RISK Screening

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Training Objectives

1. Discuss the concepts and principles of screening

2. Demonstrate the correct techniques of screening
procedures for NCD intermediate risk factors:
a. Blood Pressure Measurement
b. Capillary Blood Glucose
c. Capillary Blood Cholesterol
d. Urine Ketones
e. Urine Proteins
f. Questionnaire to determine Probable Angina, Heart Attack, Stroke
or Transient Ischemic Attack

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 Concepts and Principles of Screening
Procedure

• Screening is the presumptive identification of

unrecognized disease or defect by the
application of tests, examination or other
procedures which can be applied rapidly.
• The primary goal of screening is to detect a
disease in its early stage to be able to treat it
and prevent its further development.

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Roles of Screening on PEN Interventions

• Early identification of people with NCDs and link them to the PEN
Hypertension and Diabetes Registries
• Appropriate control of blood sugar, blood pressure and blood lipids
on people with severe elevation
• Evidence-based clinical care of people with NCD to prevent, cure
and/or delay onset of complications and improve quality of life
• Evidence-based medical care to people with major NCDs presenting
as emergencies

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Screening Procedures applied to PEN
Interventions

• Raised Blood Pressure Determination

• Raised Blood Glucose Determination
• Raised Blood Lipids Determination
• Presence or Absence of Urine Ketones
• Presence or Absence of Urine Proteins
• Determining Angina, Heart Attack, Stroke or TIA by using a Structured
Questionnaire

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 Screening for
hypertension

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Screening for Hypertension

• Defined as sustained elevation of SBP of 140 mmHg or higher and

DBP of 90 mmHg or higher
• Determined by taking the blood pressure through the auscultatory
method using a properly calibrated aneroid BP apparatus.

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Equipment
• Blood Pressure Apparatus (Aneroid or an Electronic BP apparatus)
with or without stand
• Stethoscope, if aneroid

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Blood Pressure Measurement Procedure
Checklist
• Preparatory Phase
• Applying the BP cuff and Stethoscope
• Estimating systolic BP using palpatory method
• Obtaining the BP reading by auscultation
• Recording BP and Other Guidelines

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Blood Pressure Measurement Procedure
Checklist
• Preparatory Phase
• Applying the BP cuff and Stethoscope
• Estimating systolic BP using palpatory method
• Obtaining the BP reading by auscultation
• Recording BP and Other Guidelines

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 Preparatory Phase
• Introduce self to client
• Make sure client is relaxed and
has rested for at least 5
minutes and should not have
smoked or ingested caffeine
within 30 minutes before BP
measurement

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Preparatory Phase

• Explain the procedure to the

client at his/her level of
understanding
• Assist to seated or supine
position

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Blood Pressure Measurement Procedure
Checklist
• Preparatory Phase
• Applying the BP cuff and Stethoscope
• Estimating systolic BP using palpatory method
• Obtaining the BP reading by auscultation
• Recording BP and Other Guidelines

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Applying the BP cuff and Stethoscope

• Bare client’s arm

• Apply cuff around the arm
2-3 cm above the brachial
artery
• Keep the manometer at eye
level

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Blood Pressure Measurement Procedure
Checklist
• Preparatory Phase
• Applying the BP cuff and Stethoscope
• Estimating systolic BP using palpatory method
• Obtaining the BP reading by auscultation
• Recording BP and Other Guidelines

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 Estimating systolic BP using palpatory
method
• While palpating the brachial or
radial pulse, close valve of pressure
bulb and inflate the cuff until pulse
disappears
• Note the point at which the pulse
disappeared. This is the palpated
systolic BP

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Estimating systolic BP using palpatory
method

• Deflate cuff fully

• Wait 1-2 minutes before
inflating cuff again

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Blood Pressure Measurement Procedure
Checklist
• Preparatory Phase
• Applying the BP cuff and Stethoscope
• Estimating systolic BP using palpatory method
• Obtaining the BP reading by auscultation
• Recording BP and Other Guidelines

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Obtaining the BP reading by auscultation

• Place the earpieces of stethoscope

in ears and stethoscope head over
the brachial pulse
• Use the bell (or diaphragm for
obese persons) of the stethoscope
to auscultate pulse

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Obtaining the BP reading by auscultation
• Watching the manometer, inflate the
cuff rapidly by pumping the bulb until
the column or needle reaches 30
mmHg above the palpated SBP
• Deflate cuff slowly at a rate of 2-3
mmHg/beat
• While the cuff is deflating listen for
pulse sounds (Korotkoff sounds)

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 Obtaining the BP reading by auscultation

• Fully deflate the cuff. Take another

reading after 2 minutes and record.
• Get the average of the two readings
and record.

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Blood Pressure Measurement Procedure
Checklist
• Preparatory Phase
• Applying the BP cuff and Stethoscope
• Estimating systolic BP using palpatory method
• Obtaining the BP reading by auscultation
• Recording BP and Other Guidelines

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Recording BP and Other Guidelines

• For every first visit of the

client: Take the mean of 2
readings, obtained at least 2
minutes apart, and consider
this as the client’s blood
pressure
• If the first 2 readings differ by
5 mmHg or more obtain a 3rd
reading and include this in the
average

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 Recording BP and Other Guidelines
• If first visit, repeat the procedure
with the other arm. Subsequent
BP readings should then be
performed on the arm with a
higher BP reading
• Document Phases I, IV, V by
following the format for recording
BP
systolic/muffling/disappearance
• Inform client of result and stay for
a while to answer client’s
questions/concerns
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Blood Pressure Classification (JNC-7)
BP Classification Systolic BP* Diastolic BP*
(Initial measure) (mmHg) (mmHg)
NORMAL < 120 < 80
Pre hypertension 120 – 139 80 – 89
Stage 1 140 – 159 90 – 99
hypertension
Stage 2 ≥ 160 ≥ 100
hypertension

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 Screening for
Diabetes and
Hypercholesterolemia

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Blood Sugar and Blood Cholesterol
Result
Blood Test Equipment Site of Display of Normal Elevated
puncture result

Blood Sugar Glucometer side of the within 6 < 109 110

Strips fingertip seconds mg/dl mg/dl
Blood lancet and
Lancing Device above
Blood Cholesterol side of the within 150 < 200 200 –
Cholesterol Meter fingertip seconds mg/100 mg/100
Strips ml ml and
Blood lancet above
Lancing Device

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Equipment and supplies needed for glucose
level determination
• Glucose Meter • 2 Cotton balls
• Glucose Test Strip
• Puncturer/Fingerstick (Lancing
Device)
• Lancet

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 Values for the diagnosis of diabetes and other
categories of hyperglycemia
Criteria for
Type of Testing FBS Values Classification Diagnoses of
Diabetes Mellitus
Fasting blood sugar (FBS) 109 mg/dl Normal Any of the following:
- no caloric intake for at
least 8 hours which 110- 125 mg/dl Impaired
Symptoms of diabetes
means no food, juices, glucose plus RBS> 200 mg/dL
milk, but water is allowed tolerance (11.1 mmol/L)

126 mg/dl Possible diabetes FBS> 126 mg/ dL (7.0

mellitus mmol)

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 Screening for Elevated Blood Cholesterol
Lipid profile

Measured by taking a small

Cholesterol level Interpretation
amount of blood sample (7
ml) and testing for total < 200 mg/100 ml Normal
blood cholesterol including
LDL and HDL

200 – 239 mg/100 ml Elevated, maybe at risk

240 mg/100 ml and above Elevated, at risk

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 Screening for
presence of urine ketones and
proteins

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Screening for Urine Ketones and Proteins

• Presence of Urine Ketones

• It is an indication of diabetic Ketoacidosis in
people with Type I diabetes , in some
circumstances may occur in clients with Type II
diabetes
• False Positive Measurements
• Low carbohydrate and high protein and fat can
raise ketones level in blood, which can enter
the urine
• Some drugs, e.g. glucocorticoids

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Screening for Urine Ketones and Proteins

• Presence of Urine Proteins

• It is an indication of general health disorder, e.g.
urinary tract infection, heart disease or
rheumatoid arthritis
• In pregnant it is an indication of preeclampsia

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Supplies needed
• Urinalysis Reagent Strip 10 Parameters: Ph, Glucose, Ketones, Protein, &
Specific Gravity, etc
• Urine Container (Test Tube, Graduated Cylinder or plastic specimen
container)
• Paper towel or tissue paper

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Urine Dipstick

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 Step by Step Procedure
• Explain the procedure to the
client
• Provide the client with the
urine specimen container and
ask the client to collect a
Random Urine Specimen
• Conduct the test immediately
or within one hour of
collection.

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 Step by Step Procedure
• immerse the reagent area of the strip
in fresh, well-mixed urine. Remove the
strip immediately to avoid dissolving
out the reagent

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 Step by Step Procedure
• While removing, run the side of the
strip against the rim of the urine
container to remove excess urine
• While holding the strip in horizontal
position, blot the lengthwise edge of
the strip on an absorbent paper towel
or tissue paper to further remove
excess urine

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Step by Step Procedure

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Step by Step Procedure
• Compare each reagent area to its corresponding color chart and read
at the time specified (e.g. ketones at 40 seconds and proteins at 60
seconds)
• On the space provided in the NCD High Risk Assessment and Screening
Form, write the result in mg/dl

Note: Perform Urine Ketones in Patients with diabetes or with raised blood glucose
Urine Protein is routinely checked to all clients who undergone NCD High Risk

Assessment and Screening Procedure

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 Maraming salamat po!

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