APSEA Training Study Guide

Heart Rate

How to Measure Pulse

Pulse is measured radially (at the wrist, just under the thumb)
Use 2 fingers (palpation) — never your thumb
Measure for 30 seconds and multiply by 2, OR measure for a full 60 seconds

Heart Rate Ranges by Age

Age Group	Range (bpm)
Infant (1 mo – 1 yr)	100–120
Children	70–110 (varies by age)
Average Adult	60–100
Extreme Athlete	50 or below
Elderly (65+)	60–100

Adult Heart Rate Categories

Category	Range (bpm)
Bradycardia	< 60
Normal	60–100
Tachycardia	> 100

Heart rate fluctuates extensively throughout various activities — this is normal.

Pulse Oximeter

Fingertip pulse oximeter also measures SPO2 % (oxygen saturation)
Normal SPO2: 95% – 100%

Blood Pressure

The Basics

Systolic = pressure when the left ventricle contracts (top number)
Diastolic = pressure when the left ventricle relaxes / fills with blood (bottom number)
We estimate aortic BP by measuring at the brachial artery
BP and heart rate are correlated but do NOT mirror each other

Causes of Hypertension

Essential / Primary (90–95%)

High sodium intake
Chronic stress / anxiety / depression
Excessive alcohol
Smoking
Physical inactivity
Obesity
Pain

Secondary (5–10%)

Obstructive sleep apnea
Tumors
Thyroid disease
Renal artery stenosis
Other kidney disease
Coarctation of the aorta

Blood Pressure Categories (AHA)

Category	Systolic (mmHg)		Diastolic (mmHg)
Normal	< 120	AND	< 80
Elevated	120–129	AND	< 80
HTN Stage 1	130–139	OR	80–89
HTN Stage 2	140+	OR	90+
Hypertensive Crisis	> 180	AND/OR	> 120

Patients on BP medication: goal is < 130/80 = "controlled."

Sources of Measurement Error

Inadequate rest — must rest 5 minutes
Wrong arm position — should be at level of right atrium; 1 mmHg error per 1 cm change
Unsupported arm / back / legs — back/feet adds ~6 mmHg
Crossed legs — adds 2–8 mmHg
Wrong cuff size — should be ≥ 80% of arm circumference
Cuff over clothing — adds 5–50 mmHg
Full bladder — adds ~10 mmHg
Talking / active listening — adds ~10 mmHg

One Reading is NOT Enough

Patient-measured BP is the gold standard due to the White Coat Effect
Guidelines: 3 readings in the arm with the higher BP. Discard the 1st, average the last 2.

Factors That Affect BP

Exercise — exertion causes BP to rise
Cold → vessels constrict → BP increases
Hot → vessels dilate → BP decreases
Caffeine — within 30 min to 1 hr before screening
Smoking

Proper Setup for Blood Pressure Measurement

5-minute rest prior to measurement
Legs uncrossed, feet on floor
Arm supported (resting on table)
Correct cuff size, placed on bare arm
Cuff positioned 1–2 inches above elbow crease
Cuff tight enough for 1–2 fingers only
Line up artery mark (medial, over brachial artery)
Patient should NOT talk, use phone, or read

NEVER report a false reading. If unsure, switch arms, ask someone, or try again.

First-Line HTN Medications

Thiazide diuretics
Calcium channel blockers
ACE inhibitors / ARBs (especially for diabetes, CKD)

Hypertensive Crisis Response

Ask if they are on medication & if they took it today
Re-take blood pressure
Check for: chest pain, shortness of breath, headache, nausea, vomiting, dizziness

If ANY of those symptoms are present → see a doctor IMMEDIATELY

Blood Glucose

Type 1 vs. Type 2 vs. Gestational

	Type 1	Type 2
Onset	Sudden	Gradual
Age	Any (mostly young)	Adults (mostly)
Body Type	Normal or thin	Overweight / obese
Insulin	Low / absent	Normal, decreased, or increased
Prevalence	5–10%	90–95%

Gestational diabetes = temporary condition during pregnancy that causes blood sugar to increase.

Diagnostic Criteria

	Fasting (8 hrs)	Random	A1c %
Normal	70–100	70–140	< 5.7%
Pre-Diabetic	101–125	141–199	5.7–6.4%
Diabetic	126+	200+	≥ 6.5%

Controlled Ranges (On Medication)

Measure	Target
A1c	< 7.0%
Before a meal	80–130 mg/dL
1–2 hrs after meal	130–180 mg/dL

What to Do with a High BG

Ask: "Are you on medication? Have you taken it today?"
Ask: "How often do you check your BG? What is it normally? Do you know your A1c?"
Not under control → recommend checking once or twice a day
Under control → recommend checking a few times a week
Encourage lifestyle changes and direct to APSEA Lifestyle Program

BMI

BMI Basics

Does NOT differentiate between fat, muscle, or bone
Bodybuilders may have inappropriately high BMI; elderly may have inappropriately low BMI
Always measure weight/height rather than relying on verbal report

BMI Ranges

Category	BMI
Underweight	< 18.5
Normal	18.5 – 24.9
Overweight	25 – 29.9
Obesity	30 – 34.9
Extreme Obesity	35 – 39.9

Waist Circumference

	Increased Risk	Greatly Increased
Men	94 cm	102 cm
Women	80 cm	88 cm

Waist-to-Hip Ratio

Women

≤ 0.80 = Low (Pear)
0.81–0.85 = Moderate (Avocado)
0.85+ = High (Apple)

Men

≤ 0.95 = Low (Pear)
0.96–1.0 = Moderate (Avocado)
1.0+ = High (Apple)

Visceral Fat

Found within abdominal cavity, lining organs
Much higher risk than subcutaneous fat

Level	Rating
≤ 9	Normal
10–14	High
≥ 15	Very High

Bioimpedance Device

Measures: Weight, BMI, Body Fat %, Muscle %, Basal Metabolic Rate, Body Age, and Visceral Fat.

History-Taking

Blood Pressure — 2 Mandatory Questions

Ask these to every single participant before taking BP.

"Have you been diagnosed with high blood pressure?"
- If YES → "Are you currently taking any medications for blood pressure?"
- If YES → "Have you taken them today?"
- If NO → "Have you been prescribed any medications by your doctor?"
"Have you consumed caffeine, exercised, or smoked in the past 30 minutes to an hour?"

Blood Glucose — 2 Mandatory Questions

Ask these to every single participant before taking BG.

"Have you been diagnosed with diabetes/pre-diabetes?"
- If YES → "Are you currently taking any medications?" → "Have you taken them today?"
- If NO → "Have you been prescribed any medications by your doctor?"
"Have you had anything to eat in the last eight hours?"
- If YES → do NOT take a blood sugar reading. Have them come back fasting.
- If NO → take a fasting blood sugar reading.

Lifestyle Assessment (7 Categories)

Conducted after the vitals are taken.

1. Diet

"Can you tell me about your typical daily meals?"
→ "What did you eat this morning/lunch/evening?"
→ "Is that what you typically have?"

2. Exercise

"Do you do any exercise/physical activity weekly?"
→ "How many times/hours a week?"
→ If only aerobic: "Do you incorporate weights?"
→ If only weights: "Do you incorporate aerobic?"

3. Sleep

"How many hours of sleep do you usually get?"
→ "Is that consistent throughout the week?"

4. Substances

"Do you smoke, use drugs, or drink?"
→ If yes: "How much per day/week?"

5. Stress

"How would you rate your stress levels?"
→ If high: "Okay, I understand, it's important that we keep it under control."

6. Tracking

BP: "Do you have a BP machine at home? Do you use it? Do you keep a log?"
BG: "Do you remember your A1c? Do you measure at home/with a CGM?"

7. Medication

"Do you ever miss any doses of medications?"
"Have you experienced any side effects from the medications?"

The "MMMMMM" Mnemonic

Medications — Do you take medications? Did you take them today?
Monitoring — When did you last check your BP? Do you have a machine at home?
Meals — How is your diet? Go over preventive strategies.
Metabolism — Do you exercise? What type? Trying to lose weight?
Motivation — Set SMART goals. Give specific advice.
Medical History — Any other relevant issues?

Counseling

As students, we CANNOT diagnose hypertension or diabetes. We only assess and recommend.

Bedside Manner

Always ask for consent before taking measurements (especially blood sugar)
Ask for consent to record data
Be human — ask how their day is; make it pleasant
Keep patient information private

Preventive Strategies

1. Weight Loss

Losing even 5–10% of body weight can significantly reduce BP.

2. DASH Diet

Sodium < 1500 mg/day
Potassium 3000–3500 mg/day
Low saturated fat
Remove bad food before adding good.

3. Physical Activity

150 min/week aerobic (30 min × 5)
3 days muscle-strengthening
Give specific recommendations!

4. Lifestyle

Smoking cessation, alcohol reduction, stress management, better sleep.

SMART Goals

Specific, Measurable, Achievable, Relevant, Time-bound. Examples:

"Pack lunch on Mondays and Wednesdays for the next 2 weeks"
"Take a 10-minute walk during lunch break 3 days this week"
"Replace one cup of coffee with water or herbal tea"