Week 25 - fundamentals of diagnosis & diagnostic tests Flashcards
Diagnosis
The identification of the nature of an illness or other problem by examination of the symptoms
What contributes to diagnosis?
-Patient history
-Observations
-Physical examination
-Results of diagnostic tests
-Clinical experience and professional judgement
History taking
-> 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
Introduction
-> 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
Presenting complaint (PC)
Why has the patient come to see you?
Open questions:
“What has brought you into hospital today?”
“What can I help you with today?”
“What seems to be the problem”
->Points to remember:
-Active listening
-Open body language
-Building rapport
-Letting the patient speak
History of the presenting complaint (HxPC)
Details relating to the presenting complaint
These questions depend on the presenting complaint or body system being affected
->S O C R A T E S
-Site, onset, character, radiation, associated symptoms, time, exacerbating or relieving factors, severity
Past medical / surgical history (PMHx)
Identifying what underlying conditions and surgical procedures the patient has had
Why? -> risk factors associated with PC
Open questions:
“Do you have any medical conditions”
“Have you ever had surgery”
->Useful to cross match the PMHx and DHx
M J T H R E A D S Ca
Myocardial infarction, Jaundice, Tuberculosis, Hypertension, Rheumatic fever, Epilepsy, Asthma, Diabetes, Stroke, Cancer
Family history (FHx)
This tends to relate to the presenting complaint (PC)
Some conditions have a genetic element
Not so relevant when taking a Hx over the counter but
important step in more thorough history taking
Social history (SHx)
Drug history (DHx)
-Confirming the name and dose of all the patients medication
-Confirming compliance is also essential -> how does the patient actually take the medication
Why is a DHx important?
-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?
Systems review
Specific questions relating to all body systems:
1. Cardiovascular
2. Respiratory
3. Gastrointestinal
4. Genitourinary
5. Neurological
6. Locomotor
Differential diagnosis
A list of possible conditions or diseases that could be causing the symptoms
->When a patient presents with a set of symptoms, the practitioner will develop a list of possible causes -> differential diagnosis
The list of potential causes will be based off the facts they have
obtained from:
-Patients history
-Observations
-Physical examination
-Diagnostic tests
A plan will then be made to help differentiate between the potential causes e.g. tests needed, treatment required -> This will help narrow the list of potential causes before a diagnosis is made
Professional judgement and diagnosis
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
Why is it important?
-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
Steps involved in professional judgement
- Identify the ethical dilemma / professional problem
- Gather all the relevant information
- Obtain advice from support services, seniors
- Identify the possible options
- Weight up the risk vs benefits and advantages and disasvantages of each options
- Make a decision -> must be able to justify it
- 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
Diagnostic tests – blood pressure
Diagnostic tools required:
-How to take a BP – diagnostic test workshop
->When would you check BP?
-Routine observation in hospital
-Routine as part of BP medication check
-?High BP = headache
-?Low BP = light headed, falls
Diagnostic tests – heart rate / pulse
Diagnostic tools required:
-Number of beats / min
-Count number of radial pulses over 60 seconds (30
seconds x 2)
->When would you check heart rate:
-Routine observation in hospital
-Dizziness
-Fainting / light headed
-Palpitations
Diagnostic tests – respiratory rate
Diagnostic tools required:
-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
Diagnostic tests - temperature
Diagnostic tools required:
-Multiple types of thermometers
-When would you want to take a patients temperature?
-Routine observation for patients in hospital
-? Infection
Diagnostic tests - oxygen levels / saturations
Diagnostic tools required:
->Measures the amount of oxygen in a patients blood as a
percentage:
->Healthy patient O2 sat: >95%
Respiratory conditions (COPD): 88 – 92%
How does it work?
-Shines two types of light through your finger (one red
light, one infra-red light) -> red blood cells with lots of oxygen,
high absorption of infrared light
Allows red light to pass through
->Red blood cells with low levels of oxygen: low absorption of red light -> allows infrared light to pass through
When would you see it being used?
-Routine in hospital setting as part of patients observations
-Respiratory clinics / conditions
-Covid-19
Diagnostic tests – ear examination / visualisation
Diagnostic tools required:
Wouldn’t routinely see this being used in a community pharmacy setting
When would you see it?
-Dizziness / ringing / crackling sound in ear
-Ear infection
-Hearing assessment: hearing loss / changes in hearing
Diagnostic tests- BMI / weight
BMI = Weight (kgs) / Height (m)^2
When would you want to check some ones BMI / weight?
-Weight loss clinic
-Diabetes or cardiovascular clinic -> high BMI is a risk factor
Diagnostic tests - blood sugar monitoring
Variety of types:
Continuous glucose monitoring – devices fitted under the patients skin which they can
scan using smart phone to check BMs
Blood glucose monitoring – single use blood tests used to check BMs where patient pricks
finger, collects blood and runs the test
->When would you see this being used?
-Diabetic patients
-Patients who have collapsed
-Recurrent urinary tract infections
Diagnostic tests – peak flow
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
Diagnostic tests - others
Throat Swabs:
->Sore throat test and treat service
-Patients with sore throat can have a throat
swab undertaken by a community pharmacist; ->Bacterial: antibiotics provided OTC
->Viral: self help advice
Urine Dip testing:
-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
Pregnancy testing / STI home testing kits:
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 patient contacted
by external company
Objectives
->Diagnosis is a complex and multistep process and one of the fundamental step and skills involved is the ability to take a thorough patient history
->Professional judgement is a key skill that is required by a pharmacist that is often
involved in the diagnostic process but also other tasks such as the sale and
supply of medication
->There are several diagnostic tests available to pharmacists and its important to know how and when to use them
