ASSESSMENTFranelyne P. CasugaFaculty of PharmacyUniversity of Santo Tomas

ASSESSMENTVITAL SIGNSMost frequent measurement obtained by health practitionersIndicators of health statusIndicate the effectiveness of functions: circulatory, respiratory, nervous and endocrineProvides data to determine a clients usual state of health (baseline data)

ASSESSMENTVITAL SIGNSTemperatureBlood pressure Pulse rate/cardiac rateRespiratory rate

ASSESSMENTVITAL SIGNSPain Fifth vital sign As decided by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and pain management experts

ASSESSMENTVITAL SIGNSFACTORS CAUSING VITAL SIGNS TOCHANGETemperature of the environmentPatients physical exertionEffects of illness

ASSESSMENTVITAL SIGNSChange in vital signs - indicates a change in physiological functionAllows the pharmacist Assess response to drug and non-drug therapyIdentify diagnosesImplement planned interventionsEvaluate success when vital signs have returned to acceptable values

ASSESSMENTVITAL SIGNSEssential ingredient when pharmacists, nursesand physicians collaborate to determine the patients health status

ASSESSMENTVITAL SIGNSNeed for hands-on proficiency in specificphysical assessment skills varies according to the type of patient care settingAll pharmacists should have at least a basicunderstanding of these skills

ASSESSMENTVITAL SIGNSBASIC TECHNIQUES TO DETERMINEVITAL SIGNS (IPPA)Inspection (check-up)Palpation (feel)Percussion (beating)Auscultation (stethoscope)

PercussionChest percussion, also referred to as chest physiotherapy, is an airway clearance technique that involves clapping on the chest and/or back to help loosen thick secretions. Doing this makes mucus easier to expel, or cough up.

ASSESSMENTVITAL SIGNSGUIDELINES FOR MEASURING VITAL SIGNSPart of the database/record that a pharmacist collects during assessmentBaseline for future assessments

ASSESSMENTVITAL SIGNSGUIDELINES FOR MEASURING VITAL SIGNSPatients needs and condition determine when, where, how and by whom vital signs are measuredPharmacist must analyze vital signs to interprettheir significance and make decisions aboutinterventions

ASSESSMENTVITAL SIGNSGUIDELINES FOR MEASURING VITAL SIGNSEquipment Appropriate for the size and the age of thepatientFunctional to ensure accurate findingsSelected based on the patients condition

ASSESSMENTVITAL SIGNSGUIDELINES FOR MEASURING VITAL SIGNSPatientUsual range of vital signs should be establishedMedical history, therapies and prescribedmedications should be known

ASSESSMENTVITAL SIGNSGUIDELINES FOR MEASURING VITAL SIGNSControl and minimize environmental factors affecting vital signsOrganized, systematic approach when taking vital signs

ASSESSMENTVITAL SIGNSACCEPTABLE RANGES FOR ADULTSTemperature range36 to 37 COral/tympanic 37CRectal 37.5CAxillary 36.5CPulse rate 60 to 100 beats per minuteRespiratory rate12 to 16 breaths per minuteBlood pressure110/70 mm Hg

ASSESSMENTVITAL SIGNSEQUIPMENTSThermometerStethoscopeSphygmomanometer

Thermometers

Axillary thermometer

Oral Thermometer

Stethoscope

Sphygmomanometer

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONSubjective (personal/individual)Everything is important, depending on the chief complaint Consider everythingDocument the essential

SubjectiveObjective1. I feel dizzy. 1. Blood pressure: 90/60, Pulse 110. 2. My bladder never seems empty.2.Voids 100-150ml/void q 1-2 h. 3. I am too fat.3. 14 yr. old male 150 cm (52) 36 Kg (80 lbs).

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)P What provokes discomfort?Q What is the quality of the discomfort?R Where is the region of the discomfort?S What is the severity of the discomfort?T What is the time sequence?

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)What was the mechanism of injury?What was the patient doing prior to incident?Are there any associated symptoms?Are there any aggravating/relieving factors?Is this a recurrent/continuing illness or injury?Is the patient on any medications?Notes patients eating habits, caffeine and smoking habitsAllergies? ASK FOR YOURSELF

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)GeneralNutritional status, weight gain/loss, weakness,fatigue, hydration status & overall conditionSkinChanges in skin/nail/hair texture appearance and color, rashes, itching, lumps or infection

Chicken poxEczema

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)HeadLoss of consciousness, lightheadedness/vertigo (dizziness), headaches, history of injury, sinus, pain, visual disturbancesEyesVisual changes, diplopia, pain, discharge, trauma, photophobia, glaucoma, cataracts, last eye exam, use of eyeglasses/contacts lenses

DiplopiaCataract

VertigoLoss of consciousness

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)EarsHearing loss, tinnitus, drainage, pain, infection, discharge, vertigo, hearing aidsNose/SinusesStuffiness, drainage, olfactory changes, itching, obstruction, history of trauma, hay fever, nosebleeds, sinus problems

Nosebleeding

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)ThroatHoarseness, dysphagia, enlarged tonsils, bleeding gums, sores, dental condition, caries, tongue changes, dry mouth, history of sore throat, history of traumaNeckGoiter, pain, masses, nodules, adenopathy, thyroid problems, stiffness, history of injury

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)RespiratoryCough, dyspnea, sputum (amount, type, color),asthma, bronchitis, COPD (chronic obstructive pulmonary disease), emphysema, TB, last CXR (chest x-ray), smoking history

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)CardiacHypertension, hyperlipidemia, rheumatic fever,murmurs, chest pain/discomfort, dyspnea, edema, last ECG/stress test, CHF (congestive heart failure), history of surgeries, procedures, monitors

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)Peripheral vascularNocturnal pain, varicose veins, leg cramps, CHF (congestive heart failure), swelling, tenderness GastrointestinalHeartburn, dysphagia, appetite, indigestion, belching, flatulence, stool changes, melena, diarrhea, constipation, nausea, regurgitation, vomiting, history of gallbladder or liver disease

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)Genital (male)Hernias, sores, lesions, penile discharge, pain, testicular/mass discomfort, scrotal mass/discomfort, history of STDs, sexual history, function, problems

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)Genital (female)Birth control, sexual history/function, STDs, itching, sores, discharge, dyspareunia, lastPAP/pelvic exam, menarche, menopause, LMP (last menstrual period), obstetric history, menstrual regularity, frequency, duration, amount, dysmenorrhea, amenorrhea, PMS (pre-menstrual syndrome)

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)UrinaryDysuria, polyuria, frequency, stones, patternchange, incontinence, nocturia, STD, hesitancy, dribbling, hematuria, infections,flank discomfortHematologicBleeding, bruising, anemia, history of transfusions

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)EndocrineThyroid, adrenal, hormonal, heat/cold intolerance, edema, hirsutism, sweating, excessive thirst, hunger, polyuria, pigment changesMusculoskeletalMyalgia, stiffness, gout, arthritis, backache, swelling, pain, erythema, tenderness, history of trauma

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)NeurologicSyncope, vertigo, seizures, blackouts, paresthesias, paralysis, tremors, weakness, involuntary movements, equilibriumPsychiatricAnxiety, mood swings, mania, depression, memory loss, insomnia, suicidal ideations, delusions, hallucinations

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH) Consider: any other currently active problemscomments should include: functional impairment history of trauma childhood/adult illnesses surgeries hospitalizations

FAMILY HISTORY (FH)

ASSESSMENTCOMPLETE PHYSICAL EXAMINATIONAlways start your objective with an opening statement concerning the patients general appearance and conditionWell-developed, well-nourished male not in distress. Patient is ambulatory/moving, alert , cooperative, and shows no gross mental status changes. Vital signs noted.Consider listing a minimum of 3-4 physical exam findings for each complaintCheck the system above and below, and include the possibility of cutaneous, musculoskeletal and occult findingsDocument the absence of critical findings

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSBiochemical, chemical, or physical methods of measuring biologic or physiologic functionsof the bodyImportant part of health care and have become indispensable for routinescreening and the diagnosis of disease

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSUsed routinely to assess compliance, monitor both the efficacy of prescribed treatment and the advent/start of adverse or toxic reactions, diagnosis of specific disease and at times, to help determine the drug of choice

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSOrdered appropriately and performed and interpreted correctlyResults of initial screening or diagnostic tests usually suggest the specific follow-up tests necessary for a definitive diagnosis

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSTHE PHARMACISTS ROLEInvolved in monitoring patient care, and agrowing number now have input into themanagement of patient therapyUnderstand why laboratory tests are used and of the information to be gained from them

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSTHE PHARMACISTS ROLEDrugs may influence the results of laboratorytests in a variety of ways, they are in good position to anticipate and advise on such interactions

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITION: Using word beginnings (prefixes)and endings (suffixes) as clues to procedures-Graphy To record an image-Scopy To look through a lensed instrument-Centesis To puncture-Metry To measure with an instrumentSono- To assess using soundElectro- To assess using electrical impulsesGluco- SugarEndo- Inside

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITIONEndoscopyVisual examination of internal structures using optical scopesParacentesisPuncturing the skin and withdrawing fluid from the abdominal cavity

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITIONLumbar PunctureInserting a needle between lumbar vertebraein the spine but below the spinal cordPositron Emission Tomography (PET)Combines technology of radionuclide scanningwith the layered analysis of tomography

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITIONSonogram or EchogramExamination of soft tissue using sound wavesbeyond human hearingVisual image produced by the reflection of the sound waves back from the tissues beingassessed and into the machine

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITIONElectrical Graphic RecordingsElectrocardiography (ECG)Examination of the electrical activity in the heartElectroencephalography (EEG) Examination of the energy emitted by the brainElectromyography (EMG) Examination of the energy produced by stimulated muscles

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITIONCultureTo collect from the body a sample suspected to contain infectious microorganisms, growing the microbes in a nutrient substance, and examining the resulting growth under a microscope

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSDEFINITIONPelvic examinationPhysical inspection of the vagina and cervix and palpation of uterus and ovariesPapanicolaou (Pap Smear)Screening of cells from the cervix and canal to detect abnormal cells, hormonal status, and presence of abnormal microorganisms

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSFACTORS THAT INVALIDATE TESTRESULTSIncorrect diet preparationFailure to remain fastingInsufficient bowel cleansingDrug interactionsInadequate specimen volumeFailure to deliver specimen to lab in timely mannerIncorrect or missing request form

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSCOMMON DIAGNOSTIC PROCEDURES Radiography or Roentgenography (X-ray)FluoroscopyComputerized Tomography (CT Scan)Magnetic Resonance Imaging (MRI)

ASSESSMENTLABORATORY & DIAGNOSTIC TESTSCOMMON DIAGNOSTIC PROCEDURESEndoscopic examinationsBronchoscopyinspection of the bronchiGastroscopyinspection of stomachColonoscopy inspection of colonLaparoscopyinspection of the abdominal cavityCystoscopy inspection of urinary bladder

Hematology or haematology - branch of biology (physiology), pathology, clinical laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases. - includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases.

LABORATORY TESTS HEMATOLOGY *

TestNormal ValuesWhite Blood Cell (WBC)5 x 109/LRed Blood Cell (RBC)4-6 x 1012/LHemoglobin (Hb)Male: 140-170 g/LFemale: 120-170 g/LHematocrit (Hct)Male: 37 54%ESR (erythrocyte sedimentation rate)Female: 0 20 mm/hrDifferential CountNeutrophils: 54 75%Eosinophils: 0 4%Lymphocytes: 2 35%Monocytes: 6%Basophils: 0 0.5%Mean Corpuscular Volume75 97 flMean Corpuscular Hemoglobin26 33 pg

Hematocrit-Packed RBCs in whole blood after centrifugation

Packed Cell VolumeLow Values-anemia, overhydrationor blood lossHigh Values-Polycythema vera or dehydration

Hemoglobin- a estimate of the oxygen carrying capacity of the blood. MCV- Mean Cell Volume Low MCV indicates microcytic RBCs occurs in Iron Deficiency High MCV indicates macrocytic, occurs in Vit B12 or folic acid deficiency

Erythrocyte Sedimentation Rate-measures the rate of RBC settling of whole uncoagulated blood over timeHigh ESR indicates acute and chronic infection, tissue necrosis, rheumatoid collagen disease

Coagulationcomplex process by which blood forms clots.Disorders can lead to an increased risk of bleeding (hemorrhage) and/or clotting (thrombosis).

LABORATORY TESTS COAGULATION *

TestNormal ValuesACT (activated coagulation time)70 120 secondsAPTT(activated partial thromboplastin time)30 40 secondsBleeding time (BT)1 3 minClotting time8 -15 minsFDP (d-dimmer)< 25 mg/dlFibrinogen level200 400 mg/dlPartial thromboplastin time (PTT)30 40 secondsPlatelet Count200 400 x 109 LProthrombin time (PT)12 15 secondsThrombin time10 14 seconds

Problems with coagulation may dispose to hemorrhage, thrombosis, and occasionally both, depending on the nature of the pathology.Thrombosis is the pathological development of blood clots. clots may break free and become mobile, forming an embolus or grow to such a size that occludes the vessel in which it developed.

Cofactors

Various substances are required for the proper functioning of the coagulation cascade:Calcium and phospholipid (a platelet membrane constituent)Vitamin K

BLOOD CHEMISTRY-Serum Proteins

Types: Serum albuminmost abundant blood plasma protein and is produced in the liver and forms a large proportion of all plasma protein. human serum albumin, and it normallyconstitutes about 70% of human plasma protein;Globulins - all other proteins present in blood plasma - bovine serum albumin (cattle serum albumin) or BSA, often used in medical and molecular biology labs.

Low albumin (hypoalbuminaemia) may be caused by liver disease, nephrotic syndrome, burns, protein-losing enteropathy, malabsorption, malnutrition, late pregnancy, artefact, genetic variations and malignancy.High albumin is almost always caused by dehydrationAmylase is an enzyme that breaks starch down into sugar. Amylase is present in human saliva, where it begins the chemical process of digestion

LABORATORY TESTS BLOOD CHEMISTRY *

TestNormal Values*Albumin30 50 g/LAmylase10 130 U/LFasting Blood Sugar3.89 5.88 mmol/LGlycosylated Haemoglobin< 7% 7 8 % Excellent Control8 9 % Good Control9 10% Fair Control> 10% Poor ControlGlobulins23 35 g/LSerum Ammonia: 11 -35 Umol/L

RENAL PROFILE TESTSNephrology concerns itself with the diagnosis and treatment of kidney diseases: - electrolyte disturbances and hypertension, and the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Many diseases affecting the kidney are systemic disorders not limited to the organ itself, and may require special treatment. Examples include systemic vasculitides and autoimmune diseases such as lupus.

LABORATORY TESTSRENAL PROFILE TESTS

TestNormal ValuesBlood Urea Nitrogen *3.2 8 mmol/LSerum Bicarbonate22 26 mEq/LSerum Calcium*2.02 2.60 mmol/LSerum Chloride99.9 110 mmol/LSerum Creatinine*53 133 mmol/LSerum Magnesium1.4 2.1 mmol/LSerum Phosphorus0.42 1.97 mmol/LSerum Potassium*4 4.5 mmol/LSerum Sodium*135 145 mmol/LSerum Uric Acid*0,13 0.44 mmol/L

BUNDecreased BUN levels occur with significant liver diseaseIncreased BUN levels may indicate renal disease

Creatinine Clearance (ClCR)The rate at which creatinine ( the metabolic breakdown product of muscle creatine phosphate) is removed from the blood by the kidneys[140-age(in years)] X body weight (in kg)=______________________________________________________________________________________________________ 72 X CCR (in mg/dL)

ClCR-Creatinine Clearance, CCR- serum creatinine concentration

LIPID PROFILE

VAP (Vertical Auto Profile) - a cholesterol, lipid and lipoprotein test. -VAP test includes categories of cholesterol measurement in addition to the basic scores (total cholesterol, high-density lipoproteins, low-density lipoproteins, and triglycerides), candidates for the comprehensive VAP (Vertical Auto Profile) Test.: - with family history /existing condition of diabetes, high blood pressure or heart disease -- or who are already taking cholesterol lowering medication -- are

LABORATORY TESTS LIPID PROFILE *

TestNormal Values*Serum cholesterolup to 200 mgs/dlBorderline: Up to 239 mgs/dlElevated if>240 mgs/dL on repeated valuesSerum triglycerides< 180 mgs/dlHDL Cholesterol30 60 mgs/dlLDL CholesterolBorderline: 100 190 mgs/dlRisk: > 190 mgs/dlNote: Formula for calculating LDL Cholesterol is INVALID if TGL > 400 mgs/dlTotal/HDL ratio: < 4Low Risk: 4 6High Risk: > 6

HEPATIC ENZYMES(Liver function tests)

groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver.

LABORATORY TESTS HEPATIC ENZYMES *

TestNormal Values*SGOT / Aspartate Aminotransferase (AST)Up to 34 34 U/LSGPT / Alanine Aminotransferase (ALT)Up to 30 U/LSerum Alkaline Phospatase (ALP)36 92 U/L

Thyroid function tests (TFTs)collective term for blood tests used to check the function of the thyroid.includes thyroid-stimulating hormone (TSH, thyrotropin) and thyroxine (T4), and triiodothyronine (T3) depending on local laboratory policy.

TFTrequested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), monitor the effectiveness of either thyroid-suppression or hormone replacement therapy. requested routinely in conditions linked to thyroid disease, such as atrial fibrillation.

LABORATORY TESTS THYROID FUNCTION TEST

TestNormal ValuesFree T4*0.8 2.0 ng/dlFree T3*2.3 4.2 pg/mlTSH *0.25 4.30 microunits/mlSerum T370 200 ng/dlSerum T44.0 11.0 micrograms/dl

Cardiac markers evaluate heart function. often discussed in the context of myocardial infarction, but other conditions can lead to an elevation in cardiac marker level.early markers identified were enzymes or"cardiac enzymes"

LABORATORY TESTS CARDIAC ENZYMES AND PROTEINS

TestNormal ValuesCPK *25 2000 U/LCK MB (creatine kinase isoenzyme MB)*0 9 ng/ml or < 3% of total CPKLDH0 280 U/LLDH - 120 36% of total LDH: LDH1SGOT (Serum glutamic oxaloacetic *Transaminase)< 42 U/LSGPT (Serum glutamic pyruvic transaminase)*0 48 U/LMyoglobin *0 85 ng/mlTroponin 10,0 0.1 ng/mlTroponin T< 0.18 ng/ml

Urinalysis (or "UA")array of tests performed on urine and one of the most common methods of medical diagnosis.[1] A part can be performed by using urine dipsticks, in which the test results can be read as color changes.

LABORATORY TESTS URINALYSIS *

ColorStraw dark yellowOdorSlightly aromaticAppearanceClearSpecific gravityInfants: 1.002 1.006Adult: 1.016 1.022pH4.6 6.5proteinnegativeGlucosenegativeNa10 40 mEq/LK< 8 mEq/L

LABORATORY TESTS URINALYSIS

ColorStraw dark yellowCl< 8 mEq/LbilirubinnegativeUrobilinogen0.1 1 EU/100 mlKetones *negativeOccult Blood *negativeRBCs *Female: 0 2/hpf, Male: 0/hpfWBCs *Female: 0 5/hpf, Male: 0 2/hpfBacteria *Negative on spun specimenCasts *Hyaline, coarse, fine granular, RBC, WBC, waxy castsCrystals *Interpreted by physician

Fecalysis/stool analysislaboratory tests done on fecal samples to analyze the condition of a person's digestive tractperformed to check for the presence of any reducing substances such as : white blood cells (WBCs) sugars, or bile signs of poor absorption as well as screen for colon cancer.

LABORATORY TESTS FECALYSIS *

ParameterResults/Normal ValuesParameterResults/Normal ValuesCharacterFormedPusNegativeColorBrownBloodNegativeMucusNegativeOccult BloodNegative

Creatinine ClearaneNormal valuesMale: 97 to 137 ml/min.Female: 88 to 128 ml/min.

Creatinine Clearance[140-age(in years)] X body weight (in kg)=______________________________________________________________________________________________________ 72 X CCR (in mg/dL)

ClCR-Creatinine Clearance, CCR- serum creatinine concentrationNote: (Multiply result by 0.85 for femalesUsing this formula, the unit of ClCr is mL/min

ExamplesGiven:Patient: Angela Marie P. Dela CruzAge: 780 monthsWeight: 75kgHeight: 5 ftCCr: 0.9mg/dLQuestion: Is the Creatinine Clearance of the patient within the normal range? Prove your answer..

2. Given: Patient: Gabriel Marie P. Dela CruzAge: 86Weight: 175 lbHeight: 6 ftCCr: 1.8mg/dLCompute for the Creatinine Clearance of the patient. Is it within the normal range?

E N D