27 Aug Advanced Nursing lab …

Part 1: Health Screening and Evaluation

Instructions

I. Data Collection

A. Clients should complete 2014 PAR-Q+, CHD risk profile, lifestyle questionnaire, medical clearance from physician (if needed), and informed consent. Include all forms at end of narrative.

B. Measure your client’s height, weight, and BP (see Part 2). Calculate and classify your client’s BMI.

C. Encourage client to get both a fasting blood lipid profile (TC, HDL-C, LDL-C) and blood glucose test if these have not been done within the past year.

II. Case Study Write-Up

A. Client demographics: Describe age, gender, occupation, and stress level of your client.

B. Describe physical activity (PA) status. Does the person meet current PA guidelines?

C. Analysis of medical history: Describe any medical problems and signs and symptoms of CVD, metabolic or renal disease.

D. Analysis of CHD risk profile: Evaluate your client’s score for each of the risk factors listed below:

1. Age

2. Family history

3. Cigarette smoking

4. Hypertension—measure and evaluate client’s systolic and diastolic BP

5. Dyslipidemia—evaluate client’s TC, HDL-C, and LDL-C values

6. Prediabetes—evaluate client’s fasting blood glucose level

7. Obesity—evaluate client’s BMI and/or waist circumference

8. Physical inactivity

D. Lifestyle profile: Evaluate each component, pinpointing potential problem areas.

1. Dietary considerations (e.g., snacks, salt use, foods high in saturated fat?)

2. Eating habits (frequency of meals, types of food, caloric intake)

3. Physical activity (how often? how much?) and physical activity interests

4. Smoking and drinking habits

5. Suggestions for modifying lifestyle behaviors

III. Ethical considerations:

A. Identify the professional organization most closely aligned with your career goals (e.g. American College of Sports Medicine, National Strength and Conditioning Association, American Physical Therapy Association, National Athletic Training Association, etc.) and review their Code of Conduct.

B. Identify potential areas of professional and ethical concerns pertaining to this part of the project.

C. Identify how you addressed or resolved these potential areas of concern.

Part 2: Measurement of Heart Rate and Blood Pressure

The goal of this exercise is to develop your skill in measuring (a) resting and exercise heart rates (HR) by palpation, auscultation, heart rate monitors, or electrocardiograms (ECG) and (b) resting and exercise blood pressures (BP) by auscultation.

Equipment

· HR monitors or ECG

· Sphygmomanometers

· Stethoscopes

· Cycle ergometers

· Stopwatches

Student Assignments

1. Work in a group of three: one student as client, one student as tester, and one student as data recorder.

2. Rotate assignments so that each student gets to be the client, tester, and recorder.

Heart Rate Measurement Procedures

1. Review methods:

· Palpation

· Auscultation

· Heart rate monitors

2. Review procedures.

· Resting: Subject is seated and pulse rate is counted for 30 sec or 1 min. Evaluate resting HR (normal, bradycardia, or tachycardia?).

· Exercise: Pulse rate is measured using 10- or 15-sec count; HR is measured during last minute of each workload (usually every 2 to 3 min) during graded exercise test.

· Normal HR 60-100

· Recovery: Pulse rate is monitored using 10- or 15-sec count; HR is measured every 1 to 2 min during the 3- to 5-min (low intensity and active) recovery period until stabilized.

3. Normal exercise HR responses:

· HR increases with increasing work intensities.

· HR stabilizes (steady state) during each workload.

· HR should stabilize during recovery but may not return to baseline levels within 5 min.

4. Abnormal exercise HR responses:

· HR fails to rise with increase in workload.

· There is noticeable change in heart rhythm.

· There is onset of angina or angina-like symptoms.

HR Activities

1. Attach HR monitor and electrodes to one person.

2. Following standardized procedures, take resting HR count using palpation and auscultation. Compare to HR monitor or ECG values when possible.

3. Have subject assume seated position on cycle ergometer and begin exercising at low intensity (50 W). Take exercise HR at end of each minute and compare to values obtained simultaneously from HR monitor. If you are palpating HR accurately, these values should be within 4 to 6 bpm.

BP Measurement Procedures

1. Review procedures:

· Resting: Subject is seated for at least 5 min with elbow flexed. Wrap cuff firmly around upper arm at heart level and align cuff with brachial artery. Place bell below antecubital space over the brachial artery. Rapidly inflate cuff to 200 mmHg or +20 mmHg above estimated systolic value. Slowly release pressure in cuff at rate of 2 to 3 mmHg/sec, noting first Korotkoff sound. Continue releasing pressure, noting when sound is muffled (fourth Korotkoff sound) and when it disappears (fifth Korotkoff sound). Take at least two readings. Evaluate (see table 2.3). Normal resting BP is <120/80 mmHg. Relative contraindication if resting BP is >200/110 mmHg. (Note: For clinical testing, resting BP is evaluated in both supine and exercise postures.)

2. Normal exercise BP responses:

· Systolic BP should increase with increasing exercise intensities.

· Diastolic BP should decrease or stay the same during GXT.

· Rise in systolic BP will be steeper and diastolic BP will increase during arm ergometry GXT.

· Systolic BP is more elevated during exercise in upright versus supine posture and for weight-bearing (e.g., treadmill or step exercise) versus non-weight-bearing (e.g., cycling) exercise.

· BP should stabilize during recovery but may not return to baseline values within 5 min.

3. Abnormal exercise BP responses:

· Failure of systolic BP to increase or a significant drop in systolic BP (>20 mmHg) with increase in exercise intensity

· Excessive rise in systolic BP (>250 mmHg) or diastolic BP (>115 mmHg)

BP Activities

1. Practice taking resting BP following standardized procedures. Record values. If you do not get same reading as other tester, use the dual stethoscope.

2. Practice taking exercise BPs with client exercising on cycle ergometer at low to moderate intensities (50 to 150 W). Remember to stabilize client’s arm during measurement. Use dual scope to see if your readings coincide with other tester’s values.

Group Discussion Questions

1. What are the potential sources of error in measuring heart rate by palpation? What can you do to minimize these sources of error?

2. What is your own resting HR classification?

3. Were your palpated HR values close to those obtained using the HR monitor or ECG?

4. Describe your HR response during exercise and recovery. Were your HR responses normal?

5. What are the potential sources of error in measuring blood pressure at rest and during exercise? What can you do to minimize these sources of error?

6. What is your resting BP classification?

7. When the dual stethoscope was used, how close were the BP values measured by the two technicians?

8. Describe your BP response during exercise and recovery. Were your BP responses normal?

Data Collection Form for Measurement of Heart Rate and Blood Pressure

Demographics

BMI Categories:  Underweight = <18.5 Normal weight = 18.5–24.9  Overweight = 25–29.9  Obesity = BMI of 30 or greater

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Age (yrs)	24	22	26	27	33
Height (cm)	166cm	172cm	160	172	174
Weight (kg)	74	75	57	62	80
BMI (kg/m2)	26.9	25.4	22.3	21.0	26.4

Screening

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Active (Y/N)	Y	Y	Y	Y	Y
Signs/Symptoms (Y/N)	N	N	`n	N	N
Medical clearance recommended (Y/N)	N	N	N	N	N
Recommended exercise intensity (L/M/V)	M	M	M	M	M

CVD Risk Factor Assessment – Place a check in the box if the subject has one of the risk factors. Refer to Table 3.1 in the ACSM’s Guidelines for Exercise Testing and Prescription (page 48).

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Age
Family History
Cigarette smoking
Hypertension
Dyslipidemia
Prediabetes/Diabetes
Obesity
Physically inactive

Resting HR

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Palpitation	78	79	61	74	76
HR monitor	71	81	77	67	87
Auscultation

Exercise HR

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Palpitation	100	112	134	110	120
HR monitor	124	120	129	131	135

Resting BP

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Systolic	120	125	110	119	116
Diastolic	80	80	65	73	70

Exercise BP

	Subject 1	Subject 2	Subject 3	Subject 4	Subject 5
Systolic
Diastolic

Introduction: You should explain the purpose of pre-participation screening. What are the benefits of screening and what does the literature say about pre-exercise screening?

Methods: Explain how your methodology in detail.

Results: Provide basic demographic information for your sample. Include a figure (graph or table) with your data. You should not explain your data in this section.

Discussion: Explain whether the findings were normal or abnormal. Is medical clearance recommended? If so, why? You should also explain what intensity of exercise you would recommend for your sample. What does the literature say?

Conclusion: Sum up what you found.