SURVEY METHODS Procedure: Blood Pressure and Pulse

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1 SURVEY METHODS Procedure: Blood Pressure and Pulse 1. Purpose This Blood Pressure and Pulse Manual of Operational Procedure (MOP) outlines the steps that field team members should follow when taking and recording blood pressure and pulse during the physical exam of survey participants (SPs). 2. Scope The Blood Pressure and Pulse MOP is for field team use when conducting Time 3 with able-bodied SPs using a SHOW laptop at a Survey Center, Survey Site, or Mobile Exam Center. This MOP assumes the field team staff member is working alone. For detailed discussion of SHOW blood pressure and pulse, including overview and purpose, calibration of measuring instruments, preparing the SP for the exam, tips on conducting the exam, decision making regarding which arm to use for measurement, care and list of equipment, procedures for disabled SPs, and other special circumstances, please see the Anthropometry Manual of Operations and the Blood Pressure and Pulse Manual of Operations. See also manufacturers equipment manuals. NOTE: Anthropometry has its own MOP. The Time 3 Anthropometry and Blood Pressure module is performed in the following order: Upper arm length, upper arm circumference, blood pressure, pulse, height, weight, waist, and hip. 3. Responsibilities Field team members receive training and recertification in blood pressure procedures annually. Currently, calibration of the blood pressure monitors is not required. SHOW Protocol for Out of Range Blood Pressure Readings The field team is responsible for identifying life threatening blood pressures to participants. Although the primary purpose of the Exam Center (EC) is research data collection and not diagnosis or treatment, the blood pressure measurement may result in findings that warrant further medical attention and/or that may be previously unknown to the participant. Exam Center interviewers review the data acquired with the respondent. The categories set forth in this protocol determine what type of recommendation, if any, to give participants regarding the need for follow-up monitoring or further assessment. Further this protocol provides for the re-taking of the blood pressure if the initial readings fall in a significantly abnormal category. Categories of adult blood pressure This document covers ranges of blood pressure readings that will generate proscribed information to be given to SHOW subjects. Table 1 provides a matrix of combinations of systolic and diastolic blood pressure results and the recommendations that are generated when these blood pressures (BPs) are present for adults. The left column specifies the minimum and maximum systolic pressure groupings. The first row specifies the minimum and maximum diastolic blood pressure categories. The matrix cells specify the BP category Page 1

2 severity for the systolic and the diastolic combination. The category severity defines the recommendation that exam center staff will provide. Interviewers will utilize the following table to determine if a BP reading meets the criteria for a recommended follow-up. If a blood pressure is above a Category 1, the blood pressure reading is taken two more times during the visit to the MEC (not consecutively) and if it continues to be above a Category 1, then the recommendation is given based on Table 2. Table 1: Categories for adult blood pressure recommendations* Diastolic (mm hg) Systolic (mm hg) *From the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure as used by NHANES Recommendation Levels There are three levels of recommendation for examination components. The levels are based on test findings and represent an increasing severity and threat to the health of SPs. Level 1 is an urgent recommendation and Level 3 does not generate any recommendation. Based on the results of the blood pressure measurement in the EC, interviewers place SPs in one of three recommendation categories and tell them the recommendation for their level. Table 2. Blood pressure recommendation levels, category, and action required Level 1 Recommendation Level 2 Recommendation Level 3 Recommendation (category 6) (category 4 & 5) (categories 1, 2& 3) Indicates 3 blood pressure readings that warrant immediate attention by a health care provider. Indicates blood pressure readings that warrant attention by a health care provider within the next 2 weeks. These findings are expected to cause adverse effects within this time period and they have previously been undiagnosed, unattended, not manifested, or not communicated to the examinee by his/her personal health care provider. Indicates no BP elevation; minor elevation that an examinee already knows about, and is under care for, or elevations that do not require prompt attention by a medical provider. Page 2

3 PROCEDURE Depending upon the findings, the following recommendations are provided to the subject: Level 1 Recommendations: These recommendations are generated when a dangerously high blood pressure has been found upon three separate time points in the visit to the EC. Level 2 Recommendations: The EC interviewer generates these recommendations when the blood pressure reading would require attention by a health care provider in the next 2 weeks because they are expected to cause adverse effects within this time. Level 2 recommendations allow SPs to continue MEC examinations; however, they are advised to see their primary care provider within 2 weeks following the examination. A high, but not dangerously high blood pressure is an example of a level 2 recommendation. Level 3 Recommendations: Level 3 recommendations consist of no out of range blood pressures or ranges that an SP already knows about, is under care for, or does not require prompt attention by a medical provider. This level does not provide any recommendations for follow-up care. An example is a mildly high blood pressure reading for a participant already receiving treatment for hypertension. Before leaving the EC, participants will be provided with a card that provides information on their blood pressure based on the above categories and will be told the recommended action based on their level in table 5.2. Report of Findings Comments: The following comments are based on data in the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Category 6 Your blood pressure today is severely high. Category 5 Your blood pressure today is very high. Category 4 Your blood pressure today is moderately high. Category 3 Your blood pressure today is mildly high. Category 2 Your blood pressure today is normal but at the high end of the normal range. Category 1 Your blood pressure today is within the normal range. 4. Changes Since Last Revision. None 5. Equipment Needed Omron IntelliSense Blood Pressure Monitor Model HEM-907-XL 4 sizes of blood pressure cuffs that are part of the Omron device Tubing to connect cuffs to blood pressure monitor Luer connection to connect tubing to monitor 6. Related Documents Anthropometry Manual on SHOW server Page 3

4 Blood Pressure and Pulse Manual on SHOW server. 7. Definitions blood pressure: A measurement of the force applied to the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped, and the size and flexibility of the arteries. brachial artery: This is the major blood vessel of the upper arm and typically used for blood pressure measurement. cuff: Cloth sleeve containing an air bladder, attached by tubing to blood pressure measurement device, it is wrapped around subject s arm and fastened with Velcro. SHOW s cuffs are provided in four sizes: small (7-9 inches [17-22 cm]); medium (9-13 inches [22-32 cm]); large (13-17 inches [32-42 cm]); and extra large (17-20 inches [42-50 cm]). hypertension: a common condition in which the force of the blood against the artery walls is high enough that it may eventually cause health problems, such as heart disease; also known as high blood pressure. leur connection: This small, black, plastic device securely connects the tubing to the cuff, rotating like a screw-in cap. pulse: For an adult, a normal resting heart rate ranges from 60 to 100 beats a minute. For a well-trained athlete, a normal resting heart rate may be closer to 40 beats a minute. For healthy adults, a lower heart rate at rest generally implies more efficient heart function and better cardiovascular fitness. Pulse is measured to obtain heart rate, shown in bpm. 8. Procedure Step Action Notes/Comments 1 Preparation: Anthropometry procedures in <3> of Time 3 will take interviewer through measurement of subject s upper arm. 2 Connect air tube to the blood pressure monitor. Machine should be turned on. P-SET dial should be set at Auto and MODE dial should be set at AVG. 3 Select proper size cuff for SP. 4 Connect air tube to the cuff/bladder set by rotating the luer connection. Extra-large cuff has integrated air plug and tube that connects directly to monitor. 5 SP should be seated with selected arm resting on table or counter. The cuff should be level with the SP s heart during measurement. SP s arm should be palm up. SP s ankles/legs should be uncrossed and feet should be flat on floor. 6 Explain BP procedure to SP: 1) 5-minute rest before measurement begins, no talking or movement during rest period; 2) automatic Page 4 5-minute rest period is good opportunity to

5 inflation and deflation; 3) 1-minute rest between measurements; 4) pulse being measured at same time. check SP s SAQ. 7 Align the Artery Position Mark with the brachial artery. 8 Wrap the cuff snugly using both hands and securely fasten with the Velcro tape. The lower edge of the cuff should be ½ to 1 inch above the inner side of the elbow joint. Wrap cuff so you can insert only one finger between the cuff and arm. 9 Press start on blood pressure monitor. 10 Record first blood pressure reading in computer. If you miss seeing any measurement value, you will be able to retrieve at the end of the session by using the DEFLATION button under the START button. 11 Write down first blood pressure reading on Today s Test Values form. 12 Record second blood pressure reading in computer. 13 Write down second blood pressure reading on Today s Test Values form. 14 Record third blood pressure reading in computer. 15 Write down third blood pressure reading on Today s Test Values form. 16 Record average blood pressure reading in computer. 17 Write down average blood pressure reading on Today s Test Values form. 18 Record pulse in computer. 19 Write down pulse on Today s Test Values form. 20 Remove cuff from SP 21 Use Time 3 reference sheet SHOW Protocol for Out of Range Blood Pressure Readings to check for Categories for adult blood pressure recommendations 22 Record recommendation on Today s Test Values form. 23 Inform SP of recommendation. Page 5

6 9. Records Electronic copies of this manual are available on the SHOW S Drive. Page 6

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