Body Surface Area = 0

CHEM 1406

BSA/BMI Measurement Laboratory

(revised 5/24/04)

Weight & Height Measurement:

BSA, Body Surface Area

See pages 105 -109 of dosage text for equations, calculations and adult nomogram

See pages 271 -272 of dosage calculation text for pediatric nomogram and calculations

Body Surface Area = 0.20247 x Height(m)^0.725 x Weight(kg)^0.425

Lean Body Weight (men) = (1.10 x Weight(kg)) - 128 ( Weight²/(100 x Height(m))²)
Lean Body Weight (women) = (1.07 x Weight(kg)) - 148 ( Weight²/(100 x Height(m))²)

Ideal Body Weight (men) = 50 + 2.3 ( Height(in) - 60 )
Ideal Body Weight (women) = 45.5 + 2.3 ( Height(in) - 60 )

BMI, Body Mass Index

From WEB Calculator page

Body Mass Index = Weight(kg) / Height(m)²

Lab Work

Your height = _______________ Your weight = _________________

Height, meters = _____________ weight, kilograms = _____________

Calculated BSA = ____________ calculation work space:

Calculated BMI = ____________

BMI (from web calculator) =

___________________

Conclusion from calcutations/tables is:

______________________________

see: CDC BMI calculator,

http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

Body Mass Index (BMI) – Also Known as 'Quetelet's Index'

BMI is one of the better methods to determine who is potentially overweight or obese (Kuczmarski, Carroll, Flegal, & Troiano, 1997). It can be performed rapidly in the clinical setting just by measuring the weight and height of the individual. It is best not to have the patient self-report his or her weight and height because this lacks accuracy. However, the definition of overweight and obesity in relation to BMI may differ slightly according to different medical organizations.

BMI is defined as the weight (in kilograms) divided by the square of the height in meters (kg/m²). Another method of determining BMI is to take the weight of the patient in pounds and divide this number by the square of the height in inches, and to multiply this value by 704 (pounds/inches² x 704) (Moyad, 2003). A BMI less than 25 is considered normal by the World Health Organization, while 25 to 29.9 is overweight, and 30 or greater is defined as obese. There are three classes of obesity: Class I is a BMI of 30 to 34.9 kg per m,² Class II is a BMI of 35 to 39.9, and Class III is a BMI equal or greater than 40. There has been a substantial increase in the prevalence of all three of these obesity classes over the past decade. Most statistics reported in the media on the percentage of overweight and obese individuals in a population actually are derived from medical studies that use the BMI as a measurement. BMI is arguably the most widely reported current measurement of obesity in medical studies. Some organizations define a BMI of 35 or 40 or more as "morbidly obese" and these are the BMI's that are generally needed in order to qualify for more serious conventional medical therapy such as gastric bypass surgery if no other treatments have been helpful.

BMI does not take into account more muscular frames at different heights, as is the case with measuring crude weight (mentioned later in the article). Thus, a patient who lifts weights or engages in resistance exercises may actually experience a slight increase in BMI due to an increase in lean body mass which weighs more than fat tissue. However, patients with BMI values equal to or greater than 30 generally have an excess of adipose tissue.

Metabolic Syndrome:

From: http://www.samed.com/sample/T101553.HTM

Also, see: New Definition Fro Metabolic Syndrome Predicts Coronary Heart Disease

and Type 2 Diabetes, from www.docguide.com (July 2003) In stead of waist

circumference in above table use BMI greater than 28.8 kg/m². For men, having four

or more baseline abnormalities had a 3.7-fold increased risk for CHD and a 24-fold

increased risk for diabetes.

Blood Pressure:

Position the patient's arm so the anticubital fold is level with the heart. Support the patient's arm with your arm or a bedside table.
Center the bladder of the cuff over the brachial artery approximately 2 cm above the anticubital fold. Proper cuff size is essential to obtain an accurate reading. Be sure the index line falls between the size marks when you apply the cuff. Position the patient's arm so it is slightly flexed at the elbow. [4]
Palpate the radial pulse and inflate the cuff until the pulse disappears. This is a rough estimate of the systolic pressure. [5]
Place the stetescope over the brachial artery. [6]
Inflate the cuff to 30 mmHg above the estimated systolic pressure.
Release the pressure slowly, no greater than 5 mmHg per second.
The level at which you consistantly hear beats is the systolic pressure. [7]
Continue to lower the pressure until the sounds muffle and disappear. This is the diastolic pressure. [8]
Record the blood pressure as systolic over diastolic ("120/70" for example).

Interpretation

Higher blood pressures are normal during exertion or other stress. Systolic blood pressures below 80 may be a sign of serious illness or shock.
Blood pressure should be taken in both arms on the first encounter. If there is more than 10 mmHg difference between the two arms, use the arm with the higher reading for subsequent measurements.
It is frequently helpful to retake the blood pressure near the end of the visit. Earlier pressures may be higher due to the "white coat" effect.
Always recheck "unexpected" blood pressures yourself.

Blood Pressure Classification in Adults
Category	Systolic	Diastolic
Normal	<140	<90
Isolated Systolic Hypertension	>140	<90
Mild Hypertension	140-159	90-99
Moderate Hypertension	160-179	100-109
Severe Hypertension	180-209	110-119
Crisis Hypertension	>210	>120

In children, pulse and blood pressure vary with the age. The following table should serve as a rough guide:

Average Pulse and Blood Pressure in Normal Children
Age	Birth	6mo	1yr	2yr	6yr	8yr	10yr
Pulse	140	130	115	110	103	100	95
Systolic BP	70	90	90	92	95	100	105

Notes

For more information refer to A Guide to Physical Examination and History Taking, Sixth Edition by Barbara Bates, published by Lippincott in 1995.
Unlike pulse, respirations are very much under voluntary control. If you tell the patient you are counting their breaths, they may change their breathing pattern. You cannot tell someone to "breath normally," normal breathing is involuntary.
With an irregular pulse, the beats counted in any 15 second period may not represent the overall rate. The longer you measure, the more these variations are averaged out.
Do not rely on pressures obtained using a cuff that is too small or too large. This is frequently a problem with obese or muscular adults where the regular cuff is too small. The pressure recorded will most often be 10, 20, even 50 mmHg too high! Finding a large cuff may be inconvenient, but you will also "cure" a lot of high blood pressure.
Maximum Cuff Pressure - When the baseline blood pressure is already known or hypertension is not suspected, it is acceptable in adults to inflate the cuff to 200 mmHg and go directly to auscultating the blood pressure. Be aware that there could be an auscultory gap (a silent interval between the true systolic and diastolic pressures).
Bell or Diaphragm? - Even though the Korotkoff sounds are low frequency and should be heard better with the bell, it is often difficult to apply the bell properly in the anticubital fold. For this reason, it is common practice to use the diaphragm when taking blood pressure.
Systolic Pressure - In situations where ausculation is not possible, you can determine systolic blood pressure by palpation alone. Deflate the cuff until you feel the radial or brachial pulse return. The pressure by auscultation would be approximately 10 mmHg higher. Record the pressure indicating it was taken by palpation (60/palp).
Diastolic Pressure - If there is more than 10 mmHg difference between the muffling and the disappearance of the sounds, record all three numbers (120/80/45).

from http://www.medinfo.ufl.edu/year1/bcs/clist/vitals.html#AA7

See also article, Hypertension, reference: http://www.medscape.com/viewarticle/474790_print

Table 1. Classification of Blood Pressure for Adults 18 Years of Age and Older^[^8]

Category	Blood Pressure Level (mm Hg)
Normal	Systolic < 120 and diastolic < 80
Prehypertension	Systolic 120-139 or diastolic 80-89
Hypertension
Stage 1	Systolic 140-159 or diastolic 90-99
Stage 2	Systolic >/= 160 or diastolic >/= 100

Note: These categories apply to patients who are not taking antihypertensive drugs and are not acutely ill. When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify the person's blood pressure status.

Table 2. Proper Blood Pressure Measurement Technique

Patient should refrain from smoking or caffeine ingestion for 30 min before measurement

Patient should be at rest, seated in a chair with back and feet supported, for at least 5 min before measurement is taken

Patient should not speak while blood pressure is being measured

Patient's arm should be bare, with no tight clothing constricting the upper arm

Select a proper cuff size for the arm: bladder should encircle at least 80% of arm (many adults will require a large cuff)

Position patient's arm so cuff is at the level of the heart

Place stethoscope bell over brachial artery

Inflate cuff to occlude the pulse

Deflate at rate of 2-3 mm/sec

Measure systolic (first sound) and diastolic (last sound) to nearest 2 mm Hg

Repeat measurement after 2 min

Under special circumstances, measure blood pressure with patient in standing position

Table 3. Classic Features of Essential Hypertension

Onset of hypertension in the fourth or fifth decade of life

Family history of hypertension

BP < 180/ < 110 mm Hg at diagnosis

Asymptomatic

History, physical examination, and routine laboratory studies are normal (no target-organ damage at time of diagnosis)

BP control achieved with lifestyle changes and one or two drugs

BP control is maintained once achieved