1. Blood Pressure Training for Community Screenings Dana Breeding, RN, BSN, BS, CTTS Community Wellness

2. Objectives Assure accurate documentation for follow up Assure screeners use correct technique when preforming blood pressure screenings Assure education/recommendations given are appropriate and consistent with Augusta Health community policies and protocols.

3. Filling out BP screening form Have participant fill out entire blood pressure screening authorization form –Include data on tobacco use, height and weight for community data collection purposes –Obtain signature and return phone number in case follow up needed per protocol. –Document on form any pertinent information that would assist with a follow up phone call. –Document recommendations given per protocol

4. Points to consider before the screening Ask participant if there is any reason a Blood Pressure should not be performed in an arm due to surgery/injury.

5. Points to consider before the screening The participant should: –Assume a relaxed, comfortable position. –Sit quietly with legs not crossed, do not talk. –Rest arm on table with palm up and arm at heart level. –Not have smoked or exercised for at least 30 minutes. Allow 2-5 minute rest if appear out of breath. –Sleeve rolled up but not a tourniquet: room for two fingers under sleeve. Blood pressures should not be taken over clothing, if possible. Clothing can make noise and interfere with proper inflation.

6. Performing the blood pressure screening: manual cuff Lay arm on table palm up. Select appropriate cuff size: child, adult regular or extra large. Make sure the cuff comes together within the range given on cuff. Place cuff on arm with bottom of cuff at 1 inch above elbow crease

7. Performing the blood pressure screening: manual cuff Make sure midline of bladder is over brachial artery (toward the inner side of the arm, in line with the little finger) Place the head of the stethoscope over the brachial artery. Make sure only against skin, not clothing, and don’t wedge under cuff, as both create extra noise.

8. Performing the blood pressure screening: manual cuff Inflate cuff to approximately 180. If you hear an immediate sound release of pressure, then pump cuff up to 220. (Since we are screening, we will not estimate systolic BP by palpatory method) As pressure is released, note systolic reading – first appearance of repetitive sounds (Phase 1) and diastolic reading – when sounds disappear (Phase V) Rate of deflation before and during Korotkoff sounds should be at 2mm per pulse rate.

9. Performing the blood pressure screening: manual cuff An ideal screening would allow a second measurement at least 30 seconds after the first. The average of the two would be the blood pressure reading. If time allows, please perform two. If time does not allow, only one measurement is acceptable. Record the Blood Pressure on the screening form and give recommendations based on protocol.

10. Performing the blood pressure screening: automatic machines. Some people may use an automatic cuff related to hearing ability, loud environment or the number of people to be screened. If you use an automatic cuff, check to make sure batteries do not need to be replaced. Extra batteries are in the automatic cuff box.

11. Performing the blood pressure screening: automatic machines. Follow the same points for participant positioning and placement of the cuff, as with manual cuff. Record the Blood Pressure on the screening form and give recommendations based on protocol.

12. Blood pressure categories: American Heart Association Blood Pressure Category Systolic mm Hg (upper #) Diastolic mm Hg (lower #) Normal less than 120andless than 80 Prehypertension120 – 139or80 – 89 High Blood Pressure (Hypertension) Stage 1 140 – 159or90 – 99 High Blood Pressure (Hypertension) Stage 2 160 or higheror100 or higher Hypertensive Crisis Hypertensive Crisis (Emergency care needed) Higher than 180orHigher than 110 http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding- Blood-Pressure-Readings_UCM_301764_Article.jsp

13. Interpretation and recommendations of results, per protocol If BP is Normal - less than 120 and less than 80 –Recommend healthy diet, physical activity on most days of the week and good stress management. Encourage to keep taking blood pressure medication if prescribed. Prehypertension 120 – 139 or 80 – 89 –Provide basic information on Blood Pressure Management (handout). Encourage continued monitoring and follow up with their primary provider. –If no provider relationship exists, provide brochure on physicians taking new patients and encourage follow through.

14. Interpretation and recommendations of results, per protocol High Blood Pressure (Hypertension) Stage 1: 140 – 159 or 90 – 99 –Provide basic information on Blood Pressure Management and provide coaching interventions to reinforce medication compliance, dietary changes, and activity changes. Encourage continued monitoring and follow up with their primary provider. –If no medications have been prescribed, encourage provider contact and an appointment within 30 days. –If no provider relationship exists, provide brochure on physicians taking new patients and encourage follow through.

15. Interpretation and recommendations of results, per protocol High Blood Pressure (Hypertension) Stage 2: 160 or higher or 100 or higher –Obtain at least two more blood pressure measurements. –If measurements stay in this range, recommend the individual make a phone call to their primary provider for immediate care. –If provider cannot be reached or no provider relationship exists, recommend the person go to the Emergency Department. –If any symptoms of concern (heart attack or stroke) are present, call 911 for transport to the Emergency Department.

16. Interpretation and recommendations of results, per protocol Hypertensive Crisis (Emergency care needed) Higher than 180 or Higher than 110 –Obtain at least two more blood pressure measurements. –If measurements stay in this range, recommend and assist the individual in making a phone call to their primary provider for immediate care. –If provider cannot be reached or no provider relationship exists, recommend the person go to the Emergency Department. –If any symptoms of concern (heart attack or stroke) are present, call 911 for transport to the Emergency Department. Do not leave the individual unattended and continue monitoring until transportation arrives.

17. Education for blood pressure Give participant educational handout with the following steps to lower blood pressure See your health care provider on a regular basis, especially if you are over 40, overweight, smoke or lead an inactive lifestyle. Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week). Obtain medical clearance prior to starting. For overall cardiovascular risk reduction, stop smoking. Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat. This screening follows the recommendations of the 7 th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure 2003 http://www.nhlbi.nih.gov/guidelines/hypertension/http://www.nhlbi.nih.gov/guidelines/hypertension/ An Effective Approach to High Blood Pressure Control - Go A et al. Hypertension 2014;63:878-885

18. Education for blood pressure Participant educational handout to lower blood pressure, continued: Choose and prepare foods with little or no salt. To lower blood pressure, aim to eat no more than 2,400 milligrams of sodium per day. Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further. www.heart.org/HEARTORG/GettingHealthy/Diet-and-Lifestyle- Recommendations_UCM_305855_Article.jsp www.heart.org/HEARTORG/GettingHealthy/Diet-and-Lifestyle- Recommendations_UCM_305855_Article.jsp Maintain normal body weight (body mass index 18.5–24.9 kg/m2). Avoid or practice moderate consumption of alcohol: no more than 2 drinks (1 oz. or 30 mL ethanol; e.g., 24 oz. beer, 10 oz. wine, or 3 oz. 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter weight persons. This screening follows the recommendations of the 7 th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure 2003 http://www.nhlbi.nih.gov/guidelines/hypertension/http://www.nhlbi.nih.gov/guidelines/hypertension/ An Effective Approach to High Blood Pressure Control - Go A et al. Hypertension 2014;63:878-885

19. Other things to consider: Emphasize that this is a screening of their Blood Pressure at present. The participant’s health care provider, should repeat the blood pressure reading to diagnose high blood pressure. If asked about new recommendations for elderly, educate how each individual has a combination of different chronic conditions. As a team the person and their health care provider should decide on an acceptable Blood Pressure reading for them. Concerns with elderly are combinations of medications and a higher risk of falls if blood pressure is too low or drops quickly with positional change.

20. Thank you for reviewing this information Please proceed to the quiz

21. Test 1. What information needs to be filled out on the participant consent form: a)Data on tobacco use and height and weight. b)Signature and return phone number, in case follow up needed. c)Pertinent information that would assist with a follow up phone call. d)Document recommendations given per protocol e)All the above Answer is e…. 2. It is ok to talk with the participant while their blood pressure is being taken. T/F – False…

22. Test 3. The cuff size and placement is not important as long as it fits around the arm and is on the upper arm area. T/F F 4. A blood pressure reading of 148/102 places the persons number in what category? a)Prehypertension b)Stage 1 hypertension c)Stage 2 hypertension d)Hypertension Crisis Answer is c) as the 102 diastolic places them in that category.

23. Test 5. Recommendations for Stage 2 hypertension include: a)Obtain at least two more blood pressure measurements. b)If measurements stay in this range, recommend the individual make a phone call to their primary provider for immediate care. c)If provider cannot be reached or no provider relationship exists, recommend the person go to the Emergency Department. d)If any symptoms of concern (heart attack or stroke) are present, call 911 for transport to the Emergency Department. e)All of the above Answer is E

24. Blood pressure categories: American Heart Association Blood Pressure Category Systolic mm Hg (upper #) Diastolic mm Hg (lower #) Normal less than 120andless than 80 Prehypertension120 – 139or80 – 89 High Blood Pressure (Hypertension) Stage 1 140 – 159or90 – 99 High Blood Pressure (Hypertension) Stage 2 160 or higheror100 or higher Hypertensive Crisis Hypertensive Crisis (Emergency care needed) Higher than 180orHigher than 110 http://www.heart.org/HEARTORG/Conditions/HighBloodPres sure/AboutHighBloodPressure/Understanding-Blood- Pressure-Readings_UCM_301764_Article.jsp