Point of care testing Flashcards
What is the first thing needed to be done in order to diagnose a patient?
Take an extensive history
What are the next steps after taking history?
Investigations required to confirm or reject diagnosis
What are characteristics of type II diabetes?
Polyuria
Foot ulcer
Thirst
Obesity
High blood pressure
What are questions to ask to obtain a good history?
Smoking
Drinking
Diet
Levels of activity
Family history
What is point of care testing?
Tests that can take place beside the patient to confirm the diagnosis
Diagnosis is rapid
Confirm or refute the diagnosis
What are the advantages of POCT?
Convenient and quick
Care must be taken to train and monitor operators to ensure quality and accuracy
What are examples of POCTs?
Blood pressure measurement
Ultrasound using portable devices
Dipstick urinalysis
Blood glucose measurement
What are characteristics of type II diabetes?
A metabolic disorder associated with obesity
Characterised by
- hyperglycemia
- resistance to insulin
What are diabetic neuropathies?
Affect those with both type I and type II diabetes
Family of nerve problems which produce a variety of symptoms including
- numbness
- balance problems
- muscle weakness
Which factors contribute to diabetic neuropathies?
Microvascular disease - may reduce blood supply to the nerves
Aberrant glycation of proteins - alters their structure and function
What percentage of people with type II diabetes show signs of complications by the time they are diagnosed?
50%
Include
- poor wound healing
- gangrene
- foot ischaemia
- ulceration
- intermittent claudication
What apparatus is used to measure blood pressure?
Sphygmomanometer
Blood pressure chart
What is used to measure BMI?
Tape measurement around the waist
BMI chart
What do urinalysis tests test for?
Blood
Glucose
Leukocytes
Ketones
Nitrite
pH
Protein
Specific gravity
Urobilinogen
How do dipstick tests test for glucose?
Oxidation reaction in the strip pad
Glucose oxidase enzyme in the strip catalyses the oxidation of glucose to form gluconic acid and hydrogen peroxide
H2O2 reacts with a reduced dye in the test strip producing a colour change
The colour change is proportional to the amount of hydrogen peroxide produced
The colour produced is compared to a reference chart to estimate the concentration of glucose present
How is urine collected for urine dipstick tests?
Urine should be collected midstream in a sterile container by the patient
How is urine placed on the urine dipstick test stick?
Test operator dips the dipstick into the urine
Gently wipes away excess using the container rim
Dipstick should be held horizontally for the required time (30s-120s) to prevent chemicals from the strip from mixing
What are the colour changes on the dipstick used for?
Used to approximate the levels of the various compounds by comparison to the chart on the side of the bottle
What are other types of tests that can be ordered?
More complex tests
What do more complex tests require?
Processing in a specialist pathology laboratories
Samples must be collected from the patient and sent to the correct department
Critical that the patient samples are accurately and fully labelled
How are pathology requests sent?
Online system
What information does the request form contain?
Patient identity - name, DOB, hospital number
Who and where the request is from
Type of sample
Date and time of collection
Clinical details, why test has been requested, urgency
What tests are ordered by the GP in suspicion of diabetes?
Full blood count
Blood test for type 2 diabetes - glycated haemoglobin
Lipid profile
How is a lipid profile carried out?
Performed after overnight fast of 10 hours
Patient attends blood test clinic
Regulates an aspect of the lipid profile
