Pharcare Reviewer

PHARCARE REVIEWER

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air  –  4  4 to 6 mins.

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food  –  2  2 to 3 weeks; ketoacidosis

HEALTH CARE STRATEGIES: •

Health Promotion  –  reduce risk of illness;

transforms fats to food

maintain maximal function; promote good health habits (ex. prenatal nutrition classes; exercise classes; stress management classes) •

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sex  –  pwede  pwede lang kung may marriage license

Rehabilitation  –   restoration restoration of person to

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highest level of functioning; maximizing abilities and independence; involves patient, family, and health team; provided in settings (ex. hospital, home, healthcare home, outpatient setting); extended beyond nervous system

rest and sleep  –  6  6 to 8 hours per day

WORKPLACE: adequate wages; satisfactory work environment (adequate lighting, temperature, ventilation)

Rehabilitation Programs: •

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Cardiovascular

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Pulmonary

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Chemical-induced impairments

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secure physical and emotional environment

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psychological safety

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need to be free about money and job security

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need for shelter; freedom from harm and danger

 commonly used Diagnosis and Treatment  –  commonly services; sought once person feels ill or problem is indicated (ex. teaching breast self-breast examination [early diagnosis]; vision-screening programs at school; treatments)

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Safety and Security Needs:

II.

 reduce risk factors in an Illness Prevention  –  reduce effort to avoid illness primary, secondary, or tertiary health prevention (ex. no smoking programs; controlling of breeding; immunization)

WORKPLACE: job continuity (no lay-offs); grievance system (protection against arbitrary action); adequate health insurance and retirement package (security against illness and retirement)

HEALTH PROBLEM IDENTIFICATION: IDENTIFICATION: Human Needs  –  physiologic  physiologic and psychologic conditions that individual must meet to achieve state of health and well-being

III.

Love and Belongingness Needs: •

social processes

most popular in the 1940’s

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need of affection; association; to belong

 5 need levels; Maslow ’s Hierarchy of Needs  –  5

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need to love and be loved

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need to be accepted by peers

The Need Hierarchy  –  Abraham  Abraham Maslow developed

physiologic needs > higher-level need I.

Physiological Needs:

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combination of family and community relationships outside job

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friendship on job

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establishment of fruitful and meaningful relationships

WORKPLACE: allow employees to participate in decision making; give opportunity to learn new thing about work

ASSESMENT VITAL SIGNS:

WORKPLACE: encourage social interaction; •

involvement; sensitivity to an employee ’s

most frequent measurement  obtained by health practitioners

family problems •

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Self-Esteem Needs  –  has 2 different sets of needs: need for positive self-image or selfrespect; need for recognition and respect from others

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self-worth

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self-identity

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self-respect

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body image  –  well thought of oneself and others

WORKPLACE: signs of accomplishments (ex. extrinsic rewards like job titles, public recognition, praise); provide more challenging job assignments; provide more opportunities (sense of accomplishments) V.

indicators of health status

Self-Actualization Needs  –  realization of

indicate effectiveness  of circulatory, respiratory, nervous, and endocrine functions provides data to determine client’s usual state of health (baseline data )

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change can indicate change in physiological function

essential ingredient  when medical team determine health status need for hands-on proficiency in specific physical assessment skills varies according to type of patient care setting

all pharmacists should have basic understanding of these skills

THE DIFFERENT VITAL SIGNS:

one’s potential for continued growth and individual development; self-actualized person = mentally healthy person •

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need to learn, create, understand, comprehend

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Temperature

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Blood Pressure

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Pulse Rate or Cardiac Rate

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Respiratory Rate

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Pain  –  5th vital sign; decided by Joint

need for harmonious relationships

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need for beauty or aesthetics

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need to be self-fulfilled

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need for spiritual fulfillment

Commission on Accreditation of Healthcare Organizations (JCAHO) and pain management experts

FACTORS CAUSING VITAL SIGNS TO CHANGE:

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Temperature of environment

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Patient’s physical exertion

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Effects of   illness

1. Equipment  –  appropriate for size and age; functional to ensure accurate findings; selected based on condition (ex. thermometer; stethoscope; sphygmomanometer)

2. Patient  –  usual range of vital signs should be established; medical history, therapies, and prescribed medication should be known

VITAL SIGNS ALLOWS PHARMACISTS TO: •

Asses response  to drug and non-drug therapy

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Identify diagnoses

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Implement planned interventions

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Evaluate success  when vital signs have returned to acceptable values

3. Control and minimize environmental factors 4. Organized, systematic approach when taking vital signs ACCEPTABLE RANGES FOR ADULTS 36o to 37oC 37oC 37.5oC 36.5oC

Temperature Range •

BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)

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Inspection

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Palpation

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Percussion

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Auscultation  –  using stethoscope

Oral/ Tympanic Rectal Axillary

Pulse Rate Respiratory Rate Blood Pressure

60 to 100 beats/ min 12 to 16 breaths / min 110/70 mm Hg

COMPLETE PHYSICAL EXAMINATION •

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GUIDELINES FOR MEASURING VITAL SIGNS •

Part of the database  that a pharmacist collects during assessment

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Baseline for future assessment

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Patient’s needs and condition determine when,

where, how and by whom vital signs are measured •

Pharmacist must analyze vital signs to interpret their significance and make decisions about interventions

Subjective  –  personal; individual Everything is important, depending on the chief complaint

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Consider everything

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Document the essential SUBJECTIVE

OBJECTIVE

I feel dizzy ”

Blood Pressure: 90/60 Pulse: 110

My bladder never seems

Voids: 100-150mL/ void q 1-2 h.

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empty” I am too fat ”

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14 yr. old male; 150 cm;

36 kg

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Head  –  loss of consciousness; lightheadedness/vertigo (dizziness); headaches; history of injury; sinus; pain; visual disturbances

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Eyes  –  visual changes; diplopia  –  double vision; pain; discharge; trauma; photophobia; glaucoma; cataracts; last eye exam; use of eyeglasses or contacts

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of noises; drainage; pain; infection; discharge; vertigo; hearing aids

HISTORY OF PRESENT ILLNESS (HPI): P  –  What provokes discomfort?

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Q  –  What is the quality of the discomfort?

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What was the mechanism of the injury ?

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What was the patient doing prior to incident ?

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Are there any associated symptoms ?

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Are there any aggravating/ relieving factors ?

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Is this a recurrent/ continuing illness or injury ?

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Is the patient on any medications ?

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Notes patient’s eating habits, caffeine, and

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Neck  –  goiter; pain; masses; nodules; adenopathy  –  inflammation of lymph node; thyroid problems; stiffness; history of injury

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Respiratory  –  cough; dyspnea  –  labored respiration; sputum (amount, type, color); emphysema; TB; last CXR (chest x-ray); smoking history

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Cardiac  –  hypertension; hyperlipidemia

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presence of excess fat or lipids in blood; chest pain/ discomfort; dyspnea; edema; last ECG/ stress test; CHF (congestive heart failure); history of surgeries; procedures; monitors

smoking habits •

Throat  –  hoarseness; dysphagia  –  difficulty in swallowing; enlarged tonsils; bleeding gums; sores; dental condition; caries; tongue changes; dry mouth; history of sore throat; h istory of trauma

T  –  What is the time sequence? •

Nose/Sinuses  –  stuffiness; drainage; olfactory changes; itching; obstruction; history of trauma; hay fever; nosebleeds; sinus problems

R  –  Where is the region of the discomfort? S  –  What is the severity of the discomfort?

Ears  –  hearing loss; tinnitus  –  hears sensations

Allergies ? ASK YOURSELF

REVIEW OF SYSTEM (ROS) • •

General  –  nutritional status; weight gain/loss; weakness; fatigue; hydration status; overall condition

Peripheral Vascular  –  nocturnal pain; varicose veins; leg cramps; CHF; swelling; tenderness

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Gastrointestinal  –  hearburn; dysphagia ; appetite; indigestion; belching; flatulence;

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Skin  –  changes in skin/nail/hair texture,

stool changes; melena  –  black “tarry” feces;

appearance, and color; rashes; itching; lumps or infection (ex. eczema, chicken pox)

diarrhea; constipation; nausea; regurigation

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vomiting; history of gallbladder or liver disease

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Genital

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Psychiatric  –  anxiety; mood swings; mania; depression; memory loss; insomnia; suicidal ideations; delusions; hallucinations

(Male)  –  hernias  –  organ pushes through opening (intestine); sores; lesions; penile discharge; pain; testicular/ mass discomfort; scrotal mass/ discomfort; history of STD’s; sexual history; functions; problems

(Female)  –  birth control; sexual history/

PAST MEDICAL HISTORY (PMH)  –  consider: any other currently active problems; comments should include: functional impairment, childhood/ adult illnesses; hospitalizations; history of trauma; surgeries

function; STD’s; itching; sores; discharge;

dyspareunia  –  painful sexual intercourse; last

FAMILY HISTORY (FH)

PAP/ pelvic exam; menarche  –  firs menstrual

Always start your objective with an opening

cycle; menopause; LMP (last menstrual period); obstetric history; menstrual regularity; frequency; duration; amount;

statement concerning the patient’s general

dysmenorrhea; amenorrhea  –  absence of

appearance and condition •

menstruation; PMS (pre-menstrual syndrome) •

Urinary  –  dysuria  –  painful urination; polyuria  large production of urine; frequency; stones;

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pattern change; incontinence; nocturia  –  wake up at night to urinate; STD; hesitancy;

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dribbling; hematuria  –  blood in urine; infections; flank discomfort •

Hematologic  –  bleeding; bruising; anemia; history of transfusions

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Endocrine  –  thyroid; adrenal; hormonal;

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Musculoskeletal

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myalgia  –  muscle pain;

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stiffness; gout; arthritis; backache; swelling; pain; erythema  –  redness of skin; tenderness; history of trauma •

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Neurologic  –  syncope; vertigo; seizures; blackouts; paresthesia  –  sensation of prickling on the skin; paralysis; tremors; weakness; involuntary movements; equilibrium

Consider listing a minimum of 3-4 physical exam findings for each complaint Check the system above and below, and include the possibility of cutaneous, musculoskeletal and occult findings

Document the absence of critical findings

LABORATORY AND DIAGNOSTIC TESTS

heat/cold intolerance; edema; hirsutism  –  excessive hairiness; sweating; excessive thirst; hunger; polyuria ; pigment changes

Well-developed, well-nourished male not in distress; Patient is ambulatory/moving, alert, cooperative, and shows no gross mental status changes. Vital signs noted.

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Biochemical, chemical , or physical methods  of measuring biologic or physiologic functions of the body important part of health care

Routine screening and the diagnosis of disease Asses compliance; Monitor both the efficacy of prescribed treatment and the advent/ start of adverse or toxic reactions , diagnosis of specific disease and at times, to help determine the drug of choice Ordered appropriately ; performed ; interpreted correctly Suggest specific follow-up tests

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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

THE PHARMACISTS ’ ROLE •

Monitoring patient care ; input to the management of patient therapy •

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Sonogram or Echogram  –  examination of soft

Understand why laboratory tests are used and information gained

Electrical Graphic Recordings Electrocardiography (ECG)  –  examination of the

Drugs can influence results ; anticipate and advise on interactions

electrical activity in the heart

Electroencephalography (EEG)  –  examination of the brain

the electrical activity by

Electromyography (EMG)  –  examination of the muscles

DEFINITIONS OF TERMS:

Affixes

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Definition

-graphy

Record image

-scopy

Look through lensed instrument

-centesis

Puncture

-metry

Measure with an instrument

Sono-

Access using sound

Electro-

Access using electrical impulses

Gluco-

Sugar

Endo-

inside

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energy produced by stimulated

Culture  –  collect from body, a sample suspected to contain infectious microorganisms, growing the microbes in a nutrient substance, and examining the resulting growth under a microscope

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Pelvic examination  –  physical examination of the vagina and cervix and palpation of uterus and ovaries

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Papanicolaou (Pap Smear)  –  screening of cells from cervix and canal to detect abnormal cells, hormonal status, and presence of abnormal microorganisms

Endoscopy - visual examination of internal structures using optical scopes Paracentesis  –  puncturing the skin and withdrawing fluid from abdominal cavity

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Lumbar Puncture  –  inserting needle between lumbar vertebrae in the spine bu t below spinal cord

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Positron Emission Tomography (PET)  –  combines technology of radionuclide scanning with the layered analysis of tomography

FACTORS THAT INVALIDATE RESULTS: •

Incorrect diet preparation

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Failure to remain fasting

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Insufficient bowel cleansing

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Drug interaction

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Inadequate specimen volume

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Failure to deliver specimen to lab in timely manner

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Incorrect or missing request form

COMMON DIAGNOSTIC PROCEDURES: •

Radiography or Roentgenography  (x-ray)

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Fluoroscopy

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Computerized Tomography  (CT scan)

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Magnetic Resonance Imaging  (MRI)

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Endoscopic examinations:

Bronchoscopy  –  inspection of bronchi Gastroscopy  –  inspection of stomach Colonoscopy  –  inspection of colon Laparoscopy  –  inspection of abdominal cavity Cytoscopy  –  inspection of urinary bladder