Pulse and Presence

Systolic pressure

pressure when the heart contracts

Diastolic pressure

pressure when the heart relaxes

Blood Pressure

force of blood pushing against the walls of arteries

Normal Blood Pressure

<120 systolic AND <80 diastolic

Hypotension

<90 systolic OR <50 diastolic, too low (<90/<60) can be normal, but sometimes organs may not get enough blood supply

Stage 1 Hypertension

130-139 systolic OR 80-89 diastolic

Stage 2 Hypertension

>140 systolic OR >90 diastolic

Elevated Blood Pressure

120-129 systolic AND <80 diastolic

Symptoms of Hypotension

Can cause dizziness, fainting, confusion, and muscle weakness

Hypertension

too high (>120/>80) blood pressure and can damage the body over time

Causes of Hypertension:

Artery Damage → narrowing, plaque buildup, and clots → strokes and heart attacks

Overworked Heart → heart thickens, stiffens, and over time, weakens → heart failure

Capillary Damage → delicate vessels can rupture → kidney and vision problems

Hypertension Risk Factors

• Cardiac output

• Vascular resistance:

• Blood volume

• Genetics and age also play a huge role in blood pressure!

What to say if the patient’s blood pressure was low (<90 or <60):

Ask about symptoms/history

Acknowledge: “It’s a little lower than expected.”

Don’t scare them: “Many people naturally have lower blood pressure and feel completely fine, but occasionally it can indicate an issue.”

Ask about symptoms: Are you having any dizziness, lightheadedness, weakness, fainting, confusion, chest pain, or shortness of breath?”

If the patient’s blood pressure was normal (<120 and <80):

Remind them how important it is to stay that way:

“That looks great! You’re right in the normal range. Keeping your blood pressure around here over the years is really good for your heart and blood vessels.”

If blood pressure is high with no symptoms (<180 and <120):

Don’t ignore it, but don’t scare them.

“That’s higher than the recommended range. One reading doesn’t mean you have high blood pressure, but it would be a good idea to check it for a few days and let your healthcare provider know if it stays around this level.”

If blood pressure is very high (≥180 or ≥120):

Make sure you don’t miss a medical emergency.

Ask calmly, “Are you having chest pain, shortness of breath, severe headache, weakness on one side, confusion, or vision changes right now?”

If no: Repeat test after 5 minutes of sitting quietly. If same, “Your blood pressure is still very high, even after resting. Since you aren’t having symptoms, this doesn’t necessarily mean there’s an emergency happening right now, but we recommend that you contact a healthcare professional as soon as possible for guidance.”

If yes: “We cannot diagnose anything, but we recommend urgent medical evaluation today. If you would like, we can help you find the nearest urgent care or emergency department.”

How to take blood pressure:

Ask if participant has had caffeine, nicotine, or has exercised in the last 30 minutes

a. If yes, note on the result card

2. Confirm seated posture: back supported, feet flat, arm supported at heart level

3. Rest quietly for 1-2 minutes

4. Wrap the deflated arm cuff around the left arm , about an inch above the bend of the

elbow

5. Align the arrow down the center of the inner arm

6. Clip the pressure gauge to the cuff

7. Position stethoscope over the brachial artery (on elbow crease, slightly closer to the body

from center)

8. Inflate the cuff until no pulse is heard (start around 160 mmHg for adults or 120 for kids)

9. Slowly deflate the cuff while listening for heart sounds

10. Take reading:

a. First audible heartbeat = systolic

b. Last audible heartbeat = diastolic

11. Fully deflate and remove cuff

Tachycardia

= heart rate > 100 bpm

● It can be harmless and temporary (stress, caffeine, exercise, etc) or it can reflect

○ Dehydration

○ Illness

○ Arrhythmia

○ Medication effects

Bradycardia =

heart rate < 60 bpm

● Can be normal in athletes due to their heart pumping more efficiently or it can reflect

○ Side effects from medications like beta blockers

○ Conduction problems in the heart

○ Hypothyroidism

Chronic Obstructive Pulmonary Disease (COPD)

Some Combination of:

Chronic Bronchitis: Airways are inflamed and full of mucus

Emphysema: Alveoli (microscopic sacs) collapse, reducing the surface area to transfer oxygen to the blood

Asthma

Airways are hyperactive, becoming inflamed and narrowed in response to triggers like allergens, cold air, or exercise

Infections (COVID, flu, pneumonia, etc.)

Cause the alveoli in the lungs to fill with fluid or pus, making them less effective

Procedure + Ranges for PulseOx and HR

Procedure:

1. Warm hands if cold and instruct patient to keep their arm still and rested on a flat

surface

2. Place probe, wait for stable value

3. Record SpO2 and pulse

Ranges:

● Typical range → 95-100%

● Borderline → 92-94%

● Concerning → ≤91%

● Urgent → ≤88% or concerning symptoms like shortness of breath, chest pain, confusion, dizziness, blue/gray lips, face, or fingertips

Poor performance on our vision test

typically myopia (nearsightedness)

20/20 System

● 20/20 is standard vision. This level of visual acuity was chosen as a standard in 1862.

● 20/30 means that the patient can see from 20 feet away what a standard (20/20) eye can see from 30 feet.

If 20/40 or worse:

This suggests your vision may be reduced. This is not a diagnosis,

but an eye clinic could help with glasses or an exam.

Snellen Vision Test

Procedure:

1. Ensure bright lighting and the correct distance (20 feet) from the chart

a. Explain, “We are checking how clearly you can read letters at a

distance”

2. Instruct patient to cover one eye

3. Ask them to read lines from the chart, biggest to smallest

4. Stop when they miss more than half of the letters in a line

a. Record the smallest row passed + (–# of letters missed in that row)

i. 20/30 (-2)

5. Ask patient to switch eyes and repeat the test

Diabetic Retinopathy

Glaucoma

Age-Related Macular Degeneration

Confrontational Visual Field

Sit 3–4 feet apart at eye level.

2. Have the person cover their left eye and look at your left

eye. Close your right eye.

3. Hold up 1, 2, or 5 fingers halfway between you. Ask, “How

many fingers?”

4. Test the upper and lower areas on both sides. Keep their

gaze fixed on your eye.

5. Switch eyes and repeat. Record any missed areas.

Amsler Grid Test

1. Hold the grid 12–15 inches away in good light.

Wear reading glasses if you use them.

2. Cover one eye without pressing on it.

3. Look at the center dot. Keep looking there while

checking whether any lines appear wavy, blurry, or

missing.

4. Switch eyes and repeat. Record which eye was

affected and where on the grid the change

appeared.

Cataracts

Ocular Motility + Eye dilation

PERRLA

Pupils Equal, Round, and Reactive to Light and Accommodation, the reaction we want to Ocular Motility + Eye dilation test

Glucose

is the sugar the body absorbs for energy. After a meal, there is tons of glucose in the bloodstream

Insulin

tells cells to absorb the glucose to use for immediate energy or storage

Glucose Disorders

Type 1 Diabetes and Type 2 Diabetes:

Symptoms

○ The body has trouble getting energy (increased hunger, fatigue, weight loss)

○ Glucose “leaks” into urine and causes too much water loss (increased urination, thirst)

○ High blood sugar can damage vessels in the retina, causing vision loss

Type 1 Diabetes:

Autoimmune disorder

○ Immune system destroys the cells that

make insulin

○ Typically develops in adolescence

○ Influenced by genetics, environmental triggers, and certain viruses

Type 2 Diabetes:

Insulin resistance

○ Excess visceral fat makes cells less

sensitive to insulin

○ Influenced by genetics, age, diet, and

physical activity

Prediabetes

140 - 200 mg/dL

Diabetes

>200 mg/dL

Glucose Monitor

Prep:

a. Record time since patient’s last meal.

b. Put on gloves and turn on glucometer.

c. Insert a new test strip into the glucometer.

d. Select the side of the middle or ring fingertip.

e. Clean the site with an alcohol wipe and allow it to air dry completely.

2. Test:

a. Load a lancet into the lancing device and prime.

b. Prick the side of the fingertip.

c. Dispose of the lancet immediately in the sharps container.

d. Wipe away the first drop of blood with gauze.

e. Gently massage the finger until a second drop forms.

f. Touch the edge of the test strip to the blood drop and wait for the reading.

3. Finish:

a. Apply gauze and pressure for 30 seconds, then apply a bandage if needed

b. Record the blood glucose result.

c. Dispose of all supplies appropriately and clean the glucometer according to protocol.

When to Recommend What

Primary Care (best default)

● high blood pressure follow-up

● ongoing symptoms

● chronic conditions

Urgent Care

● symptoms that need attention today

● infections, moderate breathing issues, minor injuries

Emergency Room

● chest pain

● severe shortness of breath

● confusion

● fainting

● very high BP with symptoms

Places we can recommend to Patients: Eye Care

Central Falls Eye Clinic

92 Summit Street, Central Falls, RI

- Free exams and glasses for Rhode Island

residents without vision insurance

- Supported by the RI Lions Sight Foundation

- Email for an appointment

- Process:

- Open the online request form

- Enter contact information

- List P3 as the referral organization

Where to find care?

Free / Low-Cost Clinics:

• Rhode Island Free Clinic

• 655 Broad Street, Providence, RI

• Free care for uninsured adults

• Primary care, labs, follow-up care

• - Formal referral process, QR code

• Clínica Esperanza / Hope Clinic (Spanish-Speaking)

• 60 Valley Street, Suite 104, Providence, RI

• Free care for uninsured Rhode Island adults

• Primary care, non-emergency walk-in care (Monday - Thursday

• 1-4 pm)

• Providence Community Health Centers (PCHC)

• Multiple locations including:

• Central Health Center — 239 Cranston Street

Urgent Care Options

• CareWell Urgent Care

• 349 Broadway, Providence

• Walk-in care for non-emergencies

• CVS MinuteClinic

• Multiple locations

• Basic care, screenings, vaccinations

Cardiac Output

How much blood does the heart pump per minute?

○ Obesity → heart must supply a larger body mass → increase

Vascular resistance:

How tight are the blood vessels?

○ Lack of exercise → blood vessels stiffen → increase

○ Stress, caffeine, and smoking → sympathetic nervous system → increase

Blood volume

How much fluid is in circulation?

○ Excess dietary salt → body retains fluid → ↑

○ Kidney dysfunction → impairs the body’s ability to regulate salt and fluid → ↑