Clients should be monitored regularly for changes in blood pressure, weight and foot problems. If problems are identified earlier, the doctor and/or nurse can be alerted sooner, and problems can be dealt with sooner before they get worse.
Measuring weight is important because it helps determine whether or not a client is overweight or obese. Obesity can lead to diabetes, and reducing obesity can help improve diabetes. However, you need to know the height as well as the weight to determine if someone is obese. Someone who is 160lbs and 5 feet is obese, but someone of the same weight and 6 feet is not; the extra weight is due to more muscle and bone, not fat.
Height is used to calculate the Body Mass Index (BMI) according to a special formula. “Ideal” is from 18 to 25; “overweight” is from 25 to 29; and “obese” is 30 or higher. (You don’t need to know this formula; you just have to enter weight and height in the registry, and BMI will be automatically calculated.)
Checking the feet is important because people with diabetes lose their sensation and may not notice small cuts or tears in the skin. These problems can quickly get worse if not identified early and treated. Complications of cuts or ulcers include infections, which if not treated early enough can lead to severe infections, and even amputation.
The CHW’s role is to do physical assessments on clients deemed at “high-risk”, those who have very poor control of their diabetes and require more support. See section I below on how these clients will be identified. CHWs will use the CHW Diabetes Clinical Assessment Log sheet paper form to record visit information.
1. Tell the client that you will be taking their blood pressure.
“I’d like to take your blood pressure now. We want to make sure it’s healthy. When it’s too high, that can lead to strokes and heart attacks. Do you have any questions?”
2. Have client sit down and rest for a few minutes.
3. Put the cuff so that the lower edge is about 3 cm (1”) above the bend of the elbow. Wrap the cuff around the arm and fasten it using the velcro.
(After putting on the cuff) “You’ll just feel some squeezing of your arm. It won’t last very long.”
4. Feel for a pulse from a big artery (the brachial artery). Put the arrow of the blood pressure cuff so that it points to where this pulse is.
5. Ensure the client has their feet flat on the floor and arms uncrossed.
6. Turn on the blood pressure machine and take the blood pressure.
7. Take 3 more blood pressure measurements, allowing 1-2 minutes between each.
(After the first time) “I’m going to check it three more times once you sit and relax. I am going to test your sugars in between the 3 blood pressures.”
8. Calculate average of these measurements using the machine.
9. If average blood pressure is over 160/100, do the following:
a. Dim the lights.
b. Have client lie down for 5 minutes.
c. Take 3 more blood pressure measurements.
10. Enter the average blood pressure measurement into the Log sheet.
11. If the Blood Pressure is MORE THAN 160/100 after 3 times, please refer to the nurse or doctor right away.
Download or use this online CHW sample form to practice the contents of this module.
Please note that these training modules are to be used for the purposes of CHW training in diabetes management. CHWConnect does not provide medical advice or specific diagnostic or treatment information.