Karen J. Tietze CLINICAL SKILLS FOR PHARMACISTSE ‘ios 4251 Riverport Lane SL Louis, Missouri 6308 GUNICAL SKILLS FOR PHARMACISTS: A PATIENT-FOCUSED APPROACH ‘Copyright © 2012, 2004, 1997 by Mosby, Inc., an affiliate of Elsevier Inc. No part af this publication may be reproduced or transmitted in any form oF by any meas, ‘electronic o¢ mechanical, inchiding photweopyiaig, recording, o¢ any information storage and Fetrieval system, Without permission in weiling from the publisher. Details on how to seek esmissien, further information about the Publisher's permissions policies ond our arrangements ‘with organizations sach asthe Copyeght Cewance Cente and the Copyright Licensing Agency, found at our website: wwwwicksevier.com,permisions, “This book and the individual eontsbutons contained ia it ate protected wader eopysight by the Publisher (other than as may be noted heveio}. Notice Knorvledge and best practice i this #eld are constantly changing, As new research and ‘experience broaden our understanding, changes in.tesearch methods, professional practices, tor medical treatment may become necessary ‘Pratitioners and researchers must always rely on their own experience and knowlelse in ‘evaluating and wsing any information, methods, compounds, or experiments doscrtbed herein. inusing toch information or methods they should be mind of tscirowr safety and the safely ‘of others, including partes for whom they have a professional responsibility. ‘With tespect to any drug or pharmaceutical products identified, readers axe advised to ‘check the most curtent inloemation provided (i) on procedures featured or fi) by the manu facturer of each produet to be administezed, to Verify the recommended dose ot formals, the method and duration of administration, and contraisdications. tis the respacsibality ‘of practitioners, elying on their own experience and knowledge of thelr patients, #0 make dlingnases, to determine dosages and the best treatment For each individual patient, and to take ail appropriate safety precautions. ‘To the fullest extent of the law, neither the Publisher nor the authors, eottrtbuters; or ectivors, assume any liability for any injury andor to personsor asa matier Sf produces Habit, neglgence-oratheris of fat ay star Operon crap methods, products, instructions, oF ideas contained in Ue material herein Library of Congress Cataloging in Publication Data ‘ies, Karen ‘Cline skills for pharmacists sa pavient-focused approach Karen J Tietze. em tnchules bibliographical elesences and index. Ian ove.0ct2e 054880 (alk. paper 1, Pharmacy. 2 Phasmary-Prcuce_ 3. Comnsnic ion in pharmacy. 1, Te [ONIN T Wharmgecutlell Services 2 ‘Pharmacist Mademacyrmeliods 4, Professional patient Relations. QV 737) TSoLtsea0i1 BIS tndca2 and ei.‘The otoscope consists of a head and a handle (Figure 4-10 and Figure 4-11), The otascepe is used to assess the ear canal and tympanic membrane. The head consisis of a speculum and magnifying glass and can be rotated up and down into several positions. Disposable speculum ‘covers are available in a variety of sizes to fit most ear canals. Most otoscopes and ‘ophthalmoscopes are available as interchangeable heads that fit the same handle. Full-size image GLK) Figure 4-10. ‘The Otoscope. (From Jarvis C: Physical examination and health assessment, dS, St Louis, 2008, Saunders.) sv T Eullesize image (19K) Figure 411. Components of the Otescope. ene aieES... image (26K) Figure 412. Reftex Haine. A, Tomahawk-style HBG B, Neurclogis Kaine. (From Scidel HM: Mosby's guide to physical examination, od 6, St Louis, 2006, Mosby.) Tuning Fork Tuning forks, typically aluminum, consist ofa stem (handle) and two prongs that form a U- shaped fork (Figure 4-13). The tuning fork vibrates ata set frequency after being struck on the hace of the hand and is used to assess vibratory sensation and hearing (air eondustion and bone conduction). Hold the unin Fork by the stem, not the prongs. Tuning forks are available in a wide range of frequencies (64 Hz to 40% Hz); 128 Hl is a commonly used frequency far seroening. all-sine image (12K) Figure 413, Tuning Forks ‘Tuning forks for vibratory sensation (Top) and auditory testing (Bottom). (From Seidel HM: Monty's guide vo physical examination, od 7, St Louis, 2011, Mosby.) Other Equipment Other useful equipment includes light source (pealight or flashlight) and tongue depresson. “The light source ss used to assess pupillary respomac to ight and to Facilitate closer observation of other visible features (e.g, skin lesions. carotid artery plations). Tongue depressors, used to facilitate inspection ofthe oropharyns, arc made of wood and are available i individual (sterile)