Appendix D
Health Screen Information and protocols
SCREENING EQUIPMENT
- Two blood pressure cuffs (one obese cuff and one juvenile cuff) and sphygmomanometer
- Two stethoscopes
- Scale
- Flexible cloth tape (7-foot roll)
- Flexible cloth tape for waist/hips
- Pocket calculator
- Sit-and-reach box and large towel
- Large skinfold calipers
- Room divider for body fat and waist/hip measurement
- Statement of confidentiality for technicians
- Name tags
- Black magic marker
- Six tables
- 20 chairs
- A phlebotomist to do Blood Draws, or arrangements for these off-site before this session
Screening Personnel
Statement of Confidentiality
I understand that my work, although volunteer, with the_______________________ screening is in a professional capacity and that any information or behavior that I observe as a part of the screening will be handled with the utmost confidentiality and will be shared with no other individual other than _____________________________________.
________________________________________
_____________________ _________________________________________
_________________________________________
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REGISTRATION PROTOCOL
for
HEALTH SCREENING
Purpose:
1. Welcoming area: Serves as the initial focal point of the screening
2. Information: Provides the necessary guidance and instructions for the participants
3. Coordination: Assures that the screening flows smoothly
Aids and Methods:
1. A large table with a clean, white table cover
2. Chairs for registration staff and participants
3. Appropriate registration forms
4. Manila file folders
5. Pencils/pens
6. If available/appropriate, a table centerpiece (e.g., fruit bowl, flowers)
Procedures:
1. Wear a white top, name tag, and dark blue slacks/skirt.
2. Greet participants in a pleasant manner to make them feel comfortable and at ease. Professionalism of the registration staff is very important, as it can reflect on the entire health screening.
3. Briefly explain the forms that will need to be completed.
4. Describe briefly the stations that participants will be visiting (can use screening checklist).
Forms:
Give participants the following forms: (1) sheet explaining lab fees, (2) blood analysis form, (3) Consent form, (4) PAR-Q, (5) checklist, (6) personal record, (7) permanent address form, (8) McReger Healthy Lifestyle Questionnaire, (9) SCL-90-R, (10) SF-36, (11) Lakeview Fitness Center consent form, (12) screening evaluation form.
- The first form to be completed is the blood analysis form, which registration will deliver to the phlebotomist.
- Participants will be given directions to completed the forms in a private, quiet area provided by screening staff.
- Forms will be returned to the registration staff to reassemble before participants begins the screening. Staff will direct the participants to the first screening station.
After Screening:
1. Recheck participants’ forms (front and back) for completion and signature. Check to see if they missed a station.
2. Make sure that name, address, and social security numbers appear are listed at the appropriate locations on forms.
3. Ask participants to complete the screening evaluation form (evaluation forms will be placed in a separate stack).
4. Organize forms in file folder.
BLOOD PRESSURE PROTOCOL
Purpose:
The overall purpose of this assessment is to accurately determine an individual’s normal resting blood pressure.
Aids and Methods:
Aids will include a stethoscope and a sphygmomanometer (with various cuff sizes for an adult, a large adult, and a child). The methods for blood pressure determination will generally follow the procedures established by the American Heart Association’s “Recommendations for Human Blood Pressure Determination by Sphygmomanometers.”
Procedures:
1. Introduce yourself.
2. Seat the individual in a quiet, comfortable environment with arms resting at approximately heart level. Explain to the individual that he/she needs to sit quietly and comfortably for about 5 minutes without talking, reading, eating, or drinking in order to achieve a resting heart rate and, therefore, a more accurate resting blood pressure reading.
3. Place the manometer at eye level, sufficiently close to read the calibrations marking the gauge.
4. Locate the brachial artery along the inner upper arm by palpation.
5. Wrap the cuff smoothly and snugly around the arm, centering the bladder over the brachial artery (note the position of the brachial artery guide on the cuff and adjust if necessary). The lower margin should be about 2.5 cm above the antecubital space. NOTE: If circulation is impaired, the cuff is too tight.
6. Position the stethoscope over the palpated brachial artery below the cuff at the antecubital fossa. Earpieces should point forward, and the bell head of the stethoscope should be applied with light pressure using the index or middle finger (not the thumb). NOTE: Explain to the individual that you are going to take three independent blood pressure readings and average among the three.
7. Rapidly and steadily inflate the cuff to the maximal inflation level.
8. Release the air in the cuff so that the pressure falls at a rate of 2 to 3 mm per second.
9. Note the systolic pressure at the onset of at least two consecutive beats for both adults and children. Blood pressures should always be recorded in even numbers and read to the nearest 2 mm Hg mark on the manometer.
10. Note the diastolic pressure at the muffling for children and the cessation of sound for adults. When the last sound is heard, that is the diastolic blood pressure in adults. Listen for 10 to 20 mm Hg below the last sound heard to confirm disappearance, and then deflate the cuff rapidly and completely (gently squeeze out excess or trapped air if necessary).
11. When recording blood pressures, record the cuff size, the arm used (left or right), and systolic/diastolic blood pressures (for example: adult cuff, left arm 120/68 mm Hg; (2nd reading); (3rd reading).
12. Wait 1 to 2 minutes before repeating the procedure to permit the release of blood trapped in the arm veins.
13. Three separate blood pressure readings should be taken per individual, and the average of the three will be recorded as the resting blood pressure.
14. The individual administering the assessment should maintain a professional, nonjudgmental manner at all times:
a. Respect an individual’s right to privacy and confidentiality. Do not discuss a subject’s readings with others, especially other subjects. Keep all information confidential.
b. Do not “diagnose” someone who appears to have an abnormal reading (it may be appropriate to advise an individual to see a physician if readings appear to be abnormal, but only a physician can make a diagnosis).
c. Do not use rude, vulgar, or inappropriate language in the presence of subjects, and avoid nonprofessional, inappropriate conversations as well. Be pleasant, friendly, and professional at all times.
BODY FAT PROTOCOL
Purpose:
The purpose of the skinfold assessment is to accurately measure a subject’s body mass or percentage of body fat through measurements taken at various sites on the body.
Aids and Methods:
For this measurement, a precalibrated Skyndex electronic skin caliper is used along with a percent fat chart (for example, the chart found in The Y’s Way to Physical Fitness, pp. 79-82). Methods used are based upon information supplied by the Skyndex manufacturers with slight modifications to the assessment procedure.
Procedures:
- Set aside two enclosed, secluded areas (one for males, and one for females) for assessing body fat. Assessments should be performed on a same-sex basis (a male assessing males, and a female assessing females).
- Plug in and charge the Skyndex calipers for approximately one-half hour before use. Calibrate the calipers before use as well.
- Introduce yourself to the subject.
- Ask the subject his/her age and set the calipers accordingly.
- Take all measurement’s from the right side of the subject’s body.
- Take a skinfold measurement from the triceps of the right arm (measure vertically on the back of the arm midway between the top of the shoulder point and the elbow).
- Grasp the fold of skin firmly between the left thumb and four fingers, then lift it up. Pinch and lift the fold several times to be certain that no muscle is grasped.
- Continue to hold the skinfold and place the contact surface of the skin calipers just below the thumb and fingers.
- After the skinfold measurement has been taken, lock in ready on the calipers
- Take a skinfold measurement of the biceps of the right arm (measure vertically over the midpoint of the muscle. Repeat steps 6a through 6c for the biceps measurement.
- Take a skinfold measurement at the subscapula (measure at a 45-degree angle just below the top of the scapula). Repeat steps 6a through 6c for the subscapula measurement.
- Take a skinfold measurement at the iliac crest (measure a 45-degree angle directly on top of the crest of the hip in line with the axilla, i.e., the armpit). NOTE: It may be appropriate to ask the subject to locate this site initially before applying the calipers. Repeat steps 6a through 6c for the iliac crest reading.
- A total of all four readings will be given on the Skyndex display. Record this number as total body fat.
- A percent fat chart is used to determine the percent of body fat as derived from the total body fat measurement and the subject’s age.
- The individual administering the assessment should maintain a professional, nonjudgmental manner at all times:
- Respect an individual’s right to privacy and confidentiality. Do not discuss a subject’s readings with others, especially other subjects. Keep all information confidential.
- Do not “diagnose” someone who appears to have an abnormal reading (it may be appropriate to advise an individual to see a physician if readings appear to be abnormal, but only a physician can make a diagnosis).
- Do not use rude, vulgar, or inappropriate language in the presence of subjects, and avoid nonprofessional, inappropriate conversations as well. Be pleasant, friendly, and professional at all times.
SIT AND REACH PROTOCOL
Purpose:
The overall purpose of this assessment is to test the flexibility of the joint site in the lower back and muscle flexibility in the legs (hamstrings) and lower back.
Aids and Methods:
The aid used for this assessment is the sit-and-reach box, and methods have been adapted from The Y’s Way to Physical Fitness, 1989, pp. 108-109, 142.
Procedures:
1. Introduce yourself.
2. Ask if the subject has any type of back problem that would not permit them to participate in this assessment. If the answer is yes, do not proceed (make a note of the reason for nonparticipation on the subject’s paperwork).
3. Instruct the subject to remove his/her shoes in order to achieve a more accurate measure.
4. Instruct the subject to sit on the floor with feet flat against the front of the sit-and-reach box and knees flat against the floor.
5. Explain how to position the hands (arms straight with one hand on top of the other and fingers pointing forward).
6. Explain that he/she is to reach as far as possible across the ruler on the top of the box 4 separate times (for example: “reach-relax, reach -relax...”) while keeping the knees flat against the floor at all times. Place your hand gently on their knees.
7. Instruct the subject to begin. As he/she reaches, count aloud with each independent reach (for example: “one, two, ... and four”), while at the same time marking the farthest effort only with your finger on the box. After the fourth reach, record the best reach in inches (or centimeters, depending on ruler). The scale (ruler) should range from - 6 inches to + 6 inches, with “0” being at the toes.
8. The individual administering the assessment should maintain a professional, nonjudgmental manner at all times:
- Respect an individual’s right to privacy and confidentiality. Do not discuss a subject’s readings with others, especially other subjects. Keep all information confidential.
- Do not “diagnose” someone who appears to have an abnormal reading.
- Do not use rude, vulgar, or inappropriate language in the presence of subjects, and avoid nonprofessional, inappropriate conversations as well. Be pleasant, friendly, and professional at all times.
HEIGHT AND WEIGHT PROTOCOL
Purpose:
The overall purpose of this assessment is to accurately measure and individual’s height to within 1 inch and weight to within 0-2 pounds.
Aids and Measures:
Aids for these measures are a calibrated scale, a 7-foot wall chart for height (measuring tapes), a stool, a straight edge, and tape. Methods are standard with calibrated and tested instruments.
Procedures:
1. Introduce yourself.
2. Calibrate and test equipment before screenings begin. Tape the height chart to an unobstructed wall and check for accuracy using an additional measuring tape. Check scale against a set weight.
Height
3. Ask the subject to remove his/her shoes and stand with his/her back flat against the middle of the height chart (feel should be together and about 1/2 to 1 inch from the wall.
4. With the individual looking straight ahead, take the straight edge and firmly place it on the top of the head while pressing the back of the straight edge against the chart (making sure the straight edge is level). NOTE: Make certain you are looking down or are at eye level with the straight edge (it may be necessary to use a stool).
5. Record the measurement by rounding up or down from the nearest 1/2 inch.
Weight
6. Make certain that the subject has removed his/her shoes and any other heavy clothing within reason in order to obtain a more accurate reading.
7. Have the individual step onto the scale standing straight and as still as possible in the middle of the scale until the digital readout stops changing (if using a digital scale) or until the scale is balanced at 0 after manipulation of the weights (if using a balance scale).
8. Weigh the individual once, and record weight after the scale has stabilized.
9. The individual administering the assessment should maintain a professional, nonjudgmental manner at all times:
- Respect an individual’s right to privacy and confidentiality. Do not discuss a subject’s readings with others, especially other subjects. Keep all information confidential.
- Do not “diagnose” someone who appears to have an abnormal reading (it may be appropriate to advise an individual to see a physician if readings appear to be abnormal, but only a physician can make a diagnosis).
- Do not use rude, vulgar, or inappropriate language in the presence of subjects, and avoid nonprofessional, inappropriate conversations as well. Be pleasant, friendly, and professional at all times.
BLOOD DRAW PROTOCOLThese protocols are followed by the phlebotomist or nurse who will conduct the blood draw. |
GLOSSARY OF BLOOD COMPOUNDS
Glucose
Glucose is the sugar floating free in the blood. The glucose test is performed to detect adult-onset diabetes. (Juvenile-onset diabetes is a different disease.)
Reference range: 65.0 to 130
Recommended levels: 115 and below
Suggestions: Adult-onset diabetes (95% of cases) is usually caused by a diet high in fats (derived from meats, cheeses, eggs, oil, etc.) and low in fiber. Correcting the offending diet is an essential first step. Exercise will help lower blood sugar levels. For overweight people, weight loss also helps.
Cholesterol
Cholesterol is a fatlike substance the body uses to make cell walls and hormones as well as for other functions. The body produces all the cholesterol it needs. Saturated fats and cholesterol in the diet may produce excess cholesterol which can build up on the artery walls and narrow the blood path to the heart. A heart attack occurs when an artery becomes so clogged that it cannot carry blood to the heart.
Reference range: 150 to 240 (depending on age)
Recommended values: 180 and below
Ideal values: 150 and below
Suggestions: To lower total cholesterol, eat a diet that is high in complex carbohydrates (vegetables, fruits, whole grains, peas, beans and lentils) and low in fat (reduce intake of meats, oils, whole mild, cheese, and eggs).
HDL (High-Density Lipoproteins)
HDLs are the "good" cholesterol in the blood. The presence of increased amounts of HDL has been associated with a noticeable lack of heart and artery disease.
Recommended values: cholesterol/HDL ratio of 4.5 and under
Ideal values: cholesterol/HDL ratio of 3.5 and under
Suggestions: Aerobic exercise will help improve the cholesterol/HDL ratio.
Triglycerides
Triglycerides are also fats found circulating in the blood. High triglyceride levels have been associated with an increased risk of heart disease, diabetes, and poor circulation
Reference range: 50 to 200
Recommended values: 150 and under
Suggestions: Exercise, high-fiber foods (starches and vegetables), and weight loss will lower triglycerides to healthy levels. By contrast, triglyceride levels are elevated by eating high-fat foods, drinking alcohol, and by eating simple sugars.
NAME: ______________________
SAMPLE ------------------------------------------------------------------------------------------------------------- Please check off the items below as you complete them. After you have finished, please return this form to the registration desk. ___ Registration list -make sure we have your correct name, address, and phone number Choose a seat around the table and deposit your belongings. Then proceed immediately to:
HEALTH SCREENING: PART I — visit each station to record: ___ Blood pressure ____________________
HEALTH SCREENING — PART II ___ Collect health screening packet (with your name on it) at registration desk ___ Complete all parts of the health screening packet ___ Return both the packet and this sheet to the registration desk. At the same time, |
HEALTH SCREENING PERSONAL RECORD
Blood pressure ___________________________ Pulse ___________________________ Height ___________________________ Weight ___________________________ Waist ___________________________ Hip ___________________________ Waist/Hip Ratio ___________________________ Body Fat ___________________________ Sit and Reach ___________________________ Blood Draw ___________________________
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Recommended healthful guidelines to follow during CHPP
- Park in designated area at ______________________
- Observe confidentiality regarding information shared
- Bring an open mind
- Display a willingness to participate
- Commit to behavior change
- Exercise moderately and sensibly
- Drink at least four 8-ounce glasses of water daily
- Drink 8 ounces of water for each 20 minutes of exercise
- Reduce tobacco intake by 50 percent (smoke only in parking lot area)
- Do NOT consume caffeinated beverages during class times (coffee, tea, soft drinks)
- Keep fat content below 20 percent of total calories consumed
- Reduce sodium intake to less than 2 grams daily
- Consume 25-30 grams of fiber daily: fruits, vegetables, cereals, grains, legumes
- Do NOT consume meat, chicken, turkey, or fish during the week (that is, don’t eat anything with a mother!)
- Do NOT consume alcohol during the week