CQI Project to Monitor Elevated Blood Pressure and Volume
CQI Project to Monitor Elevated Blood Pressure and Volume
Diagnose/Reason/Resolve
GOAL: HTN –85% Goal Sys 100)
PLEASE CHECK DATA BELOW THAT APPLIES TO THIS PATIENT’S VISIT
DRY WEIGHT BLOOD PRESSURE
ٱ Edema 0 1+ 2+ 3+ 4+ BP taken after patient is seated in a
quiet room for 5 mins.
Today Home BP summary: range: Avg
_________ Last Visit _____ Other Previous Visit
DIET PERITONITIS
ٱ High Na Intake ٱ Patient had peritonitis within the last 1 month
ٱ Inappropriate fluid Intake
ٱ Poor Glycemic Control
DIALYSIS MEDICATION
ٱ High Transporter ٱ Non-Compliant with Medication
ٱ Noncompliance with Prescription ٱ Too long F/U time between Med. Change/Review
ٱ Percentage of Glucose in bags too low ٱ Too much Na HC03
ٱ Dwell time too long / too short? ٱ Taking Med that elevate BP
ٱ Poor Drainage/Mechanical/Constipation ٱ Inadequate Education
ٱ Declining Renal Function ٱ Financial Issues
ٱ Orthostatic Symptoms ٱ Side Effects of Medications
COMORBID ILLNESS
ٱ Heart Failure
ٱ Liver Failure
ٱ Local Issues (eg. Lymphedema)
ٱ Neuropathy
Plans To Initiate To Achieve Goal:
1._______________________________________________________
2._______________________________________________________
3. ______________________________________________________
tracking #AL03498
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