Chapter 28 Patient Assessment Flashcards
PPCP
Pharmacists’ Patient Care Process
developed by the Joint Commission of Pharmacy Practitioners alongside other
major pharmacy organizations and key stakeholders.
Pharmacists’ Patient Care Process
five elements that should be incorporated by pharmacists practicing patient-centered
care:
Collect Assess Plan Implement Follow-up:Monitor/Evaluate
reason for the
patient’s visit.
Chief complaint (CC)
the onset of the
illness and modifying factors.
History of present illness (HPI)
all medications taken by any route
Medications, allergies, and immunizations:
patient’s family medical
history,
Family history
patient’s social activities
that may relate to the presented illness
Social history
This information is usually arranged by organ system (i.e. gastrointestinal, respiratory, musculoskeletal)
ROS
Problem-Focused Interview
open-ended questions
and statements.
this method allows the patient to elaborate on his or her
condition
Seven basic screening questions
may be used in the interview
LAST QSM Location Quality Severity Timing Setting Modifying factors Associated symptoms
Where is the symptom?
Location:
What is it like? Describe it.
Quality:
How bad is it? How does it interfere with your life?
Severity:
How long has it been present? When did it start? How often does it occur?
Timing:
How did it happen? What were you doing when it started?
Setting:
What makes it better or worse? What did you use to
treat it?
Modifying factors:
What other things have you noticed?
Associated symptoms:
four identifiable sections that interview information should be organized to:
SOAP
all the information
reported by the patient as presented.
Subjective
health care provider’s
physical or mental observations,
Medications may be listed here
if not reported by the patient.
Objective
health care provider’s evaluation
and diagnosis of the case presented
Assessment:
the health care provider’s treatment plan
and recommendations, the medication prescribed or discontinued, and
the patient counseling performed. It should include follow-up visits and
monitoring recommendations for the patient.
PLAN
Follow-up visits should include an
interim interview
4 main issues in an interim interview
control
adherence
complications
symptoms range
general observation of the patient
Inspection
use of the of touch for evaluation-brevity
palpation
skin surfaces
light touch
organs or masses
deeper touch
fine, tactile sensation
fingertips
temperature
dorsal surface of the hand
Vibrations
palm surface at the metacarpal joints
deep palpation, including the palpation
of organs.
finger pads
assessing strength
two fingers or whole hand
used to produce sounds, elicit tenderness, or assess reflexes in a patient.
locating organ borders, identifying organ shape
and position, and determining whether an organ is solid or filled with gas.
direct or indirectly
Percussion
tapping a finger against the middle finger
Indirect percussion
striking a fist
blunt percussion
tympanic-drum sound
gas bubble
hyperresonant/boom-like
emphysematous lung
resonant/hollow
healthy lung
thud-like sound
liver
flat/very dull sound
normal muscle tissue
Stethoscope
carried out last
Auscultation
measures various physiological functions
should be included in every patient case presentation
Vital signs
Vital signs
Weight RR Pulse Temp BP
Adults: 12–20
newborns: 30–60
children: 20–40
Respiratory rate
absence of breathing
Apnea
difficult breathing or
shortness of breath
Dyspnea
difficulty breathing in
supine position
Orthopnea
deep, rapid breathing;
hyperventilation
hyperpnea
deep, regular breathing with rate slow, normal, or
fast
Severe metabolic acidosis
Kussmaul breathing
Severe Metabolic AUSSidosis
unpredictably irregular breathing
Ataxic respiration
cyclic pattern of apnea and varied breathing
dying process
Cheyne-Stokes respiration
Normal body temp
37 C /98.6 F
rectal
1 F higher
axillary
1 F lower
normal pulse
60-100
pulse generally is taken _______
at the radial artery
normal BP
<120/80mmHg
135-145 mEq/L
Normal Sodium
Na i3s-iqs
3.5-5 mEq/L
K
K-3.s-s
95-106 mEq/L
Cl
CIgs-loG
8.2-10.8 mg/dL
Ca
CaB.z-lo.B
2.6-4.5 mg/dL
P (phosphate)
8-20 mg/dL
BUN-B-ZO
cause false
high Na level.
Hypertriglyceridemia and hyperglycemia
low K can be caused by
LOW Key ihi amp
diuretics and ampho B
can cause a false increase in K
hemolysis
Hi! moLIEsis? K
meds that can increase K
potaTESAHAT TRIamterine EPLErenone SPIROnolactone AmiloRIDE HEParin ACEi TRImethoprim
Chloride loss thru prox tubule in kidney can cause
Metab al(Ch)alLOSSis
can cause decrease Mg
to lose Mg
Vomitting/diarrhea
Mgsuka/Mg-tae-tae
1.5-2.2 mEq/L
Mg
i.s-Z.Z
increased Mg levels
increase MgHAR
Hemolysis
Antacids
Renal insuff
_____ inCreases Ca protein binding
Alkalosis
Sa Alcala madaming naka-bind
_____Decreases Ca protein binding
Acidosis
Achi(Decrease)osis
Ac(High free calcium)
Abnormal phosphate is associated with
MaDR PO4(police)
Malnutrition
Diarrhea
Refeeding syndrome
Medications that can increase BUN
Tetracycline
Corticosteroids
high BUN in the CT steroid cycle
false elevation of BUN
Chloral hydrate
false high BUN sa corals~
pretending mataas nasa corals naman
false decrease in BUN
chloramphenicol
Streptomycin
Strip/colored Ramp false low BUN
kala mo low~mayaman pala
Normal SCr
0.7-1.5
SCr0.T-I.S
directly related to muscle mass and muscle
metabolism.
SCr
Scr is high with these meds
SCaredy- CATS ATA Cimetidine Amiloride Triamterine Spironolactone
ACEi
Trimethoprin
Aminogly-high dose
Blood Glucose
Fasting <100
if >=126~diagnosis for diabetes
dyabet1ZG
Total cholesterol
less than 200
LDL
less than 100
HDL
MEN:
greater than or equal to 40
WOMEN:
greater than or equal to 50
A1c
<5.7
HbA1c Less than a S.T(Saint)
INR
<1
2-3 on warfarin
causes of High INR
High levels ThroPro-EC TOF-azole T-three EryTHROmycin CiPROfloxacin THREEmethoprim, OmeprAZOLE FluconAZOLE
Low INR causes
LOW INNER~ Tyred Barbi Cyclo Rif Vit K Cholestyramine Barbiturates Cyclosporine Rifampin Vit K
AST
8-42
AYT saTWO
8 42
patabaan nalang ng utak
ALT
3-30
ALT3-30
LD
100-225
Loo-zzs
False high liver transaminase
false liver enzyme”Riso”
or ISO my FAM so nagkaroon ako ng false hopes for my liver??WHAT??!
Isoniazid
Rifampin
important information
about the current status of the kidneys
electrolytes and acid–base balance
Basic metabolic panel (BMP)
BMP
Na Cl BUN Glucose
K CO SCr
135-145 95-105 8-20 <100~126
3-3.5 ? 0.7-1.5
disorders
such as infection and anemia. Laboratory values measured include
hematocrit (Hct), hemoglobin (Hgb), red blood count (RBC), white blood
cell (WBC) count
CBC w or w/o diff
risk for
atherosclerotic cardiovascular disease
Lipid panel:
tests various activities of the liver,
synthetic function, and hepatic disease
Liver function:
interference is caused by the pharmacological or the toxicological
drug effect
In vivo
