Pharcare Reviewer

PHARCARE REVIEWER PHARCARE REVIEWER HEALTH CARE STRATEGIES: HEALTH CARE STRATEGIES:

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• Health PromotionHealth Promotion –  – reduce risk of illness;reduce risk of illness; maintain maximal function; promote good maintain maximal function; promote good health habits (ex. prenatal nutrition classes; health habits (ex. prenatal nutrition classes; exercise classes; stress management classes) exercise classes; stress management classes)

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• RehabilitationRehabilitation  –  –  restoration of person to restoration of person to highest level of functioning; maximizing highest level of functioning; maximizing abilities and independence; involves patient, abilities and independence; involves patient, family, and health team; provided in settings family, and health team; provided in settings (ex. hospital, home, healthcare home, (ex. hospital, home, healthcare home,

outpatient setting); extended beyond nervous outpatient setting); extended beyond nervous system system Rehabilitation Programs: Rehabilitation Programs: • • CardiovascularCardiovascular • • PulmonaryPulmonary •

• Chemical-induced impairmentsChemical-induced impairments •

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

programs at school; treatments)

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

programs; controlling of breeding; immunization)

immunization)

HEALTH PROBLEM

HEALTH PROBLEM IDENTIFICATIIDENTIFICATION:ON:

Human Needs

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

state of health and well-being

The Need Hierarchy

The Need Hierarchy –  –  Abraham Maslow developed Abraham Maslow developed most popular in the 1940

most popular in the 1940’’ss

Maslow

Maslow’’s Hierarchy of Needss Hierarchy of Needs –  –  5 need levels; 5 need levels; physiologic needs > higher-level need

physiologic needs > higher-level need I.

I. Physiological Needs:Physiological Needs:

•• airair –  –  4 to 6 mins. 4 to 6 mins.

•• foodfood –  –  2 to 3 weeks; 2 to 3 weeks; ketoacidosisketoacidosis –  –  transforms fats to food

transforms fats to food

•• sexsex –  –  pwede lang kung may marriage pwede lang kung may marriage license

license

•• rest and sleeprest and sleep –  –  6 to 8 hours per day 6 to 8 hours per day WORKPLACE: adequate wages; satisfactory WORKPLACE: adequate wages; satisfactory work environment (adequate lighting, work environment (adequate lighting, temperature, ventilation)

temperature, ventilation)

II.

II. Safety and Security Needs:Safety and Security Needs:

•• secure physical and emotionalsecure physical and emotional environment

environment

•• psychological safetypsychological safety

•• need to be free about money and jobneed to be free about money and job security

security

•• need for shelter; freedom from harm andneed for shelter; freedom from harm and danger

danger

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

action); adequate health insurance and retirement package (security against illness retirement package (security against illness and retirement)

and retirement) III.

III. Love and Belongingness Needs:Love and Belongingness Needs:

•• social processessocial processes

•• need of affection; association; to belongneed of affection; association; to belong

•• need to love and be lovedneed to love and be loved

• combination of family and community relationships outside job

• friendship on job

• establishment of fruitful and meaningful relationships

WORKPLACE: encourage social interaction; involvement; sensitivity to an employee’s family problems

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

• self-worth

• self-identity

• self-respect

• 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. Self-Actualization Needs –  realization of one’s potential for continued growth and individual development; self-actualized person = mentally healthy person

• need to learn, create, understand, comprehend

• need for harmonious relationships

• need for beauty or aesthetics

• need to be self-fulfilled

• need for spiritual fulfillment

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

ASSESMENT VITAL SIGNS:

• most frequent measurement obtained by

health practitioners

• indicators of health status

• indicate effectiveness of circulatory,

respiratory, nervous, and endocrine functions

• provides data to determine client’s usual state of health (baseline data)

• 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:

• Temperature • Blood Pressure

• Pulse Rate or Cardiac Rate • Respiratory Rate

• Pain –  5th vital sign; decided by Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and pain management experts

• Temperature ofenvironment • Patient’sphysical exertion • Effects of  illness

VITAL SIGNS ALLOWS PHARMACISTS TO:

• Asses response to drug and non-drug therapy • Identifydiagnoses

• Implementplanned interventions • Evaluate success when vital signs have

returned to acceptable values

BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)

• Inspection • Palpation • Percussion

• Auscultation –  using stethoscope

GUIDELINES FOR MEASURING VITAL SIGNS

• Part of thedatabase that a pharmacist collects

during assessment

• Baseline forfuture assessment

• Patient’s needs and condition determinewhen,

where, how and by whom vital signs are measured

• Pharmacist mustanalyze vital signs to

interpret their significance and make decisions about interventions

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

3.Control and minimizeenvironmental factors

4. Organized, systematic approach when taking vital signs

ACCEPTABLE RANGES FOR ADULTS Temperature Range • Oral/ Tympanic • Rectal • Axillary 36o to 37oC 37oC 37.5oC 36.5oC

Pulse Rate 60 to 100 beats/ min Respiratory Rate 12 to 16 breaths / min Blood Pressure 110/70 mm Hg

COMPLETE PHYSICAL EXAMINATION

• Subjective –  personal; individual

• Everything is important, depending on the chief

complaint

• Consider everything • Document the essential

SUBJECTIVE OBJECTIVE

“I feel dizzy” Blood Pressure: 90/60 Pulse: 110 “My bladder never seems

empty”

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

36 kg

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HISTORY OF PRESENT ILLNESS (HPI):

P –  Whatprovokesdiscomfort?

Q –  What is thequality of the discomfort?

R –  Where is theregion of the discomfort?

S –  What is theseverity of the discomfort?

T –  What is thetimesequence?

• What was themechanism of the injury?

• What was thepatient doing prior to incident?

• Are there any associatedsymptoms?

• Are there anyaggravating/ relieving factors?

• Is this arecurrent/ continuing illness or injury?

• Is the patient on anymedications?

• Notes patient’seating habits, caffeine, and smoking habits

• Allergies? ASK YOURSELF

REVIEW OF SYSTEM (ROS)

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

• Skin –  changes in skin/nail/hair texture, appearance, and color; rashes; itching; lumps or infection (ex. eczema, chicken pox)

• Head –  loss of consciousness;

lightheadedness/vertigo (dizziness); headaches; history of injury; sinus; pain; visual

disturbances

• Eyes –  visual changes;diplopia –  double vision; pain; discharge; trauma; photophobia;

glaucoma; cataracts; last eye exam; use of eyeglasses or contacts

• Ears –  hearing loss;tinnitus –  hears sensations of noises; drainage; pain; infection; discharge; vertigo; hearing aids

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

• 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

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

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

• Cardiac –  hypertension;hyperlipidemia  –  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

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

• Gastrointestinal  –  hearburn;dysphagia; appetite; indigestion; belching; flatulence; stool changes;melena –  black “tarry” feces; diarrhea; constipation; nausea; regurigation –  vomiting; history of gallbladder or liver disease

• Genital

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

dyspareunia –  painful sexual intercourse; last PAP/ pelvic exam;menarche –  firs menstrual cycle; menopause; LMP (last menstrual period); obstetric history; menstrual regularity; frequency; duration; amount; dysmenorrhea;amenorrhea –  absence of menstruation; PMS (pre-menstrual syndrome)

• Urinary – dysuria –  painful urination;polyuria  –  large production of urine; frequency; stones; pattern change; incontinence;nocturia –  wake up at night to urinate; STD; hesitancy;

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

• Hematologic –  bleeding; bruising; anemia; history of transfusions

• Endocrine –  thyroid; adrenal; hormonal; heat/cold intolerance; edema;hirsutism –  excessive hairiness; sweating; excessive thirst; hunger;polyuria; pigment changes

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

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

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

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

FAMILY HISTORY (FH)

Always start your objective with an opening statement concerning the patient’sgeneral

appearance and condition

• Well-developed, well-nourished male not in

distress; Patient is ambulatory/moving, alert, cooperative, and shows no gross mental status changes. Vital signs noted.

• Consider listing a minimum of3-4 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

• 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 theadvent/ 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

THE PHARMACISTS’ ROLE

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

• Understand why laboratory tests are used

and information gained

• Drugs can influence results;anticipate and advise on interactions

DEFINITIONS OF TERMS:

Affixes Definition

-graphy Record image

-scopy Look throughlensed instrument

-centesis Puncture

-metry Measure with an instrument Sono- Access usingsound

Electro- Access using electrical impulses

Gluco- Sugar

Endo- inside

• Endoscopy - visual examination of internal

structures using optical scopes

• Paracentesis –  puncturing the skin and withdrawing fluid from abdominal cavity

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

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

• Sonogram orEchogram –  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

• Electrical Graphic Recordings

Electrocardiography (ECG) –  examination of the electrical activity in the heart

Electroencephalography (EEG) – 

examination of the electrical activity by the brain

Electromyography (EMG) –  examination of the energy produced by stimulated muscles

• 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

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

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

FACTORS THAT INVALIDATE RESULTS:

• Incorrect diet preparation

• Failure to remain fasting

• Drug interaction

• Inadequatespecimen volume

• Failure to deliver specimen to lab in timely manner

• Incorrect or missing request form

COMMON DIAGNOSTIC PROCEDURES:

• Radiography or Roentgenography (x-ray) • Fluoroscopy

• Computerized Tomography (CT scan) • Magnetic Resonance Imaging (MRI) • Endoscopic examinations:

Bronchoscopy –  inspection of bronchi

Gastroscopy –  inspection of stomach

Colonoscopy –  inspection of colon

Laparoscopy –  inspection of abdominal cavity