Pharm Practice - Midterm Material Flashcards
Subjective vs Objective
Subjective - What patient tells you, history, CC
Objective - What you detect during Exam (Vitals)
Components of Past History
Childhood illnesses Adult Illnesses w/ Dates - Medical (HTN, DM) - Surgical (indication/types) - Obstetric/Gynecologic (history) - Psychiatric (Illnes/timeframe)
ROS
Review of systems
Documents presence or absence of common symptoms related to each major body system, long list of y/n questions
7 attributes of a symptom
History Location Quality Severity Modifying Factors Onset Additional symptoms Duration
ROS Categories
General Skin Head Eyes Ears Nose Throat Neck CDV Lungs GI Limbs Genito/Urinary Musculoskeletal Hematologic Endocrine
4 cardinal techniques of examination
Inspection
Palpation
Percussion
Auscultation
Inspection
Close observation of details of patient’s appearance, behavior, movement
Palpation
Tactile pressure from the palamar fingers/pads to assess areas of skin elevation, depression, warmth, tenderness, etc.
Percussion
striking w/ fingers to create a sound wave from underlying tissues/organs
Auscultation
Listening w/ stethoscope to detect characteristics of heart/lung/bowel sounds
Problem Lists how to
Start with most severe, CC first unless will make dead
What is FIFE
Patients Perspective on illness
Feelings
Ideas
Function
Expectations
FIFE - Feelings
What the patient feels about the problem (fears/Concerns)
FIFE - Ideas
Patient’s idea about the nature/cause of the problem
FIFE - Function
Effect of problem on patients life and functioning
FIFE - Expectations
What does the patient expect of the disease/clinicion/healthcare
3 dimensions of cultural humility
Self Awareness
Respectful Communication
Collaborative Partnerships
Building Blocks of Ethics
Nonmalefeficence
Beneficence
Autonomy
Confidentiality
Primum Non Nocere
Nonmaleficence
First, do no harm
Benficence
clinician must do good for the patient
Autonomy
Patients have right to determine what is in their best interest
Confidentiality
Obligation to not say anything about patient. Give privacy.
Hx
History
PMH
Past Medical History
CC
Chief Complaint
C/O
Complains of
HPI
history of present Illness
FH
Family History
SH
social History
H&P
history and physical
WDWN
well developed/well nourished
HEENT
Hed, ears, eyes, nose and throat
HA
Headache
N/V
nausea/Vomiting
RHM
routine health maintenance
CV
cardiovascular
PV
peripheral Vascular
HTN
hypertension
BMI
Body mass Index
GU
Genito-urinary
Calculate BMI
Weight (KG) / height (m2)
6 - “7” Vital Signs
Height Weight BP HR Respiratory Rate Temperature "Pain"
Waist Circumference + Risk
Women - 35+
Men - 40+
= Risk for Diabetes/HTN/CVD
Normal HR
50-90
White Coat HTN
15-20% of stage 1 HTN in office (ambulatory readings = normal)
Masked HTN
Office BP = normal (ambulatory readings = high, risk of CVD)
CAGE
Questions Regarding substance/alcohol abuse
Cutting Down
Annoyance when criticized
Guilt
Eye Openers
RRR
Regular Rate and Rhythm
BP
Blood Pressure
BPM
beats/min breath/min
HR
Heart Rate
RR
Respiratory Rate
Na
Sodium
KCl
Potassium Chloride
Cl
Chloride
HCO3
Bicarbonate
BUN
Blood Urea Nitrogen
SCr
Serum Creatinine
CrCl
Creatinine Clearance
Ca
Calcium
ALT
Alanine Aminotransferase
ALP
Alkaline Phosphatase
RBC
Red Blood Cells
WBC
White Blood Cells
HgB
Hemoglobin
Hct
Hematocrit
H&H
Hemoglobin & Hematocrit
Plt
Platelets
Erythrocytosis
High Red Blood Cell count
Erythrocytopenia
low red blood cell count
Thrombocytosis
High platelet count
Thrombocytopenia
Low platelet count
Leukocytosis
high wbc count
Leukocytopenia
low wbc count
Pancytopenia
low RBC, WBC, and Plts
Anemia
Lack of blood (low rbc)
Hyperkalemia
High serum levels of potassium
Rhythm disturbancances (bradycardia, cardiac arrest)
Shifts: Crush injuries/burns
Increased potassium intake
Decreased output (renal failure or drugs)
Hypokalemia
Low serum levels of potassium
Shifts of Insulin/Dextrose
Deficits in diet, meds, vomiting, diarrhea
Hypernatermia
High serum levels of sodium
(low = greater water loss than Na loss)
(high - IV hypertonic solution)
Thirst, irritability, seizures
Hyponatremia
Low serum levels of sodium
often caused by dilution
Chem-7 Units
Na K Cl SCr BUN CO2 Glu
Sensitivity
ability to sense true positive
Specificity
ability to sense true negative
Na reference Range
135-145 mEq/L
K reference Range
3.5-5.0 mEq/L
Cl Reference Range
96-106 mEq/L
Follows Sodium to maintain osmolality
CO2 reference range
22-32 mEq/L
Metabolic Acidosis
Blood CO2 low, increased RR
Metabolic Alkalosis
Blood CO2 high, lethargy/confusion
BUN reference Range
8-20 mEq/L
Azotemia
High Blood Nitrogen, helpful in assessing renal function
SCr reference Range
0.7-1.2 mg/DL
BUN:SCr ratio indicates
> 20:1 = pre-renal failure (sign of dehydration)
IBW
Ideal Body Weight
Male - 50kg + (2.3kg(inches over 5ft))
Female - 45.4kg + (2.3 (inches over 5ft))
ABW
Actual Body Weight
Adj BW
Adjusted Body Weight
IBW + 0.4(ABW-IBW)
Cockcroft-Gault
CrCl = [((140-age)xWeight(kg))/(SCr x 72)] x (0.85 female)
Glu Reference Range
70-110 mg/dL
~40 needed for brain function
~400 = ER
Hyperglycemia
High Blood Glucose –> Ketoacidosis (fruity breath)
Hypoglycemia
Low Blood Glucose –> risk of coma/death
Mg reference Range
1.5-2.2 mEq/L
Mirrors Potassium
Hypermagnesemia
Decreased RR
Increased risk MI
Hypomagnesemia
Increased RR
Decreased GI absorption
Ca Reference Range
8.5-10.8 mg/dL
Neuromuscular activity/endocrine function
Hypercalcemia
Twitching, Kidney Stones, Constipation
Hypocalcemia
Tingling, Numbness
Phosphate Reference Range
2.6-4.5 mg/dL
Opposite Calcium
High energy bonds of ATP
(may cause renal failure)
Albumin Reference Range
3.5-5.0 g/dL
main serum protein produced by liver
Binds Ions/drugs
Hyperalbuminemia
May cause sudden dehydration
