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 life-threatening 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 screeningHealth 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 screeningHealth 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 areEarly detection/diagnosis and

prevention of diseaseReduced risk factorsImproved quality of lifeMaintain good health and well-

beingReduce 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 monitoringA. 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 ..

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 patient’s arm. Align the cuff with the brachial artery. Position the bottom of the cuff 2.5 cm above the

antecubital crease.

□ Place the diaphragm of the stethoscope over the brachial artery.

□ Support the patient’s 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 NationalCommittee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206-1252, 2003.

2. Cholesterol testThe cholesterol test determines a patient 's total

cholesterol (TC) , low-density lipoprotein (LDL) , high-density 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 fast—meaning 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 testPulmonary 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 patient’s 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 ValuesNormal fasting glucose: FPG<100 mg/dL

(<5.6 mmol/L SI units) Impaired fasting glucose: FPG 100–125

mg/dL (5.6–6.9 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-testExplain 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.

ProcedureA 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 testApply 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