ASSESSMENT

Agnes L. Castillo, PhD
Faculty of Pharmacy
University of Santo Tomas

ASSESSMENT
VITAL SIGNS
• Most frequent measurement obtained by
health practitioners
• Indicators of health status
• Indicate the effectiveness of functions:
circulatory, respiratory, nervous and endocrine
• Provides data to determine a client’s usual state
of health (baseline data)

ASSESSMENT

VITAL SIGNS
• Temperature
• Blood pressure
• Pulse rate/cardiac rate
• Respiratory rate

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ASSESSMENT VITAL SIGNS • Pain • Fifth vital sign • As decided by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and pain management experts .

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ASSESSMENT VITAL SIGNS FACTORS CAUSING VITAL SIGNS TO CHANGE • Temperature of the environment • Patient’s physical exertion • Effects of illness .

ASSESSMENT VITAL SIGNS • Change in vital signs .indicates a change in physiological function • Allows the pharmacist • Assess response to drug and non-drug therapy • Identify diagnoses • Implement planned interventions • Evaluate success when vital signs have returned to acceptable values .

ASSESSMENT VITAL SIGNS • Essential ingredient when pharmacists. nurses and physicians collaborate to determine the patient’s health status .

ASSESSMENT VITAL SIGNS • Need for hands-on proficiency in specific physical assessment skills varies according to the type of patient care setting • All pharmacists should have at least a basic understanding of these skills .

ASSESSMENT VITAL SIGNS BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA) • Inspection (check-up) • Palpation (feel) • Percussion (beating) • Auscultation (stethoscope) .

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Doing this makes mucus easier to expel. is an airway clearance technique that involves clapping on the chest and/or back to help loosen thick secretions. also referred to as chest physiotherapy. . Percussion Chest percussion. or cough up.

ASSESSMENT VITAL SIGNS GUIDELINES FOR MEASURING VITAL SIGNS • Part of the database/record that a pharmacist collects during assessment • Baseline for future assessments .

how and by whom vital signs are measured • Pharmacist must analyze vital signs to interpret their significance and make decisions about interventions . where. ASSESSMENT VITAL SIGNS GUIDELINES FOR MEASURING VITAL SIGNS • Patient’s needs and condition determine when.

Equipment • Appropriate for the size and the age of the patient • Functional to ensure accurate findings • Selected based on the patient’s condition . ASSESSMENT VITAL SIGNS GUIDELINES FOR MEASURING VITAL SIGNS 1.

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therapies and prescribed medications should be known . ASSESSMENT VITAL SIGNS GUIDELINES FOR MEASURING VITAL SIGNS 2. Patient • Usual range of vital signs should be established • Medical history.

ASSESSMENT VITAL SIGNS GUIDELINES FOR MEASURING VITAL SIGNS 3. systematic approach when taking vital signs . Organized. Control and minimize environmental factors affecting vital signs 4.

5°C • Axillary 36.5°C • Pulse rate 60 to 100 beats per minute • Respiratory rate 12 to 16 breaths per minute • Blood pressure 110/70 mm Hg . ASSESSMENT VITAL SIGNS ACCEPTABLE RANGES FOR ADULTS • Temperature range 36° to 37° C • Oral/tympanic 37°C • Rectal 37.

ASSESSMENT VITAL SIGNS EQUIPMENTS • Thermometer • Stethoscope • Sphygmomanometer .

Thermometers .

Axillary thermometer .

Oral Thermometer .

Stethoscope

Sphygmomanometer

ASSESSMENT COMPLETE PHYSICAL EXAMINATION • Subjective (personal/individual) • Everything is important. depending on the chief complaint • Consider everything • Document the essential .

. Pulse 110. “I feel dizzy. 2. “My bladder never seems 2.” 3. old male 150 cm (5’2”) 36 Kg (80 lbs). 14 yr. Subjective Objective 1. empty.” 1. “I am too fat.” 3.Voids 100-150ml/void q 1-2 h. Blood pressure: 90/60.

ASSESSMENT COMPLETE PHYSICAL EXAMINATION HISTORY OF PRESENT ILLNESS (HPI) P – What provokes discomfort? Q – What is the quality of the discomfort? R – Where is the region of the discomfort? S – What is the severity of the discomfort? T – What is the time sequence? .

caffeine and smoking habits • Allergies? ASK FOR YOURSELF . ASSESSMENT COMPLETE PHYSICAL EXAMINATION HISTORY OF PRESENT ILLNESS (HPI) • What was the mechanism of injury? • What was the patient doing prior to incident? • Are there any associated symptoms? • Are there any aggravating/relieving factors? • Is this a recurrent/continuing illness or injury? • Is the patient on any medications? • Notes patient’s eating habits.

itching. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) General Nutritional status. rashes. weakness. hydration status & overall condition Skin Changes in skin/nail/hair texture appearance and color. fatigue. lumps or infection . weight gain/loss.

Chicken pox Eczema .

discharge. sinus. last eye exam. lightheadedness/ vertigo (dizziness). use of eyeglasses/contacts lenses . pain. trauma. cataracts. headaches. pain. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Head Loss of consciousness. photophobia. glaucoma. visual disturbances Eyes Visual changes. history of injury. diplopia.

Diplopia Cataract .

Vertigo Loss of consciousness .

sinus problems . drainage. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Ears Hearing loss. obstruction. itching. drainage. hay fever. pain. discharge. hearing aids Nose/Sinuses Stuffiness. nosebleeds. olfactory changes. vertigo. history of trauma. infection. tinnitus.

Nosebleeding .

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thyroid problems. masses. adenopathy. nodules. dry mouth. history of sore throat. tongue changes. stiffness. history of injury . caries. pain. dysphagia. enlarged tonsils. sores. dental condition. bleeding gums. history of trauma Neck Goiter. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Throat Hoarseness.

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ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Respiratory Cough. TB. dyspnea. smoking history . sputum (amount. last CXR (chest x-ray). asthma. color). emphysema. type. bronchitis. COPD (chronic obstructive pulmonary disease).

procedures. CHF (congestive heart failure). chest pain/discomfort. rheumatic fever. history of surgeries. hyperlipidemia. edema. dyspnea. murmurs. monitors . last ECG/stress test. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Cardiac Hypertension.

vomiting. tenderness Gastrointestinal Heartburn. dysphagia. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Peripheral vascular Nocturnal pain. regurgitation. leg cramps. nausea. indigestion. history of gallbladder or liver disease . diarrhea. CHF (congestive heart failure). varicose veins. constipation. melena. flatulence. appetite. swelling. belching. stool changes.

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function. problems . history of STD’s. lesions. sores. pain. scrotal mass/discomfort. penile discharge. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Genital (male) Hernias. sexual history. testicular/mass discomfort.

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itching. sexual history/function. STD’s. menstrual regularity. dysmenorrhea. duration. LMP (last menstrual period). last PAP/pelvic exam. amenorrhea. menarche. sores. amount. frequency. menopause. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Genital (female) Birth control. obstetric history. PMS (pre-menstrual syndrome) . discharge. dyspareunia.

hematuria. pattern change. polyuria. frequency. infections. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Urinary Dysuria. bruising. dribbling. stones. incontinence. nocturia. history of transfusions . hesitancy. STD. anemia. flank discomfort Hematologic Bleeding.

edema. hormonal. backache. adrenal. excessive thirst. swelling. hunger. pain. stiffness. pigment changes Musculoskeletal Myalgia. gout. sweating. polyuria. history of trauma . hirsutism. arthritis. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Endocrine Thyroid. tenderness. heat/cold intolerance. erythema.

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insomnia. depression. weakness. memory loss. paresthesias. mood swings. delusions. tremors. equilibrium Psychiatric Anxiety. vertigo. paralysis. ASSESSMENT COMPLETE PHYSICAL EXAMINATION REVIEW OF SYSTEM (ROS) Neurologic Syncope. seizures. mania. suicidal ideations. involuntary movements. hallucinations . blackouts.

ASSESSMENT COMPLETE PHYSICAL EXAMINATION PAST MEDICAL HISTORY (PMH) Consider: • any other currently active problems • comments should include: functional impairment history of trauma childhood/adult illnesses surgeries hospitalizations FAMILY HISTORY (FH) .

and shows no gross mental status changes. and include the possibility of cutaneous. ASSESSMENT COMPLETE PHYSICAL EXAMINATION Always start your objective with an opening statement concerning the patient’s general appearance and condition • Well-developed. cooperative. • Consider listing a minimum of 3-4 physical exam findings for each complaint • Check the system above and below. Vital signs noted. well-nourished male not in distress. Patient is ambulatory/moving. alert . musculoskeletal and occult findings • Document the absence of critical findings .

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS • Biochemical. chemical. or physical methods of measuring biologic or physiologic functions of the body • Important part of health care and have become indispensable for routine screening and the diagnosis of disease .

monitor both the efficacy of prescribed treatment and the advent/start of adverse or toxic reactions. ASSESSMENT LABORATORY & DIAGNOSTIC TESTS • Used routinely to assess compliance. diagnosis of specific disease and at times. to help determine the drug of choice .

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS • Ordered appropriately and performed and interpreted correctly • Results of initial screening or diagnostic tests usually suggest the specific follow-up tests necessary for a definitive diagnosis .

and a growing number now have input into the management of patient therapy • Understand why laboratory tests are used and of the information to be gained from them . ASSESSMENT LABORATORY & DIAGNOSTIC TESTS THE PHARMACIST’S ROLE • Involved in monitoring patient care.

they are in good position to anticipate and advise on such interactions . ASSESSMENT LABORATORY & DIAGNOSTIC TESTS THE PHARMACIST’S ROLE • Drugs may influence the results of laboratory tests in a variety of ways.

Inside . To assess using electrical impulses Gluco. ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION: Using word beginnings (prefixes) and endings (suffixes) as clues to procedures -Graphy To record an image -Scopy To look through a lensed instrument -Centesis To puncture -Metry To measure with an instrument Sono. To assess using sound Electro. Sugar Endo.

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION Endoscopy Visual examination of internal structures using optical scopes Paracentesis Puncturing the skin and withdrawing fluid from the abdominal cavity .

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION Lumbar Puncture Inserting a needle between lumbar vertebrae in the spine but below the spinal cord Positron Emission Tomography (PET) Combines technology of radionuclide scanning with the layered analysis of tomography .

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION Sonogram or Echogram • Examination of soft tissue using sound waves beyond human hearing • Visual image produced by the reflection of the sound waves back from the tissues being assessed and into the machine .

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION Electrical Graphic Recordings • Electrocardiography (ECG) Examination of the electrical activity in the heart • Electroencephalography (EEG) Examination of the energy emitted by the brain • Electromyography (EMG) Examination of the energy produced by stimulated muscles .

ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION Culture To collect from the body a sample suspected to contain infectious microorganisms. growing the microbes in a nutrient substance. and examining the resulting growth under a microscope .

hormonal status. and presence of abnormal microorganisms . ASSESSMENT LABORATORY & DIAGNOSTIC TESTS DEFINITION Pelvic examination Physical inspection of the vagina and cervix and palpation of uterus and ovaries Papanicolaou (Pap Smear) Screening of cells from the cervix and canal to detect abnormal cells.

ASSESSMENT
LABORATORY & DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTS
• Incorrect diet preparation
• Failure to remain fasting
• Insufficient bowel cleansing
• Drug interactions
• Inadequate specimen volume
• Failure to deliver specimen to lab in timely manner
• Incorrect or missing request form

ASSESSMENT

LABORATORY & DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
• Radiography or Roentgenography (X-ray)
• Fluoroscopy
• Computerized Tomography (CT Scan)
• Magnetic Resonance Imaging (MRI)

ASSESSMENT
LABORATORY & DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
• Endoscopic examinations
• Bronchoscopy inspection of the bronchi
• Gastroscopy inspection of stomach
• Colonoscopy inspection of colon
• Laparoscopy inspection of the abdominal
cavity
• Cystoscopy inspection of urinary bladder

and blood diseases. clinical laboratory. the blood-forming organs. diagnosis.• Hematology or haematology . and pediatrics that is concerned with the study of blood. . treatment. and prevention of blood diseases. prognosis. internal medicine.branch of biology (physiology). pathology. .includes the study of etiology.

5% Mean Corpuscular Volume 75 – 97 fl Mean Corpuscular Hemoglobin 26 – 33 pg . LABORATORY TESTS HEMATOLOGY * Test Normal Values White Blood Cell (WBC) 5 x 109/L Red Blood Cell (RBC) 4-6 x 1012/L Hemoglobin (Hb) Male: 140-170 g/L Female: 120-170 g/L Hematocrit (Hct) Male: 37 – 54% ESR (erythrocyte sedimentation rate) Female: 0 – 20 mm/hr Differential Count Neutrophils: 54 – 75% Eosinophils: 0 – 4% Lymphocytes: 2 – 35% Monocytes: 6% Basophils: 0 – 0.

overhydrationor blood loss • High Values-Polycythema vera or dehydration .Hematocrit-Packed RBCs in whole blood after centrifugation • Packed Cell Volume • Low Values-anemia.

occurs in Vit B12 or folic acid deficiency .Mean Cell Volume Low MCV indicates microcytic RBCs occurs in Iron Deficiency High MCV indicates macrocytic.Hemoglobin. MCV.a estimate of the oxygen carrying capacity of the blood.

rheumatoid collagen disease .• Erythrocyte Sedimentation Rate- measures the rate of RBC settling of whole uncoagulated blood over time High ESR indicates acute and chronic infection. tissue necrosis.

Coagulation • complex process by which blood forms clots. . • Disorders can lead to an increased risk of bleeding (hemorrhage) and/or clotting (thrombosis).

LABORATORY TESTS COAGULATION * Test Normal Values ACT (activated coagulation time) 70 – 120 seconds APTT(activated partial thromboplastin time) 30 – 40 seconds Bleeding time (BT) 1 – 3 min Clotting time 8 -15 mins FDP (d-dimmer) < 25 mg/dl Fibrinogen level 200 – 400 mg/dl Partial thromboplastin time (PTT) 30 – 40 seconds Platelet Count 200 – 400 x 109 L Prothrombin time (PT) 12 – 15 seconds Thrombin time 10 – 14 seconds .

thrombosis. forming an embolus or grow to such a size that occludes the vessel in which it developed. . depending on the nature of the pathology. • clots may break free and become mobile. • Thrombosis is the pathological development of blood clots.• Problems with coagulation may dispose to hemorrhage. and occasionally both.

Cofactors Various substances are required for the proper functioning of the coagulation cascade: • Calcium and phospholipid (a platelet membrane constituent) • Vitamin K .

most abundant blood plasma protein and is produced in the liver and forms a large proportion of all plasma protein.all other proteins present in blood plasma . and it normally constitutes about 70% of human plasma protein.human serum albumin. BLOOD CHEMISTRY-Serum Proteins Types: • Serum albumin . • Globulins . often used in medical and molecular biology labs. . .bovine serum albumin (cattle serum albumin) or BSA.

where it begins the chemical process of digestion . artefact. nephrotic syndrome. protein-losing enteropathy. genetic variations and malignancy.• Low albumin (hypoalbuminaemia) may be caused by liver disease. • High albumin is almost always caused by dehydration • Amylase is an enzyme that breaks starch down into sugar. burns. Amylase is present in human saliva. malnutrition. late pregnancy. malabsorption.

89 – 5.88 mmol/L Glycosylated Haemoglobin < 7% 7 – 8 % Excellent Control 8 – 9 % Good Control 9 – 10% Fair Control > 10% Poor Control Globulins 23 – 35 g/L Serum Ammonia : 11 -35 Umol/L . LABORATORY TESTS BLOOD CHEMISTRY * Test Normal Values* Albumin 30 – 50 g/L Amylase 10 – 130 U/L Fasting Blood Sugar 3.

and may require special treatment. RENAL PROFILE TESTS • Nephrology concerns itself with the diagnosis and treatment of kidney diseases: . Many diseases affecting the kidney are systemic disorders not limited to the organ itself. and the care of those requiring renal replacement therapy.electrolyte disturbances and hypertension. . Examples include systemic vasculitides and autoimmune diseases such as lupus. including dialysis and renal transplant patients.

9 – 110 mmol/L Serum Creatinine* 53 – 133 mmol/L Serum Magnesium 1. LABORATORY TESTS RENAL PROFILE TESTS Test Normal Values Blood Urea Nitrogen * 3.1 mmol/L Serum Phosphorus 0.2 – 8 mmol/L Serum Bicarbonate 22 – 26 mEq/L Serum Calcium* 2.44 mmol/L .4 – 2.42 – 1.5 mmol/L Serum Sodium* 135 – 145 mmol/L Serum Uric Acid* 0.60 mmol/L Serum Chloride 99.13 – 0.02 – 2.97 mmol/L Serum Potassium* 4 – 4.

BUN • Decreased BUN levels occur with significant liver disease • Increased BUN levels may indicate renal disease .

serum creatinine concentration . CCR. Creatinine Clearance (ClCR) • The rate at which creatinine ( the metabolic breakdown product of muscle creatine phosphate) is removed from the blood by the kidneys [140-age(in years)] X body weight (in kg) = ______________________________________________________________________________________________________ 72 X CCR (in mg/dL) ClCR-Creatinine Clearance.

or who are already taking cholesterol lowering medication -. • candidates for the comprehensive VAP (Vertical Auto Profile) Test. low-density lipoproteins. high-density lipoproteins.a cholesterol.: . -VAP test includes categories of cholesterol measurement in addition to the basic scores (total cholesterol. LIPID PROFILE • VAP (Vertical Auto Profile) . lipid and lipoprotein test. high blood pressure or heart disease -.with family history /existing condition of diabetes.are . and triglycerides).

LABORATORY TESTS LIPID PROFILE * Test Normal Values* Serum cholesterol up to 200 mgs/dl Borderline: Up to 239 mgs/dl Elevated if>240 mgs/dL on repeated values Serum triglycerides < 180 mgs/dl HDL Cholesterol 30 – 60 mgs/dl LDL Cholesterol Borderline: 100 – 190 mgs/dl Risk: > 190 mgs/dl Note: Formula for calculating LDL Cholesterol is INVALID if TGL > 400 mgs/dl Total/HDL ratio :<4 Low Risk: 4 – 6 High Risk: > 6 .

HEPATIC ENZYMES (Liver function tests) • groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver. .

LABORATORY TESTS HEPATIC ENZYMES * Test Normal Values* SGOT / Aspartate Aminotransferase (AST) Up to 34 34 U/L SGPT / Alanine Aminotransferase (ALT) Up to 30 U/L Serum Alkaline Phospatase (ALP) 36 – 92 U/L .

Thyroid function tests (TFTs) • collective term for blood tests • used to check the function of the thyroid. and triiodothyronine (T3) depending on local laboratory policy. thyrotropin) and thyroxine (T4). • includes thyroid-stimulating hormone (TSH. .

such as atrial fibrillation. • requested routinely in conditions linked to thyroid disease. • monitor the effectiveness of either thyroid- suppression or hormone replacement therapy. . TFT • requested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

25 – 4.0 – 11.30 microunits/ml Serum T3 70 – 200 ng/dl Serum T4 4.3 – 4. LABORATORY TESTS THYROID FUNCTION TEST Test Normal Values Free T4* 0.8 – 2.2 pg/ml TSH * 0.0 micrograms/dl .0 ng/dl Free T3* 2.

• early markers identified were enzymes or"cardiac enzymes" . • often discussed in the context of myocardial infarction. but other conditions can lead to an elevation in cardiac marker level. Cardiac markers • evaluate heart function.

18 ng/ml .2 32 – 50% of total LDH: > LDH1 SGOT (Serum glutamic oxaloacetic * < 42 U/L Transaminase) SGPT (Serum glutamic pyruvic transaminase)* 0 – 48 U/L Myoglobin * 0 – 85 ng/ml Troponin 1 0.1 ng/ml Troponin T < 0. LABORATORY TESTS CARDIAC ENZYMES AND PROTEINS Test Normal Values CPK * 25 – 2000 U/L CK – MB (creatine kinase isoenzyme MB)* 0 – 9 ng/ml or < 3% of total CPK LDH 0 – 280 U/L LDH .1 20 – 36% of total LDH: <LDH2 LDH .0 – 0.

[1] • A part can be performed by using urine dipsticks. Urinalysis (or "UA") • array of tests performed on urine and one of the most common methods of medical diagnosis. . in which the test results can be read as color changes.

006 Adult: 1.016 – 1.022 pH 4.5 protein negative Glucose negative Na 10 – 40 mEq/L K < 8 mEq/L .6 – 6.002 – 1. LABORATORY TESTS URINALYSIS * Color Straw – dark yellow Odor Slightly aromatic Appearance Clear Specific gravity Infants: 1.

Male: 0/hpf WBCs * Female: 0 – 5/hpf. WBC. LABORATORY TESTS URINALYSIS Color Straw – dark yellow Cl < 8 mEq/L bilirubin negative Urobilinogen 0. fine granular. RBC. coarse. waxy casts Crystals * Interpreted by physician . Male: 0 – 2/hpf Bacteria * Negative on spun specimen Casts * Hyaline.1 – 1 EU/100 ml Ketones * negative Occult Blood * negative RBCs * Female: 0 – 2/hpf.

or bile signs of poor absorption as well as screen for colon cancer. Fecalysis/stool analysis • laboratory tests done on fecal samples to analyze the condition of a person's digestive tract • performed to check for the presence of any reducing substances such as : white blood cells (WBCs) sugars. .

LABORATORY TESTS FECALYSIS * Parameter Results/Normal Parameter Results/Normal Values Values Character Formed Pus Negative Color Brown Blood Negative Mucus Negative Occult Blood Negative .

Female: 88 to 128 ml/min. Creatinine Clearane • Normal values Male: 97 to 137 ml/min. .

CCR.serum creatinine concentration Note: (Multiply result by 0. the unit of ClCr is mL/min .85 for females Using this formula. Creatinine Clearance [140-age(in years)] X body weight (in kg) = ______________________________________________________________________________________________________ 72 X CCR (in mg/dL) ClCR-Creatinine Clearance.

Dela Cruz Age: 780 months Weight: 75kg Height: 5 ft CCr: 0. Given: Patient: Angela Marie P. Examples 1.9mg/dL Question: Is the Creatinine Clearance of the patient within the normal range? Prove your answer. ..

8mg/dL Compute for the Creatinine Clearance of the patient.2. Dela Cruz Age: 86 Weight: 175 lb Height: 6 ft CCr: 1. Is it within the normal range? . Given: Patient: Gabriel Marie P.

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