PHARCARE REVIEWER

HEALTH CARE STRATEGIES:

Health Promotion reduce risk of illness;
maintain maximal function; promote good
health habits (ex. prenatal nutrition classes;
exercise classes; stress management classes)
Rehabilitation restoration of person to
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
Rehabilitation Programs:
Cardiovascular
Pulmonary
Chemical-induced impairments
Diagnosis and Treatment commonly used
services; sought once person feels ill or problem
is indicated (ex. teaching breast self-breast
examination [early diagnosis]; vision-screening
programs at school; treatments)
Illness Prevention reduce risk factors in an
effort to avoid illness primary, secondary, or
tertiary health prevention (ex. no smoking
programs; controlling of breeding;
immunization)
HEALTH PROBLEM IDENTIFICATION:
Human Needs physiologic and psychologic
conditions that individual must meet to achieve
state of health and well-being
The Need Hierarchy Abraham Maslow developed
most popular in the 1940s
Maslows Hierarchy of Needs 5 need levels;
physiologic needs > higher-level need
I. Physiological Needs:
air 4 to 6 mins.
food 2 to 3 weeks; ketoacidosis
transforms fats to food
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license
rest and sleep 6 to 8 hours per day
WORKPLACE: adequate wages; satisfactory
work environment (adequate lighting,
temperature, ventilation)



II. Safety and Security Needs:
secure physical and emotional
environment
psychological safety
need to be free about money and job
security
need for shelter; freedom from harm and
danger
WORKPLACE: job continuity (no lay-offs);
grievance system (protection against arbitrary
action); adequate health insurance and
retirement package (security against illness
and retirement)
III. Love and Belongingness Needs:
social processes
need of affection; association; to belong
need to love and be loved
need to be accepted by peers


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 employees
family problems
IV. Self-Esteem Needs has 2 different sets of
needs: need for positive self-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
ones 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 clients 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 5
th
vital sign; decided by Joint
Commission on Accreditation of Healthcare
Organizations (JCAHO) and pain management
experts

FACTORS CAUSING VITAL SIGNS TO CHANGE:


Temperature of environment
Patients physical exertion
Effects of illness

VITAL SIGNS ALLOWS PHARMACISTS TO:
Asses response to drug and non-drug therapy
Identify diagnoses
Implement planned 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 the database that a pharmacist collects
during assessment
Baseline for future assessment
Patients 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
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 minimize environmental
factors
4. Organized, systematic approach when
taking vital signs
ACCEPTABLE RANGES FOR ADULTS
Temperature Range
Oral/ Tympanic
Rectal
Axillary
36
o
to 37
o
C
37
o
C
37.5
o
C
36.5
o
C
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.
I am too fat
14 yr. old male; 150 cm;


36 kg






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?
What was the mechanism of the 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 patients eating 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; history 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 STDs;
sexual history; functions; problems
(Female) birth control; sexual history/
function; STDs; 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 patients general
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 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
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



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 through lensed instrument
-centesis Puncture
-metry Measure with an instrument
Sono- Access using sound
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 but below spinal
cord
Positron Emission Tomography (PET)
combines technology of radionuclide scanning
with the layered analysis of tomography
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
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
Insufficient bowel cleansing


Drug interaction
Inadequate specimen 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
Cytoscopy inspection of urinary bladder