Chapter 2: Preliminary Health Screening and Risk Classification Flashcards
What is the purpose of the Physical Activity Readiness Questionnaire (PAR-Q)?
to determine a client’s readiness for physical activity and determine if further medical clearance is necessary
When should a patient be referred to a physician to obtain medical clearance after filling out the PAR-Q?
if they answered yes to any of the questions on the questionnaire
What are you trying to determine through the pre-assessment screening procedures?
- recognition of known C-V, metabolic, renal diseases and presence of major signs/symptoms suggestive of dz
- is client currently exercising regularly?
- recommendations for medical clearance and level of exercise intensity
What 4 items should the client complete during preliminary health screening and evaluation?
- PAR-Q
- medical history questionnaire
- lifestyle evaluation
- informed consent form
What is the Physical Activity Readiness Medical Examination (PARmed-X)?
a physical activity-specific checklist used by the physician to assess and convey medical clearance for physical activity participation, or to make a referral to a medically supervised exercise program for individuals who answered yes to a PAR-Q question
What are the 8 positive risk factors of coronary heart disease?
- age
- family history
- cigarette smoking
- hypertension
- dyslipidemia
- prediabetes
- obesity
- sedentary lifestyle
What is a negative risk factor of coronary heart disease?
high HDL-C (subtract from total risk factors)
What should you do if a client will not or cannot provide the information you need to include or exclude a positive risk factor?
include it in your total risk factor count (except for prediabetes, which should only be included if a patient has BMI>25)
Which individuals comprise the low CHD risk category?
people asymptomatic w/ no more than one major risk factor
Which individuals comprise the moderate CHD risk category?
people asymptomatic and have two or more risk factors
Which individuals comprise the high CHD risk category?
individuals who have one or more signs or symptoms of cardiovascular, pulmonary, renal, or metabolic disease or individuals with who have these diseases
What is the SCORE system?
tool that can be used to estimate the 10 year risk of a first fatal cardiovascular event due to atherosclerosis for Europeans
What is the Relative Risk Chart?
tool that can be used to educate younger people how their risk for an atherosclerotic event is affected by lifestyle choices and modifiable risk factors
What are two ways from which you can obtain a lifestyle profile from your clients?
- the Lifestyle Evaluation form
2. the Fantastic Lifestyle Checklist
What is included in the informed consent form?
- the purpose and nature of each physical fitness test
- any inherent risks in the testing
- the expected benefits of the tests
- ensures confidentiality
What is blood pressure?
a measure of the force or pressure exerted by the blood on the arteries
What is systolic blood pressure?
pressure when the heart contracts and the arteries fill with blood
What is diastolic blood pressure?
pressure when the heart relaxes/fills with blood
What is the pulse pressure?
the difference between the systolic and diastolic BPs
What are some of the drugs available to treat hypertension?
- diuretics
- beta blockers
- direct renin inhibitors
- potassium channel openers
- sympathetic nerve inhibitors
- vasodilators
- angiotensin-converting enzyme inhibitors
What is the difference between individuals with absolute and relative contraindications to exercise testing?
individuals w/ absolute contraindications should not be given a graded exercise test unless their condition has been stabilized or medically treated
individuals w/ relative contraindications may perform exercise tests if the benefits outweigh the risks
How is blood pressure typically measured in clinical or field settings?
indirectly by auscultation or oscillometry
What are some sources of error when measuring BP?
- improper cuff width or length
- inaccurate sphygmomanometer
- cuff no centered, too loose, over clothing
- improper rate of inflation
- background noise
- improper stethoscope placement or pressure
- arm unsupported or elbow lower than heart level
Why are mercury column manometers preferred over aneroid manometers?
- mercury manometers based on gravity, leaving little room for mechanical errors
- aneroid manometers must be calibrated frequently (every 6 months)
What are some benefits to using oscillometric devices for measuring BP?
- they require little technician training
- they require less calibration and maintenance
What are some disadvantages of oscillometric devices for measuring BP?
may misestimate the BP of clients having irregular heart rhythms
What are some of the concerns with mercury column manometers?
their environmental impact, and thus the NIH is trying to phase them out
What is a hybrid sphygmomanometer? How are they used?
combines features of both electronic and auscultatory BP devices; the mercury column is replaced w/ an electronic pressure gauge
technician uses stethoscope to listen and presses button to show numbers at systolic and diastolic pressures
What are the tapping sounds heard as the BP cuff is gradually deflated called?
Korotkoff sounds
What is terminal digit bias?
the tendency of the technician to round BP values to the nearest 0 or 5 mmHg instead of reporting values rounded to the nearest even number
What is an advantage of automated BP devices?
they eliminate terminal digit bias
How does posture affect BP?
BP increases from lying (supine) to sitting to standing
How does raising the arm above heart level affect BP?
underestimates BP
How does positioning the arm below heart level affect BP?
overestimates BP
What is white coat hypertension?
condition where individuals who are normotensive outside of clinical environment become hypertensive when their BP is measured by a health professional
Which method of BP measuring leads to a higher (5x) likelihood of white coat hypertension?
the traditional manual method (compared w/ automated BP readings)
How does white coat hypertension affect CVD risk?
increased risk of CVD
What is masked hypertension?
condition where individuals exhibit elevated BP readings outside of the physician’s office yet have normal BP values in the office
Is white coat hypertension more prevalent in older or younger adults? Women or men?
older adults, women
Is masked hypertension more prevalent in older or younger adults?
younger adults
What is miscuffing?
undercuffing or overcuffing, a source of measurement error caused by using a BP cuff with a bladder that is not appropriately scaled for the client’s arm circumference
What is undercuffing?
occurs when the bladder is too small for the arm circumference, leading to an OVERESTIMATION of BP
What is cuff hypertension?
the overestimation of BP due to undercuffing
What is overcuffing?
the UNDERESTIMATION of BP because the bladder is too large for the arm circumference
When should a conical cuff be used?
for adults w/ a larger proximal upper arm than distal upper arm
What is bradycardia?
condition of resting heart rate below 60 bpm
What is tachycardia?
condition of resting heart rate above 100 bpm
What are four ways of measuring heart rate?
- auscultation (stethoscope)
- palpation
- heart rate monitors
- ECG monitoring system
What are the sites of palpation for measuring heart rate?
brachial artery, carotid artery, radial artery, temporal artery
Why shouldn’t you use the thumb to palpate?
because it has a pulse of its own and may produce an inaccurate count
What are baroreceptors?
receptors in the carotid site that cause a reflex of slowing heart rate in response to pressure
What is an electrocardiogram (ECG)?
a composite record of the electrical events in the heart during the cardiac cycle
What is the purpose of the health evaluation?
detect the presence of disease and assess initial disease risk classification of clients
What 3 things are you trying to obtain through a medical history questionaire?
- examine client record of personal illnesses (surgery, etc)
- assess previous medical diagnoses and s/sxs
- analyze client family history
T/F: Some individuals have medical conditions and risk factors that outweigh potential benefits of exercise testing
True
What is normal bp (normotensive) defined as?
values less than 120/80 mmHg
What is prehypertension defined as?
systolic 120-139 and diastolic 80-89
What is hypertension stage 1 defined as?
systolic 140-59 and diastolic 90-99
What are some ways for prehypertensive people to reduce their risk of developing hypertension?
- losing body weight
- adopt healthy diet
restrict dietary sodium intake to < 2.4g per day - engage in aerobic physical activity at least 150min/wk
- limit alcohol consumption
What do diuretics do?
rid body of excess salt and fluids
What do beta-blockers do?
reduce heart rate and cardiac output
What do direct vasodilators do?
induce relaxation in the smooth muscle of arterial walls
What do potassium channel openers do?
hyperpolarize vascular smooth muscles and endothelial cells
What do sympathetic nerve inhibitors do?
prevent constriction of arterioles
What is hypertension stage 2 defined as?
systolic >160 and diastolic >100
How is bp measured by auscultation?
using stethoscope and sphygmomanometer (bp cuff and mercury column or aneroid manometer)
How is bp measured by oscillometry?
automated electronic manometer
