Describe various methods of monitoring blood pressure in the home setting for patients with ESRD
receiving hemodialysis.
business model analyses
Paper details:
Using the material and information from this course, you will need to perform an in-depth analysis on one of the five companies you selected in Part One and prepare a
written research report on this company. Your target audiences are portfolio managers and analysts. Part Three should be no longer than three pages of single-spaced
text and three optional pages of graphs, charts, spreadsheets, etc. The optional items should be used to illustrate and back up the body and conclusion of your
research report. Do not include copies of financial statements or charts from the 10K/10Q as the portfolio manager already has access to these items.
The goal of the research report will be to determine the intrinsic value of the selected company through use of a valuation model. You may determine that the company
is overvalued, undervalued, or fairly valued based on your calculations. The important aspects of the report will be the method and logic you use to come up with your
“accurate” valuation. The structure of the report and the date/exhibits will be left up to you. There is no right or wrong report format.
You may use any valuation method as long as it makes sense and you effectively back-up the report’s conclusion. Include a copy of your valuation spreadsheet as one of
your exhibits.
One useful tip is to become familiar with other Wall Street research reports and see how the “Pro’s” value an individual company. Once you have your valuation, be sure
to compare and contrast your valuation vs. that of the current market. Remember that you will be graded on how well you make your valuation case, using a valuation
method that is both sound and accurate.
Major topics to cover in the report: Business model analysis (10 Points)
Risk/Return and Financial Ratio analysis discussion (15 Points)
Historical and Future performance (10 Points)
Earnings and Cash-flow analysis (15 Points)
Assumption Justification (10 Points)
Intrinsic Value and Valuation Model. (15 points)
Nephrology Nursing Journal January-February 2012 Vol. 39, No. 1 31
Hypertension Management in Patients
Receiving Hemodialysis: The Benefits
Of Home Blood Pressure Monitoring
H
ypertension in individuals re –
ceiving hemodialysis management
is associated with cardiovascular
complications and is
believed to be an independent risk
factor for mortality in this population
(Fagugli, Taglioni, Rossi, & Ricciardi,
2008). The etiology for the increased
mortality is multifactorial and complex.
While hypertension appears to
be a risk factor (Kauric-Klein &
Artinian, 2007), the association re –
mains controversial (Fagugli et al.,
2008). The diagnosis and treatment of
hypertension in this population is a
challenge due to the variability of
associated physiological effects, such
as fluid volume fluctuations, variations
in sodium intake, uremic toxin
levels, cardiac co-morbidities, and
non-adherence to medication regimes
(Agarwal & Saha, 2007; Fagugli et al.,
2008; Kauric-Klein & Artinian, 2007;
Peixoto & Santos, 2010). To further
complicate the diagnosis and management,
there is uncertainty about
which blood pressure (BP) measurements
are more accurate when considering
medication therapy (Agawal
& Lewis, 2001). While BP measurements
obtained at dialysis centers are
documented before, during, and after
dialysis sessions, there is a concern
Kim Lingerfelt
Donna Hodnicki
Continuing Nursing
Education
Kim Lingerfelt, DNP, FNP-BC, CNN-NP, is a
Nurse Practitioner and Chief Clinical Coordinator,
Chattanooga Kidney Centers, LLC, Chattanooga,
TN, and a member of ANNA’s Scenic Center
Chapter. She may be contacted via e-mail at
kllfnp@comcast.net
Donna Hodnicki PhD, FNP-BC, FAAN, is a
Professor, School of Nursing, Georgia Southern
University, Statesboro, GA.
Acknowledgements: This pilot project was possible
through the support of a $2500 clinical practice
grant from the American Nephrology Nurses’
Association (ANNA).
Statement of Disclosure: The authors reported no
actual or potential conflict of interest in relation to
this continuing nursing education activity.
This offering for 1.3 contact hours is provided by the American Nephrology Nurses’
Association (ANNA).
ANNA is accredited as a provider of continuing nursing education (CNE) by the American
Nurses Credentialing Center’s Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number
CEP 00910.
Accreditation status does not imply endorsement by ANNA or ANCC of any commercial product.
This CNE article meets the Nephrology Nursing Certification Commission’s (NNCC’s) continuing
nursing education requirements for certification and recertification.
Copyright 2012 American Nephrology Nurses’ Association
Lingerfelt, K., & Hodnicki, D. (2012). Hypertension management in patients receiving
hemodialysis: The benefits of home blood pressure monitoring. Nephrology Nursing
Journal, 39(1), 31-36.
Patients with end stage renal disease on hemodialysis are at risk for cardiovascular events
and increased mortality. Hypertension contributes to these risks and can be difficult to assess
due to unreliable blood pressure (BP) measurements at dialysis centers. A clinical practice
grant from the American Nephrology Nurses’ Association allowed for the purchase of 35 home
BP monitors to study the use of these monitors to provide additional information for BP management.
Findings indicated that home BP monitoring can be an effective tool in hypertension
management.
Key Words: Home blood pressure monitor, ambulatory blood pressure monitor,
hypertension, end stage renal disease, hemodialysis.
Goal
To provide an overview of the benefits of home blood pressure monitoring in patients
with end stage renal disease.
Objectives
1. Explain the challenges of diagnosis and treatment of hypertension in patients with
end stage renal disease (ESRD) receiving hemodialysis.
2. Discuss the recommended protocol for measuring and evaluating blood pressure
in patients with ESRD receiving hemodialysis.
3. Describe various methods of monitoring blood pressure in the home setting for
patients with ESRD receiving hemodialysis.
that these readings may not be the
most accurate. Utilization of home BP
measurements may provide a more
accurate representation of overall BP
measurement. Utilization of automatic
BP monitors or ambulatory BP monitor
devices provides useful information
in the management of hypertension
for patients on hemodialysis
(Agarwal, 2009).
This article provides an overview
of the evidence on recommendations
for evaluating BP measurements in pat –
ients on hemodialysis. Findings of a
pilot study related to the clinical application
of home BP monitoring in this
population for the improvement of hy –
pertension management are describ ed.
32 Nephrology Nursing Journal January-February 2012 Vol. 39, No. 1
Hypertension Management in Patients Receiving Hemodialysis: The Benefits of Home Blood Pressure Monitoring
Literature Review
Hypertension is the major risk
factor in the occurrence and prevalence
of chronic kidney disease
(CKD); however, the kidney can be
the cause as well as the target of hypertension
(Bakris & Ritz, 2009). The
United States Renal Data System
[USRDS] (2011) continues to identify
hypertension as the second leading
cause in the progression of kidney disease
to end stage renal disease
(ESRD). The high incidence of hypertension
among patients on hemodialysis
indicates the essential need for
more effective management (Hörl,
2010). The Seventh Report of the Joint
National Committee on Prevention,
Detection, Evaluation, and Treatment of
High Blood Pressure (JNC 7) recommends
that BP be maintained at a
level less than or equal to 130/80 for
those individuals with CKD (Chobanian
et al., 2003). A 2002 report by the
USRDS indicates that approximately
75% of patients requiring hemodialysis
also have a diagnosis of hypertension
(Kauric-Klein & Artinian, 2007).
Hypertension must be managed to
decrease further kidney damage and
the development of additional endorgan
damage. While the accuracy of
the measurement is essential, the
measurements obtained at the dialysis
center (peri-dialytic, pre- and postdialysis)
are highly variable (Agarwal,
Andersen, Bishu, & Saha, 2006).
The differences between BP
measurements of pre-dialysis and
post-dialysis contribute to a lack of
consensus on the accepted criteria for
the diagnosis of hypertension in patients
receiving hemodialysis (Agarwal &
Lewis, 2001). Scientific evidence indicates
that the etiology of hypertension
is multifaceted and includes, but is not
limited to, sodium and water retention,
increased vascular resistance
from renin-angiotensin system activity,
increased symptomatic nervous
system activity, vasodilatation from
impaired endothelial cell-mediation,
circulating natriuretic peptide in –
crease, erythropoietin therapy, and secondary
hyperparathyroidism (Purcell,
Manias, Williams, & Walker, 2004).
Thus, it is important to identify a
method of BP monitoring that will
provide accurate data to determine
the presence of hypertension and to
manage the condition.
Methods to Monitor Blood
Pressure
Blood pressure readings in a dialysis
unit taken before and after treatment
cannot be used to adequately
determine ambulatory BP (Agarwal,
2006), and in fact, may be poor indicators
of BP control (Thompson &
Pickering, 2006). Hypertension control
must be evaluated with either
ambulatory or concomitant home BP
measurements because of the poor
specificity in diagnosing hypertension
with peri-dialytic BP alone (Agarwal,
Peixoto, Santos, & Zoccali, 2009).
Ambulatory blood pressure
monitoring. Ambulatory BP monitoring
allows for continuous assessment
over a period of time of BP readings
outside the clinical setting.
Thompson and Pickering (2006) identified
the prognostic significance of
ambulatory BP monitoring and intermittent
home BP readings in patients
with CKD. Their findings indicate
that the absence of a nocturnal BP dip
is associated with left-ventricular
hypertrophy, adverse cardiovascular
outcomes, and increased mortality
rate in patients with ESRD. The use of
the 24-hour ambulatory BP monitoring
for serial readings provides a more
comprehensive assessment of the
patient’s true BP and cardiovascular
risk when compared to in-office, randomized
BP measurements alone
(Ararwal & Andersen, 2006).
Conventional BP measurements ob –
tained during office visits and over the
period of dialysis neither provide the
information needed to evaluate nocturnal
BP dips nor determine the
patient’s overall hypertensive control
and risk for cardiovascular events
(Thompson & Pickering, 2006).
The use of ambulatory BP monitoring
in clinical practice provides
automated measurements over a 24-
hour period without interruption of a
patient’s daily activities, such as physical
activity, work, rest, and sleep
(White, 2003). Techniques for ambulatory
BP monitoring provide indirect
measurement of BP by auscultation of
Korotkoff’s sounds and/or through
oscillometric measurement of the
vibratory signals from brachial artery
blood flow (Marchiando & Elston,
2003). For over four decades, ambulatory
BP monitoring has been used to
assess the true contribution of BP to the
cardiovascular risk profile, but it is not
routinely used because of the additional
expense and time needed to set up
and evaluate findings (Covic, Haydar,
& Goldsmith, 2004). The provider’s
cost of a single monitoring unit and the
necessary computer software for interpretation
of measurements is estimated
to be $4500 to $5500, with additional
expenses of $60 to $100 for a single
patient study to cover clinician time for
interpretation, and for staff and patient
follow up. Although third-party reimbursement
for ambulatory BP monitoring
is variable (Marchiando & Elston,
2003), the Center for Medicare and
Medicaid Services of the United States
(CMS) has recognized the diagnostic
value of ambulatory BP monitoring
(Krakoff, 2006). Reimbursement rates
allowed by CMS vary from $70 to
$105 for ambulatory BP monitoring
(Pickering et al., 2008). The use of
ambulatory BP monitoring has been
shown to result in a 3% to 14% savings
in the cost of care for hypertension and
a reduction in treatment days by 10%
to 23% during the process of evaluation
for hypertension (Krakoff, 2006).
Home blood pressure monitoring.
A home BP monitoring device
used for self-measurement is less
expensive than ambulatory BP monitoring
and an effective tool to aid the
management of hypertension (Pickering
et al., 2008). Data obtained from the
use of serial home BP measurement
provide more frequent diagnostic
information for the management of
patients with hypertension receiving
hemodialysis. The home BP device
most often recommended has an electric
inflation of the BP cuff, oscillometric
detection, and memory capability
(Pickering et al., 2008). The patient’s
out-of-pocket cost per device ranges
from $80 to $100, unless reimburse-
Nephrology Nursing Journal January-February 2012 Vol. 39, No. 1 33
ment is provided by health insurance
coverage (Pickering et al., 2008). The
oscillometric BP devices designed for
home use are usually fully automated,
user friendly, and may have a memory
capacity.
Pickering et al. (2008) recognized
that when home BP monitoring was
used in comparison to office BP measurements,
the home BP measurement
was lower, thus eliminating the potential
impact of white-coat hypertension
on treatment decisions. Home BP
readings are more reproducible than
office measurements and assist in
improving BP control to reduce
potential target organ damage.
Agarwal (2007) stated that the BP
measurements obtained in the dialysis
center are helpful in the decision-making
process for elevated BP with
hemodialysis; however, it is suggested
that home BP readings should be used
for hypertension management.
Home BP monitoring is indicated
when patients undergoing hemodialysis
exhibit fluctuations in BP measurements
at the dialysis center or when
symptoms associated with hemodynamic
instability, such as dizziness,
visual disturbances, or weakness at
home, are reported. The premise of
this pilot project is that BP readings
may vary in patients receiving hemo –
dialysis as a result of fluid volume fluctuations,
variations in sodium intake,
uremic toxins levels, cardiac co-morbidities,
and non-adherence to medication
regimes. This population
would likely benefit from a home BP
monitoring program to improve
hypertension management and to
assist in clinical-decisions.
Home Blood Pressure Monitoring
Pilot Project
The purpose of the pilot project
was to improve BP evaluation methods
to manage hypertension as evidence
by achievement of BP measurements
of 130/80 or lower as recommended
by the JNC 7 guidelines for
improved patient outcomes with the
hemodialysis population treated at the
Chattanooga Kidney Center (CKC).
In clinical observations at the CKC,
peri-dialytic BP measurements appear
to be poor predictors of hypertension
control due to the fluctuation of interdialytic
fluid gain and sodium intake
and changes in hemodynamic stability
during the dialysis procedure. To provide
improved hypertension management
and to prevent overtreatment of
higher-than-normal BP, a combination
of peri-dialytic and home BP measurements
was needed before modifying
patient medication regimens. The
advanced practice registered nurse
(APRN) (first author) initiated the study
under the direction of the CKC medical
director and co-medical director.
Population
The recruitment of participants
from the patient population with
ESRD and hypertension was at the
direction of the APRN. The criteria
for selection of participants were
determined by in-center BP measurements
above 130/80 mmHg after consecutive
dialysis treatments over a one
to two-week period of time. The use of
antihypertensive agents was not a
requirement for participation in the
pilot study. Through the support of a
$2500 clinical practice grant from the
American Nephrology Nurses’
Association (ANNA), the practice site
purchased 35 Omron digital BP monitors
(HEM-773AC) to evaluate 35
participants with elevated blood pressures.
Institutional Review Board
approval was obtained through the
author’s doctoral program university.
Informed consent was obtained prior
to distribution of BP monitors, and
participants agreed to return the
devices if bi-weekly BP recordings
were not submitted to the APRN. If
participants continued to demonstrate
utilization of the home BP monitors,
they were allowed to keep the devices.
Methodology
From August 2010 to January
2011, patients whose in-center BP
measurements did not meet the recommended
goal of less than 130/80
mmHg after consecutive dialysis treatments
over a one to two-week period
of time were approached to participate
in the study. Thirty-five monitors were
available for use and were provided to
the first 35 individuals who met the criteria
and agreed to participate in the
study. Participants were encouraged to
return the BP device if it was not being
utilized so that other patients could be
offered to participate in the study. One
participant returned the BP monitor to
the APRN, and another person was
recruited. Informed consent was
obtained from all participants.
Each participant received instructions
on the proper technique for
using the home BP monitor device
with a return demonstration indicating
his or her ability to correctly use
the equipment. Additional instructions
included how often to measure
BP, a written schedule of when to
measure BP, and the target BP goal.
Participants were instructed to submit
BP measurements in writing or by use
of the BP monitor memory to the
APRN for review on a bi-weekly
schedule over a period of six weeks.
During the bi-weekly visits, the
decision to make treatment adjustments
was determined by the APRN
or nephrologist after assessing average
home BP measurements. The treatment
changes, individualized to each
patient, included an adjustment of dry
weight as indicated by edema or
shortness of breath, representing fluid
volume excess, reinforcement of daily
sodium restrictions, and adjustment of
oral antihypertensive agents as recommended
by JNC 7 guidelines.
A BP of 130/80 mmHg or lower
recommended by JNC 7 for the management
of hypertension in CKD was
the goal for each participant. Bi-weekly
BP results were evaluated to determine
if the BP average met this recommendation.
Interdialytic fluid gains
were recorded at each dialysis session,
with a weight gain recommendation
of less than three kilograms indicating
adherence for each participant. So –
dium intake under 3 grams a day was
recommended based on JNC 7 guidelines;
however, no actual dietary log
was required to verify sodium intake.
An interdisciplinary team, consisting
of a nephrologist, APRN, renal dietician,
and dialysis nurses, was available
for support to all participants.
34 Nephrology Nursing Journal January-February 2012 Vol. 39, No. 1
Hypertension Management in Patients Receiving Hemodialysis: The Benefits of Home Blood Pressure Monitoring
Findings
Thirty-six patients from the
Chattanooga Kidney Center were
enrolled in a pilot study using home
BP monitoring with bi-weekly follow
up over six weeks. One participant
voluntarily dropped out of the study
and was replaced. The demographic
characteristics of the final 35 participants
are shown in Table 1. The participant
age range was 23 to 82 years
(mean 52, mode 51). The history of
ESRD ranged from two months to
just under 10 years (mean 2.5 years).
The majority of participants were
male (63%), with a close split in ethnicity
(African American [54%] and
Caucasian [46%]).
BP results. After six weeks of biweekly
reviews and treatment adjustments
when indicated, home BP
measurements were re-evaluated to
determine if the BP goal was met. It is
important to point out that the availability
of home monitoring influenced
the decision to treat elevated BPs and
led to improved hypertension control
in some participants (see Table 2).
All 35 participants had BPs above
130/80 mmHg for in-center measurements
at the beginning of the pilot
study. Nine (26%) of the 35 participants
had an average home BP reading
below 130/80 mmHg during the
first week of monitoring on non-dialysis
days before treatment adjustments
were made. These nine participants
maintained the BP goal after six weeks
on the pilot study. This finding indicates
that these nine participants did
not have elevated BPs outside of the
dialysis setting.
Ten (29%) other participants met
the goal 130/80 mmHg or lower for
average home BP readings at the six
week end-point of the study. In addition,
at the six-week end-point, two of
the 10 had intermittent hypotension, a
possible indication of over-treatment
of hypertension. Thirteen of the
remaining 16 participants who did not
meet the BP goal by the end of the six
weeks as determined by home BP
measurements showed a systolic
reduction of at least 12 mmHg at the
end of the study. The three participants
who did not meet the BP goal at
the end of the pilot study had no
improvement in BP measurements
when compared to home BP readings
taken at the beginning of the study.
Fluid gain results. Analysis of
data indicates that 16 (46%) of the participants
demonstrated an average
interdialytic fluid gain above the recommendation
of 3 kilograms. Ten
(53%) of the 19 participants with an
average interdialytic fluid gain of less
than 3 kilograms obtained the BP goal
of 130/80 mmHg or lower after six
weeks.
Sodium intake. The sodium
intake could not be determined as
absolute due to inconsistencies in selfreporting.
Participants were not
required to keep a dietary log of foods
to determine hidden sodium intake,
although each participant reported a
pattern to avoid adding salt to foods at
the table.
Analysis of the Findings
After six weeks of bi-weekly
reviews and treatment adjustments
when indicated, home BP measurements
were evaluated to determine if
the BP goal in hypertension manageTable
1
Participant Characteristics
Variable Category Proportion (%) N = 35
Age Ranges 20 to 35 years 17 6
36 to 50 years 23 8
51 to 65 years 43 15
66 to 80 years 14 5
Over 80 years 3 1
Gender Male 63 22
Female 37 13
Ethnicity African American 54 19
Caucasian 46 16
Time Range for HD Start 1 to 12 months 26 9
13 to 24 months 26 9
25 to 36 months 14 5
37 to 48 months 6 2
49 to 60 months 14 5
Over 60 months 14 5
Note: HD = hemodialysis.
Table 2
Results
Variable Proportion (%) n
Home BP 130/80 or lower at baseline 26 9
Home BP greater than 130/80 at baseline 74 26
Home BP 130/80 or lower after 6 weeks 54 19
Home BP greater than 130/80 after 6 weeks 46 16
Interdialytic fluid gains less than 3 kg 54 19
Note: BP = blood pressure.
Nephrology Nursing Journal January-February 2012 Vol. 39, No. 1 35
ment was met. It is important to point
out that the availability of home monitoring
influenced the decision to treat
elevated BPs and led to improved
hypertension control in some participants
(see Table 2). These findings
indicate that not all patients with a BP
above 130/80 mmHg using peri-dialytic
measurements need medication
adjustments. Medication regimen
changes based solely on in-center BP
readings could result in over-treatment.
However, elevated in-center BP
measurements accompanied by elevated
home BP readings are useful
indicators to help monitor and adjust
therapy in the presence of uncontrolled
hypertension.
Agarwal and Light (2009) suggested
a possible correlation of elevated
pre-dialysis BP measurements with
an accumulation of fluid, sodium, and
uremic toxins as a factor of timedependent
hypertension. Home BP
measurements taken after hemodialysis
and prior to fluid and uremic toxin
level accumulation may provide a
more accurate depiction of hypertension
control compared to pre-treatment
BP readings at the dialysis center.
The assumption that intradialytic
hypertension indicates the need for
adjustments in anti-hypertension medication
may result in over-treatment of
hypertension for some patients. The
risk of symptomatic hypotension for
patients on hemodialysis performing
routine daily activities could be
reduced if home BP monitoring is
available to assess BP.
The study participants provided
positive feedback regarding the availability
of home BP monitors for
hypertension management. Although
the pilot study has ended, the majority
of participants continue to bring in
BP measurements for review at least
monthly. Overall, patient awareness
of adequate BP control among the
study participants improved.
Limitations of the Study
The findings are not generalizable
beyond the sample. The participants
were not randomized and were selected
by the APRN based on consecutive
in-center BP measurements
above 130/80 over a one to two-week
interval. Although instructions on
proper technique for BP monitoring
were provided, the accuracy of athome
BP monitoring could not be
verified. The accuracy of the measurements
is dependent on technique, timing,
and the participant’s level of activity
prior to taking the BP.
The use of intermittent home BP
measurements is also limited to the
waking hours and will not provide a
true representation of the dip or fall in
systolic BP during the night. A study
by Agarwal and Andersen (2006) concluded
that night ambulatory BP
measurements are stronger predictors
of total mortality, and the lack of dipping
in blood pressures appears to
predict those at higher risk for death.
Implications for Further Research
The findings of this pilot study
indicate that home BP monitoring can
provide added value in monitoring for
hypertension in ESRD. However, further
research is needed to evaluate if
home BP monitoring can be an effective
tool in the management of hypertension
in patients who are receiving
dialysis for ESRD. A controlled study
to establish the effects of home BP
monitoring and resultant hypertension
management adjustments related
to physiologic parameters of ESRD
and long-term mortality and morbidity
is needed.
Summary
The significance of hypertension
on increased cardiovascular risk and
mortality among patients on hemo –
dialysis remains apparent. It is estimated
that 72% of the chronic
hemodialysis population in the U.S.
have hypertension (Agarwal, 2002).
Further, with the large variations in
BP results obtained during hemodialysis,
the accuracy of BP measurements
is not easily ascertained. It is
difficult to effectively assess whether
hypertension is present and whether it
is controlled because of these variances,
which can result from fluid volume
fluctuations, excessive sodium
intake, uremic toxins, and sub-therapeutic
medication regimens. Accurate
BP monitoring is essential to improve
hypertension management and re –
duce cardiovascular risk associated
with the hemodialysis population.
Diagnosing and managing hypertension
in the hemodialysis population
requires a comprehensive approach to
evaluate BP control using in-center
and home BP measurements. Home
BP monitoring provides vital information
in hypertension management to
prevent over-treatment if medication
adjustments are made as a result of incenter
BP measurements, exclusively.
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White, W. (2003). Ambulatory blood-pressure
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348(24), 2377-2378.
Nephrology Nursing Journal Editorial Board Statements of Disclosure
In accordance with ANCC-COA governing rules Nephrology Nursing Journal Editorial Board statements of disclosure
are published with each CNE offering. The statements of disclosure for this offering are published below.
Paula Dutka, MSN, RN, CNN, disclosed that she is a consultant and research coordinator, is on the speaker’s
bureau, and has sat on the advisory board for Genentech.
Patricia B. McCarley, MSN, RN, NP, disclosed that she is on the Consultant Presenter Bureau for Amgen,
Genzyme, and OrthoBiotech. She is also on the Advisory Board for Amgen, Genzyme, and Roche and is the
recipient of unrestricted educational grants from OrthoBiotech and Roche.
Nephrology Nursing Journal January-February 2012 Vol. 39, No. 1 37
ANNJ1203
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ANSWER/EVALUATION FORM
Hypertension Management in Patients Receiving Hemodialysis:
The Benefits of Home Blood Pressure Monitoring
Kim Lingerfelt, DNP, FNP-BC, CNN-NP; Donna Hodnicki PhD, FNP-BC, FAAN
1.3 Contact Hours
Expires: February 28, 2014
ANNA Member Price: $15
Regular Price: $25
1. What would be different in your practice if you applied what you have learned
from this activity? (Response Required)
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Strongly Strongly
Evaluation disagree agree
2. By completing this offering, I was able to meet the stated objectives
a. Explain the challenges of diagnosis and treatment of hypertension in patients with end stage
renal disease (ESRD) receiving hemodialysis. 1 2 3 4 5
b. Discuss the recommended protocol for measuring and evaluating blood pressure in patients with
ESRD receiving hemodialysis. 1 2 3 4 5
c. Describe various methods of monitoring blood pressure in the home setting for patients with ESRD
receiving hemodialysis. 1 2 3 4 5
3. The content was current and relevant. 1 2 3 4 5
4. This was an effective method to learn this content. 1 2 3 4 5
5. Time required to complete reading assignment: _________ minutes.
6. I am more confident in my abilities since completing this material. 1 2 3 4 5
I verify that I have completed this activity ________________________________________________________________________________
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To provide an overview of the benefits of
home blood pressure monitoring in patients
with end stage renal disease.
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