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Health screening services

Introduction
Health

screening services are the services


provided by the health care professionals to
screen the health status of individuals with
or without positive sign and symptoms.
Health screening plays an important role in
detecting traces of illness in its early stages.
Early detection can make a difference between
relatively simple courses of treatment or lifethreatening complications requiring lengthy and
expensive hospital stays.
Early diagnosis has always a better chance for
cure.

For

example:
Measuring
blood pressure helps to
identify one of the risks of heart disease.
Health

screening services can be


provided at hospital, clinical and
community pharmacies or any other
suitable
setting
(hospital,
community pharmacy) by health
professionals or trained technicians,
which fulfil the minimum requirements.

Benefits of health
screening
Health

Screening check up in order to


maintain your optimum health.
Health screenings save lives by early
detection
of
conditions
such
as
hypertension or elevated blood sugar and
can help prevent serious diseases like
diabetes and heart disease that kill
thousands of people every year.
The benefits of ongoing health screening
services revolve around prevention and
early detection.

The

aim of health screening is that the

prevention is better than cure.


Health

screening is viewed as an ongoing

health management's process but not as


a medical examination.
The

majority of people screened require no

further advice or treatment.

Advantages of health
screening
Health

screenings are readily


available,
Affordable (inexpensive),
very reliable with few false negatives
and flexible.
Also it is painless, non-invasive and
inexpensive tests.
Health screenings can educate you
on the simple changes to your
lifestyle that keep you in good health.

A standard health screen


comprises of
Blood

pressure measurement
Total blood Cholesterol measurements
Blood glucose measurement
Body mass index measurement
% Body fat measurement
Lung function test
Height & weight measurements
Health education materials
Provision of lifestyle advice and dietary advice and
advice on risk factors
Smoking cessation support
Regular support, follow up and contact with the
patient

The outcomes of health


screening services are
Early

detection/diagnosis and
prevention of disease
Reduced risk factors
Improved quality of life
Maintain good health and wellbeing
Reduce cost and future complex
problems

1.Blood Pressure
Blood

pressure is defined as the lateral


pressure exerted on the walls of the
vessels by the contained blood. This is due
to the muscularity and elasticity of the walls of
blood vessels.
The B.P. also depends on the force with which
heart pumps the blood.
The maximum pressure during systole is defined
as systolic blood pressure whereas the minimum
pressure during diastole is defined as the
diastolic B.P..
The difference between systolic and diastolic
B.P. described as the pulse pressure.

Type of monitoring
Mercury sphygmomanometer:
.
This type of monitor is the most
accurate and does not need calibration.
. The blood pressure is determined by
measuring the length of the mercury
column while listening for the Korotkoff
sounds in the stethoscope.
. Mercury monitors are usually not used as a
home device because of their large size,
the need for use of a stethoscope, and
the potential for mercury spill ..
A.

B. Finger monitors:
These detect blood pressure by
compressing the finger and
converting blood vessel movement
into blood pressure by oscillometric
technology.
Finger blood pressure monitors are
least
accurate
and
not
recommended for home monitoring.

C. Aneroid sphygmomanometer :
This
is
similar
to
a
mercury
sphygmomanometer, except that instead of a
column of mercury, it has a dial to be read.
advantage
less expensive than mercury models;
they do require regular calibration with a
mercury sphygmomanometer to ensure proper
results.
These types of monitors are portable and
lightweight , however . Most require manual
inflation of the cuff , but a separate
stethoscope is not required.

D. Electronic or digital monitor:


This type of monitor detects blood pressure by
using a microphone or by oscillometric technology, which
converts movement of vessels into blood pressure.
This type is easier to use than a mercury or aneroid
sphygmomanometer.
There is not a need for a separate stethoscope.
These models are more expensive, can provide
inaccurate readings if the patient moves while the
blood pressure is being per formed,
frequent
calibration
against
a
mercury
sphygmomanometer ;
Patients with very large or very small upper arms
may need to purchase a special cuff in order to obtain
an accurate reading.

Procedure
Blood Pressure
Patients should be at rest for at least 15 minutes.
Place the arterial portion of the cuff directly over
the brachial artery with the bottom of the edge
approximately 2.5 cm above the antecubital crease
.
Blood Pressure Checklist
Make sure the patient has both feet flat and
supported on the ground.
Ask the patient if the patient knows his or her blood
pressure.
Palpate for the brachial pulse before putting the cuff
on the patients arm.

Align the cuff with the brachial artery.


Position the bottom of the cuff 2.5 cm above the

Place the diaphragm of the stethoscope over the


brachial artery.
Support the patients arm at the level of the
heart.
Close the valve on the bulb and pump the cuff to
20 mm Hg over the expected systolic blood
pressure.
Open the valve and slowly release the pressure
at a rate of 2-4 mm Hg/sec.
Deflate and remove the cuff.
Report/record the systolic and diastolic
pressures. (Example: The blood pressure is 120
over 80 mm Hg.)

Blood Pressure Cuff


Position

Blood Pressure
Classification
The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure. Hypertension 42:1206-1252, 2003.

2. Cholesterol test
The cholesterol test determines a patient 's total
cholesterol (TC) , low-density lipoprotein (LDL) , highdensity lipoprotein (HDL) and/or triglycerides.
(1) Some tests provide the patient only with a TC level,
whereas others provide a full lipid profile (TC, LDL, HDL,
and/or triglycerides).
(2) Some cholesterol kits are a single-use test in which
patient applies a blood sample onto a collecting card, which
is mailed to a laboratory for evaluation. The measurement of
the amount of cholesterol is determined by a colour chart ,
which is provided with the test .
(3) Regardless of the test used, the patient places a large
drop of blood onto the test card or cassette. Some of the
tests require the patient to fastmeaning nothing to eat or
drink except water for 12-14 hr before collecting the blood.
(4) These tests can be useful for patients who want to
monitor their therapy.

3. Lung function test


Pulmonary

function testing (PFT)


includes a series of measurements
of
pulmonary
volume
and
capacity.
These measurements are made by a
spirometer, which is a breathing
system that allows gas to be breathed
in and out.

PFTs

are typically ordered to evaluate signs


and symptoms of lung disease such as
cough, dyspnea, and hypoxemia;
to assess progression of lung disease
and response to treatment;
to assess high-risk preoperative patients;
to screen people at high risk of pulmonary
disease due to smoking or occupational
exposure to substances toxic to the
pulmonary system.

PFT includes information regarding airway flow rates


and regarding lung volumes and capacities.

Airway flow rate information is obtained primarily


through two measurements.

Forced vital capacity (FVC) is the amount of air which


can be forcefully exhaled from a maximally inflated
lung.

Forced expiratory volume in 1 second (FEV1) is the


volume of air expelled during the first second of the
FVC.

Four

volume measurements are essential parts of


the PFT.
The Tidal volume (TV) is the normal volume of
air inspired and expired with each regular
respiration.
The Expiratory reserve volume (ERV) is the
maximal volume of air that can be exhaled after a
normal expiration.
The Residual volume (RV) is the volume of air
remaining in the lungs following forced expiration.
The Inspiratory reserve volume (IRV) is the
maximal volume of air that can be inspired from
the end of a normal inspiration.

By

combining two or more of these lung volume values,


four lung capacity values can be calculated.
The inspiratory capacity (IC), which is the maximal
amount of air that can be inspired after a normal
expiration, is calculated by adding IRV and TV.
The Functional residual capacity (FRC), the amount of
air left in the lungs after a normal expiration, is calculated
by adding ERV and RV.
The vital capacity (VC), which is the maximum amount
of air which can be expired after a normal inspiration, is
determined by adding the IRV, VT, and ERV.
The total lung capacity (TLC), the volume to which the
lungs can be expanded with the greatest inspiratory effort,
is calculated by adding the IRV, TV, ERV, and RV. Another
way to determine TLC is to add the VC and RV values.

Interventions/Implications
Pre-test
Explain to the patient the purpose of the test
and the procedure to be done.
No fasting is required prior to the test, but
the patient should not eat a heavy meal
before the test.
Instruct the patient to use no
bronchodilators for 6 hours prior to the
test, if ordered by the primary care provider.
Instruct the patient not to smoke for 6
hours prior to the test.
Measure the patients height and weight.

Procedure

The patient is in a sitting or standing position.


The patient is fitted with a mouthpiece that is connected to
the spirometer.
A noseclip is used so that only mouth breathing is possible.
The patient is instructed:
to breathe normally for 10 breaths. (TV)
to inhale deeply and then to exhale completely (VC).
{repeat two additional times.}
to breathe normally for several breaths and then to
exhale completely (ERV).
to breathe normally for several breaths and then to inhale
as deep as possible (IC).
Testing after administration of a bronchodilator may also
be done to assess for improvement in function.

Post

test

Assess patient for dizziness or weakness


following the testing. Allow the patient to
rest as needed.

Report abnormal findings to the primary care


provider.

4. Blood glucose
Glucose

is normally formed in two ways:


from
the
metabolism
of
ingested
carbohydrates and from the conversion of
glycogen to glucose in the liver.
The maintenance of normal blood glucose is
dependent upon proper functioning of two
hormones.
. Glucagon causes the blood sugar to rise by
speeding the breakdown of glycogen in the
liver.
. Insulin allows glucose to pass into cells for use
as energy, leading to a decrease in the blood
glucose.

Conditions

such as burns or trauma can increase the blood

sugar.
Criteria for the diagnosis of diabetes mellitus, as
developed by the American Diabetes Association
1. Symptoms of diabetes plus casual plasma glucose
concentration 200 mg/dL (11.1 mmol/L). Casual is
defined as any time of day without regard to time since last
meal. The classic symptoms of diabetes include polyuria,
polydipsia, and unexplained weight loss.
2. FPG 126 mg/dL (7.0 mmol/L). Fasting is defined as
no caloric intake for at least 8 hours.
3. 2-hour postload glucose 200 mg/dL (11.1 mmol/L)
during an oral glucose tolerance test (OGTT). The test
should be performed as described by WHO, using a glucose
load containing the equivalent of 75 g anhydrous glucose
dissolved in water.

Normal
Normal

Values

fasting glucose: FPG<100 mg/dL


(<5.6 mmol/L SI units)
Impaired fasting glucose: FPG 100125
mg/dL (5.66.9 mmol/L SI units)
Provisional diagnosis of diabetes: FPG 126
mg/dL ( 7.0 mmol/L SI units) (diagnosis
must be confirmed)

Drugs

which may increase fasting blood


glucose
levels:
atypical
antipsychotics,
azathioprine,
basiliximab,
beta
blockers,
bicalutamide,
corticosteroids,
diazoxide,
epinephrine,
estrogens,
furosemide,
gemfibrozil, isoniazid, levothyroxine, lithium,
niacin, protease inhibitors, thiazides.
Drugs which may decrease fasting blood
glucose
levels:
acetaminophen,
basiliximab,carvedilol, desipramine, ethanol,
gemfibrozil, hypoglycemic agents, insulin, MAO
inhibitors,
phenothiazines,
risperidone,
theophylline.

Interventions/Implications
Pre-test
Explain

to the patient the purpose of the test


and the need for a blood sample to be
drawn.
Fasting of at least 8 hours is required prior
to the test. Water is permitted.
Insulin or oral hypoglycemic agents are
to be withheld until after the blood sample is
drawn.

Procedure
A

7-mL blood sample is drawn in a


collection tube containing a glycolytic
inhibitor such as sodium fluoride.
Gloves
are worn throughout the
procedure.

Post test
Apply

pressure at venipuncture site.


Apply dressing, periodically assessing for
continued bleeding.
Label the specimen and transport it to
the
laboratory
immediately.
Blood
glucose levels decrease when blood is
left at room temperature.
Report abnormal findings to the primary
care provider.

Thanx