Apha-34patient Assessment Laboratory (1).docx

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APHA- Chapter-34- patient assessment laboratory Obtaining a Comprehensive Patient History; Chief complaint.; - the reason for the patient's visit. History Of present illness: identifies the onset of the illness and modifying factors Past medical history; - The patient's medical background of disease state and conditions. Distinguish between chronic conditions (e.g., diabetes, hypertension) and acute conditions (e.g., recent surgery, injury, or infection). → A patient's previous medical record included. MEDICATION ALLERGY AND IMMUNIZATIONS; - all medications taken by any route (e.g., oral, injectable), prescription drugs, OTC medications, herbal preparations, and treatment remedies. Adverse drug reactions, allergies, and immunization history should also be noted. Family history; - the patient's family medical history, such as diabetes, hypertension, high cholesterol, mental illness, and any genetic disorders Social history; - social activities that may have related to the present illness REVIEW OF SYSTEMS; - physical assessment, vital signs& observations Tem, B.P, abnormal mental status PROBLRM FOCUSED INTERVIEW Patient interview- open-ended questions and statements Seven basic screening questions;1) Location 2) quality 3) severity 4) timing 5) setting 6) modifying factors 7) associated symptoms Closing the interview;  Summarize all the gathered information for the patient.  Discuss the plan and follow-up method.

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 Ask for additional questions and concerns.  Write an organized document DOCUMENTATION; SOAP Subjective information, objective information, assessment, plan Subjective information; All the information reported by the patient How the patient feels, observation about the current conditions, current medications. Objective information; - physical & mental observations, vital signs, physical findings, lab; test results Assessment; - evaluation & diagnosis of the case presented, eg. UTI Plan;-treatment plan & recommendations Physical assessment, tech, terminology and modification; Inspection; - Inspection involves a general observation of the patient, noting abnormal physical appearance or behavior. Cleanliness, appropriateness of patient’s attire, general deportment Gait → examined, → abnormalities ataxia, foot drop, intoxication Palpation; - use of sense of touch in the evaluation of the patient .it helps the provider assess the texture, moisture, temperature, masses, vibrations, & pulsations in the patient body A light touch should be used for skin surfaces. Deeper touches should be used to assess organs or masses in the body. Percussion;-

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Percussion is used to produce sounds, elicit tenderness, or assess reflexes in a patient. It is also helpful in locating organ borders, identifying organ shape and position, and determining whether an organ is solid or filled with gas. Administrated- → directly or indirectly Auscultation; - Auscultation involves listening for normal and abnormal sounds with a stethoscope. Sounds, including heart, breath, bowel, blood pressure, and blood vessels, can also signify medical conditions, if abnormal. Triage & referral skills Common complaints; HEADACHES;OTC; - → aspirin, magnesium salicylate, naproxen, ibuprofen, acetaminophen, and ketoprofen. Children under 15 years of age should not receive salicylates or ketoprofen, and children under 12 years of age should avoid naproxen. Patients with renal disease should not use magnesium salicylate. Patients with asthma, coagulation disorders, congestive heart failure, or chronic gastrointestinal ulcers should avoid salicylates and nonsteroidal antinflammatory drugs (NSAIDs) MUSCLE AND JOINT PAIN Acute, chronic, muscle and joint pain severe alert to body Patients with weakness in any limb, visually deformed joints or movement, or pain associated with severe nausea or vomiting should also consult their health care provider Fever; To reduce the body tem – main goal of fever treatment Treatment includes NSAIDs, aspirin, and acetaminophen. Infants with rectal temperature greater than 101°F- referred to health care provider

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Children older than 3 months of age with a rectal temperature equal to or greater than 104°F- referred to health care provider COMMON COLD Hydration and rest are usually the first line for treatment. Nasal sprays and humidifiers can be used in alleviating congestion and rhinorrhea. COUGH; Treatments include antitussives (menthol, camphor, diphenhydramine, dextromethorphan) and expectorants (guaifenesin) CONSTIPATION: pharmacist should interview the patient regarding diet, medications, and any other symptoms that may occur with the constipation. Treatment;Increased amount of fiber and fluid in the diet. Laxatives (e.g., bisacodyl) and stool softeners (e.g., docusate) may also be recommended, depending on the patient's age and underlying conditions. VITAL SIGNS Used to measure various physiological functions of the patient Evaluates as- patient weight, respiration, pulse, temperature, blood pressure Laboratory Values and Diagnostic Tests Basic metabolic panel (BMP).;- current status of kidney ,blood sugar and calcium level Complete blood count; -disorders such as infection and anemia, hematocrit, hemoglobin red blood count, white blood count (with or without differential count), and platelet count.

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Lipid panel; - assess risk for coronary artery disease;- Labs measured include highdensity lipoprotein (HDL), low-density lipoprotein (LDL), very low- density lipoprotein (VLDL), total cholesterol, and triglycerides Liver function; - This test assesses the various activities of the liver, synthetic function, and hepatic disease. False positive and negative test; In vivo interference; - pharmacological and toxicological drug effect In vitro interference; - the interaction of drugs in specimens (urine, blood, tissue) with laboratory testing reagents Labotary test of therapeutic drugs; Drugs that requires TDM;- Neurological medications; Immunosuppressant’s. Antibiotics., Antiarrhythmic. Antiasthma tics, Hormones, Anticoagulants Over the counter testing devices Blood Glucose monitors- diabetic patients for self-monitoring Pregnancy testing devices; - measure HCGH level in the urine Drug screening for Home use; - amphetamine, barbiturates, cocaine etc DNA Paternity Test; - identify father & child DNA Blood pressure testing kit The patient should allow at least 2 hours after meals. He or she should be resting in a seated position for at least 5 minutes. He or she should avoid having a full bladder, exercising, eating, talking, or moving before checking BP. PRINCIPLES OF ELECTROCARDIOGRAPHY; An electrocardiogram, abbreviated as ECG or EKG Recording the electrical activity of the heart Performing- attaching skin electrodes to the patient produce electrocardiograph

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12 leads- 12 different views of the electrical activity of the heart 6 limb leads- heart frontal plane 6 chest leads to view the heart anteriorly and posteriorly P- Contraction of atria PR- PR interval- conduction of atrioventricular (AV) node medications can affect the PR interval, Eg. beta blockers, verapamil, digoxin, clonidine, diltiazem, and amiodarone Largest spike – QRS COMPLEX- ventricular contraction Downward slope spike- QT Interval- ventricular repolarization medications can affect the QT interval- quinolones, clarithromycin, erythromycin, and tricyclic antidepressants T- Repolarization of the ventricle SINUS RHYTHM: Electrocardiogram paper contains small squares that are 1 mm in height and width 5 of these smaller squares are contained within a larger square – darker inked boundaries Each smaller square represents – 0.04 seconds Each larger square represents – 0.2 seconds (0.04 seconds X 5) Regular rhythm of the heart classified - fast, normal, slow “P” wave, QRS complex & T wave will appear the same at regular intervals Sinus Bradycardia  Increased vagal tone (seen mostly in athletes, but also caused by straining at stool or vomiting)  Sleep  Increased intracranial pressure  Certain medications (beta blockers)

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SINUS TACHYCARDIA Sinus tachycardia is classified as any heart rate that exceeds 100 beats per minute Causes of sinus tachycardia include stress, dehydration, blood loss, systemic infection, and certain medications (e.g., stimulants, caffeine, and cocaine). Rapid heart rates, in addition to tachycardia, could also include atrial tachycardia, atrial flutter, and ventricular tachycardia

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ATRIAL FIBRILLATION  Atrial fibrillation is the most clinically encountered arrhythmia.  Atrial fibrillations, also known as supraventricular arrhythmias,  characterized by unorganized electrical activity between the atria and the ventricles.  Irregular rhythms are usually classified by their appearance on an electrocardiograph

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Atrial flutter  Atrial flutters are characterized by rapid atrial rates that could exceed 250 beats per minute  They occur when the AV node does not allow some of the electrical impulses to travel to the ventricles.  Both atria and ventricles are in regular rhythm.  Although T waves cannot be identified, P waves often appear to have a saw-tooth configuration. QRS complexes are normal.

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Ventricular tachycardia;  Ventricular tachycardias occur when three or more consecutive premature ventricular contractions occur.  The heart rate is typically regular, with ventricular rate measuring between 100 and 200 beats per minute  The QRS complex, which has a saw-tooth appearance, is widened, and P and T waves are usually absent  One type of ventricular tachycardia is referred to as torsades de pointes, or "twisting of the points." Although the electrocardiograph in torsades is similar to ventricular tachycardia, the former has a distinctive twisting of the QRS complex around an isoelectric point.

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VENTRICULAR Fibrillation

 During a ventricular arrhythmia, organized electrical or mechanical activity of the heart is absent  The rate is irregular, and P and T waves and QRS complexes are indiscernible on an electrocardiograph  This arrhythmia requires electrocardioversion, ordeath will ultimately result.

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ST SEGMENT CHANGES; Changes in the area between the QRS complex and T wave can signify myocardial problems When ST segment depression occurs, → signifies myocardial ischemia without heart tissue damage. ST segment elevation →indicates injury to the myocardium, typically a myocardial infarction. During a heart attack, ST segment elevation can appear anywhere between immediately and a few hours after injury. Cardiopulmonary arrest occurs when ventilation and circulation spontaneously terminate. Causes; Bradyarrhythmias, Asystole, Electrocution, Drowning, Choking, Trauma Illegal drug use, Myocardial infarctions that result in ventricular fibrillation Cardiopulmonary arrest- 4 to 6 minutes of onset CPR – cardio pulmonary resuscitation, early defibrillation, pharmacological therapy CPR – administrated by ABCD SEQUENCE A- Airway B- Breathing C- Circulation D- Defibrillations

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Pharmacological therapy; Vasopressors and agents to control rhythm – epinephrine & vasopressin Resuscitation- 1mg epinephrine I.V push every 3-5 minutes Antiarrhythmic agents to restore sinus rhythm; - lidocaine, amiodarone, procainamide, adenosine, atropine