Continuing Medical Education Programs Dr. Anika Niambi Al-Shura, Lecturer Copyright 2014 Niambi Wellness. All rights reserved

Integrative Examination in Cardiovascular Disease Copyright 2014 Niambi Wellness. All rights reserved

Physical Examination in This course is approved by the following agencies: National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for 9 PDA points and Florida State Board of Acupuncture for 12 CEUs. The companion textbook: Physical Examination in Cardiovascular Chinese Medicine must be ordered at www.elsevier.com Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Course Description This course focuses on the basic cardiac patient examination routine using protocols of both western medicine and TCM. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Course Objectives Understand the basics of how to take a cardiac patient history and triage vitals. Understand blending of basic western and TCM methods for examining cardiovascular patients in the clinic. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Course Modules Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Module 1: Hypertension and Arrhythmia Questionnaire Module 2: The Triage Module 3: Exam Room I Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Module 2 The Triage Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Contents Chapter 2: BAI vs. BMI Chapter 3: Blood Pressure Errors Chapter 4: Temperature Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Chapter 2: Weight Measurement Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Contents Part 1: Body Adiposity Index (BAI) vs. Body Mass Index (BMI) Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Part 1: BAI vs. BMI Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The Body Adiposity Index (BAI) is a method of measuring body fat without considering body weight. The body mass index (BMI) is a method of measuring body fat by including weight. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The BAI Formula Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Hip and height measurements are correlated to percentage of body fat. Where m=meters Hip circumference R=0.602 Height R= −0.524 Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The BAI is approximate to body fat percentages for adult males and females across different races and ethnicities. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The BMI measures body fat based on weight and height. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The BMI Formula Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved BMI is calculated by dividing weight in kilograms (Kg.) by height in meters squared (m²). Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Males and females with the same BMI might have various amounts and locations of extra body fat. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved BMI is not a very accurate indicator for fat measurement for athletes, across racial and ethnic groups. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved BMI provides a more accurate measurement of fat for Caucasian/white people. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

According to the textbook Classify lipoprotein disorders in Chinese medicine. Explain two risk factors linked to heart failure. List the genetic causes of high lipids in some patients? Explain the significance of waist circumference. Copyright 2014 Niambi Wellness. All rights reserved

According to the course How is BAI calculated? How is BMI calculated? What are the differences between BAI and BMI for fat calculation across ethnic groups? Copyright 2014 Niambi Wellness. All rights reserved

Chapter 3: Blood Pressure Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Contents Part 1: Introduction Part 2: Proper Technique Part 3: Common Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Part 1: Preparation Copyright 2014 Niambi Wellness. All rights reserved

Terminal digit preference This is the rounding off of numbers to the nearest zero, which can increase the reading and cause misdiagnosis. Using an automatic blood pressure cuff rather than a manual one may reduce errors. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Stethescope How the stethoscope is used is important in other areas of the body. However, the bell or diaphragm are both common to use in blood pressure measurement. One does not provide better sound quality over the other. Copyright 2014 Niambi Wellness. All rights reserved

Underestimating true blood pressure Rounding down the to the nearest 0, could cause a loss of around 5 mmHg. The consequences: under-treatment of an underlying serious heart condition ie: myocardial infarction or stroke. Copyright 2014 Niambi Wellness. All rights reserved

Overestimating true blood pressure Rounding up the to the nearest 0, could cause a padding of around 5 mmHg. The consequences: over-treatment of a minor condition, a non-existent condition or white coat hypertension. Copyright 2014 Niambi Wellness. All rights reserved

White-coat hypertension A rise in blood pressure in the clinic, under competently acquired readings, which is different from a normal blood conducted at home. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved If an initial blood pressure reading is elevated and a second reading is lower, the initial reading may be higher because of doctor-related white-coat effect. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Part 2: Proper Technique Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Sitting Measurement Copyright 2014 Niambi Wellness. All rights reserved

Sitting measurement The patient's back is supported. The cuff is a proper size and placed securely over a bare upper arm.

The arm is supported on a table and positioned at heart level. Both feet are on the floor.

Copyright 2014 Niambi Wellness. All rights reserved Standing Measurement Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Standing measurement This should be a routine measurement for elderly patients ≥70 years old. Also for all patients who are taking anti-hypertension medications and for patients with dizziness or orthostatic hypertension. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Standing systolic pressure may decrease blood pressure by ≥20 mmHg in elderly patients. A blood pressure reading this low could constitute orthostatic hypotension. Copyright 2014 Niambi Wellness. All rights reserved

The patient should wait 2-3 min The patient should wait 2-3 min. in the standing position before blood pressure is measured.

The arm should be supported by being placed on a table or held.

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Part 3: Common Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Patient Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Patient Errors The back and arm is unsupported. They are talking and actively listening. They cross the legs or need to urinate. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Lack of back and arm support can increase the systolic pressure by 10 mmHg. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Talking and actively listening to the nurse or other technician can increase systolic blood pressure by 10 mmHg. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Crossed legs and the need to urinate can increase the systolic pressure by >10 mm Hg. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Cuff Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The Cuff The bp cuff is over clothing. The cuff is the wrong size or malposition The arm dangles. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Measurements taken over a sleeve or pushed up causes a tourniquet which produces artifacts. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Placing a cuff which is too big or small can increase or decrease the systolic pressure by 10mmHg. Forearm pressure is often 3.6/2.1 mmHg higher than upper arm pressure. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Measurement taken on a dangling arm causes the systolic pressure to be 5 -10 mmHg higher than a supported arm. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

According to the textbook . List two main tools used to measure and examine the blood pressure. Describe the common and genetic factors to consider in hypertension? Describe the moment during the procedure when systolic pressure can be measured? Describe the moment during the procedure when diastolic pressure can be measured? Copyright 2014 Niambi Wellness. All rights reserved

According to the textbook . Indicate blood pressure ranges at each stage of hypertension according to JNC7 classification. Indicate the differences between the average heart rates of athletes, adults and children of age 12 and above. Copyright 2014 Niambi Wellness. All rights reserved

According to the course What are the dangers of over-estimating/underestimating a blood pressure reading? List the proper sitting and standing blood pressure measurements. List the common patient and cuff errors Copyright 2014 Niambi Wellness. All rights reserved

Chapter 3: Temperature Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Contents Part 1: Introduction Part 2: Description of Devices Part 3: Common Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Part 1: Introduction Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The temperature is divided into core temperature and peripheral temperature. Core temperature is within the body. Peripheral can be measured at different areas of the body which maintains stable temperatures. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved The differences between core and peripheral temperatures is called clinical bias. Clinical bias is also the result of inaccurate temperature readings due to device failure or procedure failure. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Part 2: Description of Devices Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Temporal Artery Temperature Copyright 2014 Niambi Wellness. All rights reserved

Temporal Artery Temperature The device uses infrared technology. The accuracy is comparable to rectal reading. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Ear Temperature Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Ear The device uses infrared technology. The accuracy is comparable to rectal reading. Copyright 2014 Niambi Wellness. All rights reserved

Sublingual Temperature Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Sublingual Glass: The device can be sterilized, is convenient to use. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Sublingual Digital: The device uses infrared technology. The accuracy is comparable to a rectal reading. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Axillary Temperature Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Axillary Glass: The device can be sterilized, is convenient to use. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Axillary Digital: The device uses infrared technology. The accuracy is comparable to a rectal reading. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Rectal Temperature Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Rectal Rectal temperature-taking is considered the method of choice for infants. It gives an accurate reading of core body temperature. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Errors Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Temporal Artery Temperature Doesn’t track core internal body temperature. Doesn’t accurately express internal temperature changes. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Ear Doesn’t track core internal body temperature. Requires a precise technique. Temperature may be ambient. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Sublingual Mouth temperature may be ambient Difficult in small children, the weak and unconscious Dwelling time varies Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Axillary May not be accurate for adults May be better in children 3 mos. to 5 years Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Rectal May be a too invasive option Insertion depth and direction problems Problems with dwelling time Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

According to the textbook . 1. Describe the purpose of recording body temperature. 2. Explain the problems associated with hyperthermia. 3. Explain the problems associated with hypothermia. Copyright 2014 Niambi Wellness. All rights reserved

According to the course Describe the purpose of recording body temperature. List the methods of taking a temperature. List the errors of taking a temperature. Copyright 2014 Niambi Wellness. All rights reserved

Copyright 2014 Niambi Wellness. All rights reserved

Module 1 Review Questions Copyright 2014 Niambi Wellness. All rights reserved

review interactive practice quiz. Complete the Module 2 review interactive practice quiz. Copyright 2014 Niambi Wellness. All rights reserved

Please continue on to Module 3 Copyright 2014 Niambi Wellness. All rights reserved