to Stop Hypertension.each answer has four options (a,b,c,d) , I request you to answer all the questions .
d. Increased blood sugar level [ ] 2.one among the following is the normal value of Blood in adults (25- 35years) is: a. 140/70 mm of hg [ ]
b. 160/90 mm of hg [ ]
c. 120/80 mm of hg [ ]
d. 90/60 mm of hg [ ] 3. In Elderly (60-75 years), the average level of normal Blood Pressure is: a. 180/100 mm of hg [ ]
b. 140/90 mm of hg [ ]
c. 190/110 mm of hg [ ]
d. 195/11 5mm of hg [ ] 4. Risk factors for Hypertension are a. Hereditary and life style patterns [ ]
b. Reaction during blood transfusions [ ]
c. Through physical contact among patients [ ]
d. Harmful radiation from the sun [ ] 5. Hypertension is found most commonly among: a. Men between 20 - 25 years [ ]
b. Females between 25 -30 years [ ]
c. Females between 30 -35 years [ ]
102
d. Men between 45 - 50 years [ ] 6. Hypertension can be most effectively controlled by: a. Exercise and Diet [ ]
b. Vaccination and First Aid [ ]
c. Accupuncture [ ]
d. Massage Therapy and Aromatherapy [ ] 7. One of the following drug which causes hypertension some times is: a. Pain Killers [ ]
b. Antibiotics [ ]
c. Birth Control Pills [ ]
d. Sleeping Pills [ ] 8.Regular exercise among hypertensive clients will help to: a. Increase the cholesterol levels in the body [ ] b. Increase the blood pressure [ ] c. Reduce the blood pressure in the long run [ ] d. Maintain the adequate minerals in the body [ ] Questions regarding complications of Hypertension 9. The body organs mainly affected by Hypertension are: a. Lungs, ears, stomach, spleen [ ] b. Heart, brain, kidneys & eyes [ ] c. Ear, nose & throat, stomach [ ] d. Muscle, rectum, colon & uterus [ ] 10. One of the following is not complication of hypertension: a. Heart attack [ ] b. ulcer [ ] c .Stroke [ ] d. Kidney failure [ ]
Questions regarding DASH diet 11. DASH stands for a.Dietary approaches to suppress hypertension [ ]
103
b. Dietary approaches to stimulate hypertension [ ] c.Dietary approaches to stop hypertension [ ] d.Dietary approaches to save hypertension [ ] 12. Dietary management of Hypertension includes: a. Liberal amount of fresh fruits and low fat foods [ ]
b. Oily and Fatty foods [ ]
c. Food rich in Iron and Calcium foods [ ]
d. Food rich in Sodium and Calcium [ ] 13. DASH diet helps to a. Increase blood pressure [ ] b.Control Hypertension [ ] c.Maintain normal body temperature [ ] d.Increase body weight [ ] 14. Rich source of sodium is: a. Fruits and dairy products [ ]
b. Canned food and bakery products [ ]
c. Green leafy vegetables [ ]
d. Grains and cereals [ ]
15. Sodium intake can be controlled by: a. Eating more meat and diary products [ ]
b. Adding canned foods in diet [ ]
c. Eating more fresh fruits and removing added salt from recipes [ ]
d. Increasing the intake of salads and ketchup [ ] 16. While buying frozen and canned foods one should observe for : a. Those rich in minerals and fat [ ]
b. Those labelled rich in sodium only [ ]
c. Those labelled rich in fat and sodium [ ]
d. Those labelled low in sodium or without added salt [ ] 17. While purchasing processed milk as a component of DASH diet one should opt for a. Rich in fat and protein [ ]
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b. Low in fat or fat free [ ]
c. Rich in sodium and vitamin c [ ]
d. Rich in potassium and sodium [ ] 18. One among the following should be considered while selecting sweets: a. Fat-free or low-fat cookies [ ]
b. Coconut cookies [ ]
c. Butter cookies [ ]
d. chocolate cookies [ ] 19. Fast foods should be consumed in moderate quantity because they: a. Are poor sources of Sodium and fat [ ]
b. Are high source of minerals [ ]
c. Help to maintain the water levels in the body [ ]
d. Increase sodium and cholesterol levels in the body [ ] 20. In hypertensive patients fat intake must be restricted to: a. 60 gm/day [ ]
b. 35 gm/day [ ]
c. 50 gm/day [ ]
d. 100 gm/day [ ] 21. Rich sources of low fat food group are: a. Egg and meat [ ]
b. Canned food and bakery products [ ]
c. Milk and milk products [ ]
d. Green leafy vegetables [ ] 22. One among the following is appropriate while consuming fruits: a. A piece of fruit with meals and one as snacks [ ]
b. A piece of fruit on a weekly basis [ ]
c. Fruit juice on a monthly basis [ ]
d. A piece of fruit on a monthly basis [ ] 23. Frequency and amount of consuming Nuts should be:
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a.1/2 cup 4-5 times a week [ ]
b.1 cup4-5 times a week [ ]
c.1/3 cup 4-5 times a week [ ]
d.2 cup 4-5 times a week [ ] 24. Assorted spices beneficial in hypertension include one among the following: a. Rose water and Indian Pickle [ ]
b. Turmeric and Cardamom Seeds [ ]
c. Clover and Black Salt [ ]
d. Black pepper and basil [ ] 25. Fruits and Vegetables rich in Potassium and magnesium are: a. Tomatoes and Banana [ ]
b. Cabbage and Watermelon [ ]
c. Cucumber and Strawberries [ ]
d. Apple and onions [ ] 26. The quantity of salt intake for normal person per day is: a. 5-6 Teaspoon [ ]
b. 7 -8Teaspoon [ ]
c. 1 -4Teaspoon [ ]
d. 9 -10Teaspoon [ ] 27. Recommended salt intake for hypertensive patients per day is: a. 3 Teaspoon [ ]
b. 1 Teaspoon [ ]
c. 2 Teaspoon [ ]
d. 2/3 Teaspoon [ ] 28. Meat, poultry and fish products should be cooked by: a. Boiling with skin and fat [ ]
b. Fry deeply in oil [ ]
c. Trimming skin and fat then boil [ ]
d. Deep fry in butter or ghee [ ]
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29. Best alternative to meat would be: a. Fatty foods [ ]
b. Sodium rich foods [ ]
c. Canned foods rich in saturated fats [ ]
d. Egg white [ ] 30. Cooking oil which is recommended for healthy living is: a. Groundnut oil [ ]
b. Sun flower oil [ ]
c. Coconut oil [ ]
d. Palm oil [ ] 31. While buying rice it is advisable to select one of the following: a. Basmati rice [ ]
b. White rice [ ]
c. Brown rice [ ]
d. Steamed rice [ ] 32. For normal person, ideal frequency of tea/coffee to be consumed in a day is: a. once [ ] b. Thrice [ ] c. Four times [ ] d. More than four times [ ] 33. With regard to coffee/tea intake DASH recommends: a. Have coffee/ tea as part of the weekly diet [ ] b. strictly avoid use of coffee/tea [ ] c. Have coffee/tea if you have high blood pressure [ ] d. Have coffee/tea twice on a daily basis. [ ] 34. One among the following statements is true with regard to smoking: a. Completely disregarded as they have no effect [ ] b. Encouraged as they help reduce tension [ ] c. Recommended as they have a positive effect [ ] d. Should be avoided as they have adverse effects [ ]
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ANNEXURE – F (1)
ANSWER KEY FOR STRUCTURED QUESTIONNAIRE
QUESTION
NUMBERS
KEY
ANSWERS
QUESTION
NUMBERS
KEY
ANSWERS
QUESTION
NUMBERS
KEY
ANSWERS
1 a 13 b 25 a
2 c 14 b 26 c
3 b 15 c 27 d
4 a 16 d 28 c
5 d 17 b 29 d
6 a 18 a 30 b
7 c 19 d 31 c
8 c 20 a 32 a
9 b 21 d 33 b
10 b 22 a 34 d
11 c 23 c
12 a 24 d
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ANNEXURE – F (2)
BLUE PRINT OF STRUCTURED TEACHING PROGRAMME ON DASH DIET
Sl.No
Selected aspects on DASH diet
Knowledge Comprehension
Application Total no. of question
Percentage (%) Items No.
of qts.
Items No. of qts.
Items No. of qts.
1 Questions regarding hypertension
1,3
2 2,4,5 3 6,7,8 3
8 23.52
2 Questions regarding complications of hypertension
9 1 10 1 0 0
2
5.88
3 Questions regarding DASH diet
11, 14,23,24,25,26,27,3233.
9
12, 21, 22, 28, 29, 30, 34.
7
13, 15, 16, 17, 18, 19,20,31.
8
24
70.58
TOTAL 12 11 11 34 100
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ANNEXURE – G
LESSON PLAN FOR STRUCTURED TEACHING PROGRAMME ON:
(Dietary Approaches to Stop hypertension)
Name of the investigator : Mr.Arun Babu
Group : Hypertensive Patients
Venue : Community area
Topic : DASH diet
Time : 45 Minutes
Size of the group : 5-10 members
Method of teaching : Lecture and Discussion
Language : Kannada and English
Audio Visual Aids : Flash Cards,charts
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OBJECTIVES
GENERAL OBJECTIVES:
At the end of the teaching hypertensive patients will gain in depth knowledge on Dietary Approaches to Stop Hypertension and
applies the same knowledge in control of hypertension.
SPECIFIC OBJECTIVES:
Hypertensive patients will be able to,
1. defines hypertension
2. lists out the causes for hypertension
3. enumerates the risk factors for hypertension
4. explains the signs and symptoms of hypertension
5. describes the complications of hypertension
6. explains the importance of lifestyle modifications for control of hypertension
7. discuss about dietary approaches to stop hypertension(DASH) diet
8. define DASH diet
9. explains the principles of DASH diet
10. explains the importance of DASH diet
11. discuss about components of DASH die
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TIME
EXPECTED
OUTCOME
CONTENT
TEACHER
ACTIVITY
LEARNER
ACTIVITY
A.V aids
REAL LEARNERS
OUTCOME
2mins
5mins
Defines
hypertension
Lists out the
causes for
hypertension
1.DEFINITION
Hypertension is a persistent elevation of the systolic blood pressure at a level of 140 mm Hg or higher and the diastolic blood pressure at a level of 90 mm Hg or higher.
2.CAUSES FOR HYPERTENSION
The etiology of hypertension can be classified as either primary or secondary.
Primary hypertension:
The exact cause of primary hypertension is unknown. Several contributing factors of hypertension are
Increased sodium intake Greater than ideal body weight Diabetes mellitus Excessive alcohol consumption Cigarette smoking
Teacher defines
hypertension and
explains the meaning
of hypertension.
Teacher discusses
causes by using flash
cards.
Learners
listen
Learners
listen and
clarify their
doubts
Flash
cards
Flash
cards
What is
hypertension?
What are the
causes of
hypertension?
112
2mins
Enumerates
the risk factors
for
hypertension
Stress Elevated levels of cholesterol &
triglycerides Secondary Hypertension
Secondary hypertension is elevated blood pressure with a specific cause and often can be identified and corrected.
Causes are:
Renal diseases Tumor of the adrenal gland Neurologic disorders such as Brain tumor, head injury Estrogen replacement therapy Oral contraceptive pills Cirrhosis Pregnancy induced hypertension Non steroidal anti-inflammatory drugs
3.RISK FACTORS FOR HYPERTENSION
Age Alcohol Cigarette smoking Diabetes mellitus Elevated serum lipids
Teacher explain the
risk factors
Learners
listen and
clarify the
doubts.
Flash
card
What are the risk
factors for
hypertension?
113
2mins
Explains the
signs and
symptoms of
hypertension.
Excess sedentary sodium Gender Obesity Family history Ethnicity Sedentary lifestyle Socioeconomic lifestyle Stress
4. SIGNS AND SYMPTOMS • Referred as the “ silent killer” • Frequently asymptomatic until target
organ disease occurs or recognized on routine screening
• Symptoms often secondary to target organ disease.
• Can include: Fatigue, reduced activity
tolerance Dizziness Palpitations Dyspnea Headache Blurred vision Nausea and vomiting Chest pain and shortness of
The first line of treatment for hypertension is lifestyle change which includes: dietary
Teacher explains the
complications of
hypertension
Listener
listen
Flash
card
What are the
complications of
hypertension?
115
6mins
Explain the
importance of
lifestyle
modifications
for control of
hypertension
changes ,physical exercise, and weight loss. These have all been shown to significantly reduce blood pressure in people with hypertension. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication.
a) EXERCISE:
• maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2)
• engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week)
• exercising regularly
b) HABITS:
• limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women.
• Smoking should be avoided as they have adverse effects.
Discuss the lifestyle
modifications
Listener
listen
Flash
card
How lifestyle
modifications
are important in
Controlling
hypertension?
116
c) MEDICATIONS
Diuretics
Adrenergic inhibitors
Direct vasodilators
Angiotensin inhibitors
Calcium channel blockers
d) DIET
consume a diet rich in fruit and vegetables (e.g. at least five portions per day)
eating a nutritious, low-fat diet
decreasing salt (sodium) intake
e) FOLLOW-UP CARE The most important element in the management of high blood pressure is follow-up care.
117
2mins
Discuss the
dietary
approaches to
stop
hypertension
• Routine blood pressure check-up are important to monitor readings and decide upon a treatment plan.
• Routine physical examinations and screening blood tests may be suggested to help monitor the success of blood pressure management.
• Follow-up visits are a great opportunity for monitoring for other associated risk factors, such as high cholesterol, smoking cessation, and obesity.
7. DIETARY APPROACHES TO STOP HYPERTENSION(DASH) DIET
Introduction
DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is a lifelong approach to healthy eating that's designed to help treat or prevent high blood pressure (hypertension).
The DASH diet may offer protection against
Teaches about
dietary approaches to
stop hypertension
Listeners
listen and
clarify
doubt
Flash
cards
and
charts
What are the
dietary
approaches to
stop
hypertension?
118
2mins
Define DASH
diet.
osteoporosis, cancer, heart disease, stroke and diabetes.
a) Meaning
The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium.
8.Definition: DASH is an eating plan that,
• Is low in saturated fat, cholesterol, and total fat
• Focuses on fruits, vegetables, and fat-free or low-fat dairy products
• Is rich in whole grains, fish, poultry, beans, seeds, and nuts
• Contains fewer sweets, added sugars and sugary beverages, and red meats.
e.g. vitamins, garlic, fish oil, L-arginine, soy, herbs, phytosterols, and chelation therapy.
9.PRINCIPLES OF DASH DIET • Lowering blood pressure
Teacher defines
DASH diet
Learners
listen
Flash
card
What is dash
diet?
119
2mins
2mins
Explain
principles of
DASH diet
Explain
importance of
DASH diet in
hypertension.
• Lower the risk of heart disease, stroke and cancer.
• Support reaching and maintaining a healthy weight.
10.IMPORTANCE OF DASH DIET IN HYPERTENSION A Diet is not just a plan for losing weight; a diet refers to the way we eat. Dietetic management includes:
• Set up a healthy eating plan with foods low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and low fat dairy foods such as the DASH eating plan.
• Write down everything that you eat and drink in a food diary. Note areas that are successful or need improvement.
• If you are trying to lose weight, choose an eating plan that is lower in calories.
Teacher explains
principles of DASH
diet
Teacher explains the
importance of DASH
diet in hypertension.
Learners
listen
Listeners
listen
Flash
cards
Chart
What are the
principles of
DASH diet?
What are the
importance of
DASH diet in
hypertension?
120
10mins
Discuss about
components of
hypertension.
11.Components of DASH diet
i. Protein In severe hypertension the protein has to be restricted to 20 gm/day where as the mild and moderate hypertensive can have 1 gm/kg body weight. For example if the person is 60kg then he can have 60 gms of protein / day. ii. Fats It is better to avoid high intake of animal fat which contain saturated fatty acids. The cholesterol rich foods such as liver, meat, egg yolk, crab and prawns should be minimised in the diet. The dietary fats should consist of vegetable oil like, olive oil and sunflower oil. The recommended fat for hypertensive patient is 60gms. iii.Minerals and Vitamins
• Low sodium and high potassium diet will help to lower high blood pressure. Moderate sodium restriction 2- 3 gm per day decreases diastolic blood pressure 6- 10 mm of Hg.
• Potassium intake should be increased.
Teacher discuss
about components of
hypertension
Learners
listen
Flash
cards
What are the
components of
DASH diet?
121
Food sources of potassium should be increased to patients. For example apricots, tomato, chickoo, watermelon, banana, leafy vegetables, bitter gaurd, brinjal and potato should be included in the daily diet since they contain low sodium and high potassium. Hypertensive patients with kidney disease should avoid a high intake of potassium as it puts an excessive load on the kidney.
• Vitamins should be adequate to the recommended allowances that can be achieved by consuming fruits and vegetables.
Effect of sodium on Blood pressure Sodium: Essential in small amounts, Your body needs some sodium to function properly. Benefits of sodium � Helps maintain the right balance of fluids in your body
� Helps transmit nerve impulses
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� Influences the contraction and relaxation of muscles Hazards of sodium People who are sodium sensitive retain sodium more easily, leading to excess fluid retention and increased blood pressure. If you're in that group, extra sodium in your diet increases your chance of developing high blood pressure, a condition that can lead to cardiovascular and kidney diseases. Identification of food stuffs rich in sodium
• The best way to determine sodium content is to read food labels. The Nutrition Facts label tells you how much sodium is in each serving. It also lists whether salt or sodium-containing compounds are ingredients.
• Examples of these compounds include: Monosodium glutamate (MSG) ,Baking soda ,Baking powder ,Disodium phosphate ,Sodium nitrate or nitrite
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Main sources of sodium
� Processed and prepared foods, such as canned vegetables, soups, luncheon meats and frozen foods. .
� Sodium-containing condiments. One teaspoon of table salt has 2,325 mg of sodium, and 1 tablespoon of soy sauce has 1,005 mg of sodium. � Natural sources of sodium. Sodium naturally occurs in some foods, such as meat, poultry, dairy products and vegetables. For example, 1 cup of low-fat milk has about 110 mg of sodium. cut your sodium intake
• Eat more fresh foods and fewer processed foods.
• Eats lots of fresh fruits and vegetables. They need no added salt. They also increase potassium stores, which helps lower blood pressure.
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• Opt for low-sodium products. Look for unsalted snacks (if you need them) and foods that have reduced sodium.
• Limit the use of Salad dressings, sauces, ketchup and mustard all contain sodium.
• Use herbs, spices and other flavourings to enhance foods. Learn to flavor foods with lemon juice, parsley, garlic, or onions, instead of salt.
• Not adding salt when cooking rice or hot cereal.
• Buying foods labeled "no salt added," "sodium-free," "low sodium" or "very low sodium"
Lower sodium DASH diet: You can consume up to 1,500 mg (2/3 teaspoon of table salt) of sodium a day.
iv. Fluids
Fluid restriction is not necessary for
125
hypertension unless the patient is having oedema and heart failure where the fluid restriction is regulated according to the urine output.
v. Grains (6 to 8 servings a day) Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1 slice whole-wheat bread, 1 ounce (oz.) dry cereal, or 1/2 cup cooked cereal or rice. Focus on whole grains because they have more fiber and nutrients than do refined grains. For instance, use brown rice instead of white rice and whole-grain bread instead of white bread. Look for products labeled "100 percent whole grain" or "100 percent whole wheat."Grains are naturally low in fat, so avoid spreading on butter or adding cream and cheese sauces. Some examples of whole grain food choices include: Brown rice, oatmeal, popcorn, whole wheat bread, noodles, corn flakes, white bread white rice.
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vi. Vegetables (4 to 5 servings a day)
Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fiber, vitamins, and such minerals as potassium and magnesium. Examples of one serving include 1 cup raw leafy green vegetables or ½ cup cut-up raw or cooked vegetables.
Fresh or frozen vegetables are both good choices. When buying frozen and canned vegetables, choose those labelled as low sodium or without added salt.
Beneficial vegetables and spices for hypertension
A number of common vegetables and spices have beneficial effects in controlling hypertension. Incorporate these into your cooking. Alternately, you can make a tea or a vegetable soup.
Garlic: Garlic is a wonder drug for
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heart. It has beneficial effects in all cardiovascular system including blood pressure. In a study, when people with high blood pressure were given one clove of garlic a day for 12 weeks, their diastolic blood pressure and cholesterol levels were significantly reduced. Eating quantities as small as one clove of garlic a day was found to have beneficial effects on managing hypertension. Use garlic in your cooking, salad, soup, pickles, etc. It is very versatile.
Onion: Onions are useful in hypertension. What is best is the onion essential oil. Two to three tablespoons of onion essential oil a day was found to lower the hypertension. This should not be surprising because onion is a cousin of garlic.
Tomato: Tomatoes are high in gamma-amino butyric acid (GABA), a compound that can help bring down blood pressure.
Broccoli: This vegetable contains several active ingredients that reduce
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blood pressure. Carrot: Carrots also contain several
compounds that lower blood pressure. Saffron: It contains a chemical called
crocetin that lowers the blood pressure. You can use saffron in your cooking. You can also make a tea with it. Unfortunately, it is very expensive.
Assorted spices: spices such as fennel, oregano, black pepper, basil and tarragon have active ingredients that are beneficial in hypertension. Use them in your cooking.
vii.Fruits (4 to 5 servings a day) Many fruits need little preparation to become a healthy part of a meal or snack. Like vegetables, they're packed with fiber, potassium and magnesium and are typically low in fat. � Have a piece of fruit with meals and one as a snack, then round out your day with a dessert of fresh fruits topped with a splash of low-fat .
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viii. Dairy (2 to 3 servings a day) Milk, cheese and other dairy products are major sources of calcium, vitamin D and protein. But the key is to make sure that you choose dairy products that are low-fat or fat-free because otherwise they can be a major source of fat. Examples of one serving include 1 cup skim or 1% milk, 1 1/2 oz. cheese. Go easy on regular and even fat-free cheeses because they are typically high in sodium. ix.Lean meat, poultry and fish (6 or fewer servings a day) Meat can be a rich source of protein, vitamins, iron and zinc. But because even lean varieties contain fat and cholesterol, don't make them a mainstay of your diet — cut back typical meat portions by one-third or one-half and pile on the vegetables instead. Examples of one serving include 1 oz. cooked skinless poultry, seafood or lean meat, 1 egg. � Trim away skin and fat from meat and then broil, grill, roast or poach instead of frying.
� Fish: has always been considered health
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food. Fish oils are known to maintain blood pressure. Eat heart-healthy fish, such as salmon and tuna. These types of fish are high in omega-3 fatty acids, which can help lower your total cholesterol Consuming fish like Mackerel (Bangada), Tuna and Surmai at least thrice a week will help you reduce your daily dose of medicines.
x.Nuts, seeds and legumes (4 to 5 servings a week) Almonds, sunflower seeds, kidney beans, peas and other foods in this family are good sources of magnesium, potassium and protein. They're also full of fiber which are plant compounds that may protect against some cancers and cardiovascular disease. Serving sizes are small and are intended to be consumed weekly because these foods are high in calories. Examples of one serving include 1/3 cup (1 1/2 oz.) nuts, 2 tablespoons seeds or 1/2 cup cooked beans or peas. Soybean-based products, can be a good alternative to meat because they contain all of the amino acids your body needs to make a complete protein, just like meat.
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xi. Sweets (5 or fewer a week) You don’t have to banish sweets entirely while following the DASH diet – just go easy on them. Examples of one serving include 1 tablespoon sugar, jelly or jam. Whenever you eat sweets, choose those that are fat-free or low-fat, such as sorbets, fruit ices, jelly beans, hard candy, and low-fat cookies. xii. Alcohol and caffeine Drinking too much alcohol can increase blood pressure. The DASH diet recommends that men limit alcohol to two or fewer drinks a day and women one or less. The DASH diet doesn’t address caffeine consumption. The influence of caffeine on blood pressure remains unclear. But caffeine can cause your blood pressure to rise at least temporarily. If you already have high blood pressure or if you think caffeine is affecting your blood pressure. 12.DASH DIET CHART
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Food group Daily servings Serving sizes
Grains 6-8 1 slice bread
1 oz dry cereal
½ cup cooked rice, pasta or
cereal
Vegetables 4-5 1 cup raw leafy vegetable
1/2 cup cut-up raw or
cooked vegetable
1/2 cup vegetable juice
Fruits 4-5 1 medium fruit
1/4 cup dried fruit
1/2 cup fresh, frozen, or
canned fruit
1/2 cup fruit juice
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Fat – free or
Low- fat milk and milk
products
2-3 1 cup milk or yogurt
11/2 oz cheese
Lean meats, poultry and
fish
6or less 1 oz cooked meats, poultry,
or fish
1 egg+
Nuts, seeds and legumes 4-5 week 1/3 cup or 11/2 oz nuts
2 Tbsp peanut butter
2 Tbsp or 1/2 oz seeds
1/2 cup cooked legumes
(dry beans
and peas)
Fats and oils 2-3 1 tsp soft margarine
1 tsp vegetable oil
1 Tbsp mayonnaise
2 Tbsp salad dressing
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Sweets and added sugars 5 or less/week 1 Tbsp sugar
1 Tbsp jelly or jam
1/2 cup sorbet, gelatin
1 cup lemonadeB O X 3
Sodium 1,500 to 2,400
mg a day
1,500 mg of sodium equals
about 4 grams, or 2/3
teaspoon of table salt
CONCLUSION:
The patient with hypertension will achieve and maintain goal BP as defined for the
individual, understand, accept and implement the therapeutic plan.
Summary:
Hypertension is a silent killer disease which needs to be identify as early as possible and
manage with lifestyle modifications, especially dietary approaches are most important to