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M103 > W21 Fundamentals of Prescribing, Diagnosis and Diagnostic Tests > Flashcards

W21 Fundamentals of Prescribing, Diagnosis and Diagnostic Tests Flashcards

1
Q

Supplementary vs Independent Prescribing
Supplementary prescriber definition:

A

Prescribe under a specific Clinical Management Plan (CMP) set out
under a doctor stating what can and can’t be prescribed and under what
circumstances. The Doctor is the overall responsible clinician accountable for care of
the patient(s)

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2
Q

Independent Prescriber definition:

A

Can prescribe any medication independently for any condition within the scope of practice and competence. EXCEPT for Cocaine, diamorphine and dipipanone for addiction. Pharmacist is accountable clinician for care of the patient.
PIPs can now prescribe CD

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3
Q

What is meant by Prescribing??

A
  • Healthcare practitioner authorises the use of a medicine or treatment for an
    individual patient.
  • Enables patient to obtain treatment required for their condition e.g. Abx for
    tonsillitis
  • Usually by writing a legally valid prescription form e.g. FP10/WP10
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4
Q

What is Clinical decision making?

A
  • A process that involves gathering and understanding of information e.g. from, patient, diagnostic test
  • Application of clinician knowledge
  • Provide the most appropriate treatment that will benefit treatment and reduce harm
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5
Q

Principles of prescribing

A
  • Be clear in the reasons for prescribing
  • Clear diagnosis
  • Benefit vs. risks to the patient
  • Consider patient medication Hx before prescribing
  • Drug Interactions, Adverse Drug Reactions, Allergies
  • Consider factors that might affect the benefits & risks of treatment
  • Age, Pregnancy, Kidney/Liver Function, Heart failure
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6
Q

Prescribing process:

A

History taking
Observations
Physical examination
Diagnostic tests and results
Clinical experience, prof judgement, decision making
= Prescribe/Not prescribe

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7
Q

What is the definition of a diagnosis?

A

“The identification of the nature of an illness or other problem by examination of the symptoms”

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8
Q

What factors contribute to a diagnosis?

A

Patient history
Results of diagnostic tests
Clinical experience & Profession judgement
Physical examination
Observations

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9
Q

What is history taking?
What are the steps in history taking? (8)

A
  • “Information gathering”
    Split into 8 stages:
    a) Introduction
    b) PC: Presenting complaint
    c) HxPC: History of the presenting complaint
    d) PMHx: Past medical (and surgical) history
    e) FHx: Family history
    f) SHx: Social history
    g) DHx: Drug history
  • Allergies
    h) System review
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10
Q

What is the ‘introduction’ step of history taking?

A
  • Opening the consultation
  • What should we include here?
  • Wash hands / don correct PPE
  • Introduce yourself (name, job role)
  • Identify you are speaking to the correct individual (name, address/dob)
  • Purpose/permission: explain the purpose of the consultation/history taking
  • Position: eye level with the patient, 1m away (2m to help with social distancing)
    (WIIPP)
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11
Q

What is the ‘PC’ step of history taking?

What questions can you ask here?

A

Presenting complaint.
* Why has the patient come to see you?

Open questions:
* “What has brought you into the hospital today?”
* “What can I help you with today?”
* “What seems to be the problem”
* Points to remember from your communication skills workshop

Active listening
* Open body language
* Building rapport
* Letting the patient speak

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12
Q

What is the HxPC step of history taking?

A
  • Details relating to the presenting complaint
  • These questions depend on the presenting complaint or body system being affected
  • SOCRATES acronym is used
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13
Q

“Can I get some Gaviscon please, biggest bottle you
have? I have never had heartburn like this before
Would you sell the product?
What other information would you want to know?

A
  • Reflux/dyspepsia
    S- Central chest pain
    O- Sudden onset
    C- Heaviness in the chest
    R- Radiates to the jaw
    A- Sweaty, clammy
    T- Walking the dog
    E- Taking a rest
    S- 8/10
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14
Q

What does SOCRATES stand for?

A

Site
Onset
Character
Radiates
Associations
Timing
Exacerbating factors
Severity

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15
Q

What is identified in the Past Medical / Surgical History (PMHx) stage in the process?

A

Identifying what underlying conditions and surgical procedures the patient has had

Why?
* Risk factors associated with PC
e.g. Type II diabetes  heart attack risk
* Open questions:
* “Do you have any medical conditions”
* “Have you ever had surgery”
* Useful to cross-match the PMHx and DHx:

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16
Q

D) Past Medical / Surgical History (PMHx)
* Another acronym is used to ensure nothing is missed (medical conditions):

What does M J T H R E A D S Ca stand for?

A

Myocardial Infarction
Jaundice
Tuberculosis
Hypertension
Rheumatoid arthritis
Epilepsy
Asthma
Diabetes
Stroke

(Or JAM THREADS where a= anaemia & other haematological conditions

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17
Q

What is identified in the E) Family History (FHx) process?

A
  • This tends to relate to the presenting complaint (PC)
  • E.g. Cardiovascular PC
  • 1st degree relatives having hx of heart attacks?
  • Parents or siblings passed away before the age of 65 - ?cause
  • E.g. Hay fever / asthma / eczema
  • Any immediate relatives with “atopic” conditions
  • Some conditions have a genetic element
  • Not so relevant when taking a Hx over the counter but important step in more thorough history taking
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18
Q

What is identified in Drug History (DHx) process?

A
  • Confirming the name and dose of all the patients medication
  • Confirming compliance is also essential- how does the patient actually take the medication
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19
Q

Why is DHx important?

A
  • Side-effects / Adverse drug reactions
  • Drug-drug interaction
  • Drug–patient interaction
  • Drug–disease interaction
  • Compliance

Allergies
* Nature of the reaction

How do they take their medication?
* Does anyone help them?
* Nomad box?
* Carers?

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20
Q

What happens during h) Systems review?

A
  • Specific questions relating to all body systems:
    1. Cardiovascular
    2. Respiratory
    3. Gastrointestinal
    4. Genitourinary
    5. Neurological
    6. Locomotor
    (covered in y2&3)
21
Q

What is a differential diagnosis?
What could these potential causes be based off?

A

A list of possible conditions that could be causing the symptoms.
Facts that they have obtained from:
1. Patients history
2. Observations
3. Physical examination
4. Diagnostic tests

22
Q

What is meant by professional judgement?

A

“Professional judgement could be described as the use of accumulated knowledge and experience, in order to make an informed decision.”

“It takes into account the law, ethical considerations and all other relevant factors related to the surrounding circumstances.”

23
Q

Why is professional judgement important?

A
  • Needed day-to-day when working as a pharmacist in all sectors.
  • Part of the decision-making process
  • Easy concept to understand but often exercising professional judgement takes consideration.
24
Q

What are the steps involved in professional judgement? (7)

A
  1. Identify the ethical dilemma / professional problem
  2. Gather all the relevant information
  3. Obtain advice from support services, seniors
  4. Identify the possible options
  5. Weight up the risk vs benefits and advantages and disadvantages of each option
  6. Make a decision- must be able to justify it
  7. Where appropriate or significant document your decision-making process and reasoning

Two pharmacists could have the same scenario, the same options available but make a different decision

25
Q

Diagnostic tests – Blood pressure
When would you check BP? (4)
How do you take a BP?

A
  • Routine observation in hospital
  • Routine as part of BP medication check
  • ?High BP = headache
  • ?Low BP = light headed, falls

Using a sphygmomanometer, or a blood pressure cuff.

26
Q

How do you Pulse?
When would you check HR? (4)

A
  • Number of beats / min
  • Count number of radial pulses over 60 seconds (30 seconds x 2)
    (The radial pulse is felt on the wrist just under the thumb)

When would you check heart rate:
* Routine observation in hospital
* Dizziness
* Fainting / lightheaded
* Palpitations

27
Q

How do you check resps?
When would you check resps?

A

Number of breaths / min
* Count the number of times the patients chest rises in 60 seconds (30 seconds x 2)

When would you check heart rate:
* Routine observation in hospital
* Shortness of breath
* Respiratory assessment (e.g. Asthma)

28
Q

How do you check temp and when would you check it?

A
  • Multiple types of thermometers
  • Routine observation for patients in hospital
  • ? Infection
29
Q

What are oxygen levels/saturations?
How does it work?

A
  • Measures the amount of oxygen in a patients blood as a percentage:
  • Health patient O2 sat: >95%
  • Respiratory conditions (COPD): 88 – 92%
  • Shines two types of light through your finger (one red light, one infra-red light)
  • Red blood cells: Lots of oxygen
  • Inc absorption of infrared light
  • Allows red light to pass through
  • Red blood cells with low levels of oxygen:
  • Inc absorption of red light
  • Allows infrared light to pass through
30
Q

When would you see sats being taken?

A
  • Routine in hospital setting as part of patients
    observations
  • Respiratory clinics/conditions
  • Covid-19
31
Q

Ear examination / visualisation:
When would you see it being used?

A
  • Wouldn’t routinely see this being used in a community pharmacy setting
  • When would you see it?
  • Dizziness/ringing / crackling sound in the ear
  • Ear infection
  • Hearing assessment: hearing loss/changes in
    hearing
32
Q

BMI/Weight:
What is the calculation to calculate BMI?

A

BMI= Weight (kgs) / [Height (m)]^2

33
Q

When would you want to check someones BMI/weight?

A
  • Weight loss clinic
  • Diabetes or cardiovascular clinic
  • High BMI is a risk factor
34
Q

Blood sugar monitoring:
What are the different types?
When would you see them being used?

A
  • Continuous glucose monitoring – devices fitted under the patient’s skin which they can scan using smartphone to check BMs
  • Blood glucose monitoring – single-use blood tests used to check BMs where patient pricks finger, collects blood and runs the test
  • Diabetic patients
  • Patients who have collapsed
  • Recurrent urinary tract infections
35
Q

Measuring Peak flow:
What is it?
When would you see it being used?

A
  • Measures how quickly you can blow air out of your lungs

How to use:

  • Take a deep breath in
  • Blow as hard and fast as you can into the peak flow meter = Peak Expiratory Flow (PEF)
  • Plot on the chart to see where your PEF score sits
  • Helps identify changes in your airways
  • When would you see it being used:
  • Respiratory conditions (e.g. Asthma) – monitor stability, triggers, medication is work etc
36
Q

Diagnostic tests - Throat swabs

A
  • Sore throat test and treat service
  • Patients with a sore throat can have a throat
    swab undertaken by a community pharmacist;
  • Bacterial: antibiotics provided OTC
  • Viral: self-help advice
37
Q

Diagnostic tests- Urine Dip testing

A
  • Urinary tract infection service
  • Pilot in Hywel Dda – Jan 2022
  • Allows urine to be tested to look for infection
    markers- Abx provided if needed
  • Also can highlight excessive glucose, blood
    which may warrant further investigation and
    referral
38
Q

Diagnostic- Pregnancy testing / STI home testing kits

A
  • Now available in community pharmacies
  • STI kits:
  • HIV
  • Chlamydia / gonorrhoea
  • Syphilis
  • Tend to be provided in community pharmacy
    (charge) and sent to be tested and the patient contacted by external company
39
Q

What diagnostic tests would you do on a patient with respiratory problems?

A

Peak flow
Respiratory rate (sats)
Pulse

40
Q

Symptoms of an asthma attack

A

Symptoms are getting worse (cough, breathlessness)
Blue inhaler is not helping
Peak flow score is lower than normal

  • Regular review with GP/nurse
  • Check if pt uses the appropriate inhaler technique
41
Q

Diagnostic tests for UTI/Cystitis

A

Urine analysis
Body temperature

42
Q

How do you take blood pressure? Step-by-step process:

A

1.Take radial pulse
2. Place sphygmanometer on brachial artery

43
Q

How to take a radial pulse?

A
  • Your radial pulse can be taken on either wrist.
  • Use the tip of the index and third fingers of your
    other hand to feel the pulse in your radial artery
    between your wrist bone and the tendon on the
    the thumb side of your wrist.
  • Apply just enough pressure so you can feel each
    beat.
  • When you feel your pulse, look at your watch and
    count the number of beats in 60 seconds.
44
Q

What is a normal resting HR?

A
  • Sinus Rhythm: 70 – 100 BPM
  • Sinus Bradycardia: <60 BPM
  • Sinus tachycardia: >100 BPM
45
Q

How to take a manual blood pressure (recap)?

A
  • Introduce yourself and role
  • Identify patient
  • Wash/gel hands
  • Explain procedure and consent patient
  • Ensure correct cuff size
  • Attach cuff to upper arm – align correctly
  • Palpate radial pulse (take measurement)
  • Inflate cuff and estimate systolic blood pressure and verbalise/write (then deflate cuff)
  • Palpate brachial pulse
  • Place diaphragm of stethoscope over brachial pulse
  • Inflate cuff to about 20 mmHg above estimated systolic pressure
  • Slowly deflate cuff
  • When pulsatile sound appears (1st Korotkoff sound) this is actual systolic pressure
  • When pulsatile sound disappears (5 th Korotkoff sound) this is diastolic pressure
  • Quickly deflate cuff and remove
  • Verbalise/write BP in the format, e.g. 120/75mmHg
  • Thank patient and ask if any questions
    Checklist
46
Q

Auscultation method: Blood pressure

A
  1. Close the valve on the blood pressure cuff.
  2. Position the diaphragm of your stethoscope over the
    brachial artery.
  3. Re-inflate the cuff 20-30 mmHg above the systolic blood
    pressure you previously estimated.
  4. Slowly deflate the cuff at around 2-3 mmHg per second.
  5. Using your stethoscope, listen carefully for the onset of
    a pulsatile noise (Korotkoff sound) = systolic blood
    pressure.
  6. Continue to deflate the cuff while listening through your
    stethoscope until the pulsatile sound completely
    disappears (fifth Korotkoff sound) = diastolic blood
    pressure.
47
Q

Palpation Method: Blood pressure

A

Ensure the valve on the blood pressure cuff is
closed.
* Palpate the volunteer’s radial pulse, located at
the radial side of the wrist, with the tips of
your index and middle fingers aligned
longitudinally over the course of the artery.
* Inflate the blood pressure cuff until you can no
longer feel the volunteer’s radial pulse.
* Record the reading on the sphygmomanometer
at the point at which the radial pulse becomes
impalpable. This reading is an approximate
estimate of the volunteer’s systolic blood
pressure.
* Deflate the blood pressure cuff.

48
Q

Taking a blood pressure of a patient
(OSCE)

A

Hi im Hana the pharmacist. Today I would like to take your blood pressure so that will entail me taking this cuff, inflating it around your arm, feeling and listening to your pulse
It might feel uncomfortable but it shouldn’t hurt. Is that ok with you?
If you pop your arm on the table.
Align cuffmaker with brachial artery
Approximate Systolic BP (where you no longer feel pulse) Note reading.
Palpate brachial artery, place stethoscope on brachial artery
Reinflate cuff 20-30mmHg above systolic BP
Slowly deflate cuff 2-3mmHg per second
Listen for first Korotkoff sound and note the BP (this is Systolic BP)
When this sound disappears you have found the Diastolic BP
Deflate cuff, Remove it
That completes the procedure. Thank patient.

M103 (46 decks)

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