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APHA- Chapter-34- patient assessment laboratory

Obtaining a Comprehensive Patient History; -

Chief complaint.; - the reason for the patient's visit.
History Of present illness: identifies the onset of the illness and modifying factors
Past medical history; - The patient's medical background of disease state and
conditions. Distinguish between chronic conditions (e.g., diabetes, hypertension)
and acute conditions (e.g., recent surgery, injury, or infection). → A patient's
previous medical record included.
MEDICATION ALLERGY AND IMMUNIZATIONS; - all medications taken by any
route (e.g., oral, injectable), prescription drugs, OTC medications, herbal
preparations, and treatment remedies.
Adverse drug reactions, allergies, and immunization history should also be noted.
Family history; - the patient's family medical history, such as diabetes,
hypertension, high cholesterol, mental illness, and any genetic disorders
Social history; - social activities that may have related to the present illness
REVIEW OF SYSTEMS; - physical assessment, vital signs& observations
Tem, B.P, abnormal mental status
PROBLRM FOCUSED INTERVIEW
Patient interview- open-ended questions and statements
Seven basic screening questions;-
1) Location 2) quality 3) severity 4) timing 5) setting 6) modifying factors
7) associated symptoms
Closing the interview;
 Summarize all the gathered information for the patient.
 Discuss the plan and follow-up method.
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 Ask for additional questions and concerns.

 Write an organized document
DOCUMENTATION; -
SOAP
Subjective information, objective information, assessment, plan
Subjective information; -
All the information reported by the patient
How the patient feels, observation about the current conditions,
current medications.
Objective information; - physical & mental observations, vital signs, physical
findings, lab; test results
Assessment; - evaluation & diagnosis of the case presented, eg. UTI
Plan;-treatment plan & recommendations
Physical assessment, tech, terminology and modification;
Inspection; - Inspection involves a general observation of the patient, noting
abnormal physical appearance or behavior.
Cleanliness, appropriateness of patient’s attire, general deportment
Gait → examined, → abnormalities ataxia, foot drop, intoxication
Palpation; - use of sense of touch in the evaluation of the patient .it helps the
provider assess the texture, moisture, temperature, masses, vibrations, &
pulsations in the patient body
A light touch should be used for skin surfaces.
Deeper touches should be used to assess organs or masses in the body.
Percussion;-
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Percussion is used to produce sounds, elicit tenderness, or assess reflexes in a

patient. It is also helpful in locating organ borders, identifying organ shape and
position, and determining whether an organ is solid or filled with gas.
Administrated- → directly or indirectly
Auscultation; - Auscultation involves listening for normal and abnormal sounds
with a stethoscope. Sounds, including heart, breath, bowel, blood pressure, and
blood vessels, can also signify medical conditions, if abnormal.
Triage & referral skills
Common complaints;
HEADACHES;-
OTC; - → aspirin, magnesium salicylate, naproxen, ibuprofen, acetaminophen, and
ketoprofen.
Children under 15 years of age should not receive salicylates or ketoprofen, and
children under 12 years of age should avoid naproxen.
Patients with renal disease should not use magnesium salicylate.
Patients with asthma, coagulation disorders, congestive heart failure, or chronic
gastrointestinal ulcers should avoid salicylates and nonsteroidal anti-
nflammatory drugs (NSAIDs)
MUSCLE AND JOINT PAIN
Acute, chronic, muscle and joint pain severe alert to body
Patients with weakness in any limb, visually deformed joints or movement, or
pain associated with severe nausea or vomiting should also consult their health
care provider
Fever; -
To reduce the body tem – main goal of fever treatment
Treatment includes NSAIDs, aspirin, and acetaminophen.
Infants with rectal temperature greater than 101°F- referred to health care
provider
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Children older than 3 months of age with a rectal temperature equal to or greater
than 104°F- referred to health care provider
COMMON COLD
Hydration and rest are usually the first line for treatment. Nasal sprays and
humidifiers can be used in alleviating congestion and rhinorrhea.
COUGH; -
Treatments include antitussives (menthol, camphor, diphenhydramine,
dextromethorphan) and expectorants (guaifenesin)
CONSTIPATION: -
pharmacist should interview the patient regarding diet, medications, and any
other symptoms that may occur with the constipation.
Treatment;-
Increased amount of fiber and fluid in the diet. Laxatives (e.g., bisacodyl) and
stool softeners (e.g., docusate) may also be recommended, depending on the
patient's age and underlying conditions.
VITAL SIGNS
Used to measure various physiological functions of the patient
Evaluates as- patient weight, respiration, pulse, temperature, blood pressure
Laboratory Values and Diagnostic Tests
Basic metabolic panel (BMP).;- current status of kidney ,blood sugar and calcium
level
Complete blood count; -disorders such as infection and anemia, hematocrit,
hemoglobin red blood count, white blood count (with or without differential
count), and platelet count.
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Lipid panel; - assess risk for coronary artery disease;- Labs measured include high-
density lipoprotein (HDL), low-density lipoprotein (LDL), very low- density
lipoprotein (VLDL), total cholesterol, and triglycerides
Liver function; - This test assesses the various activities of the liver, synthetic
function, and hepatic disease.
False positive and negative test; -
In vivo interference; - pharmacological and toxicological drug effect
In vitro interference; - the interaction of drugs in specimens (urine, blood, tissue)
with laboratory testing reagents
Labotary test of therapeutic drugs;
Drugs that requires TDM;- Neurological medications; Immunosuppressant’s.
Antibiotics., Antiarrhythmic. Antiasthma tics, Hormones, Anticoagulants
Over the counter testing devices
Blood Glucose monitors- diabetic patients for self-monitoring
Pregnancy testing devices; - measure HCGH level in the urine
Drug screening for Home use; - amphetamine, barbiturates, cocaine etc
DNA Paternity Test; - identify father & child DNA
Blood pressure testing kit
The patient should allow at least 2 hours after meals.
He or she should be resting in a seated position for at least 5 minutes.
He or she should avoid having a full bladder, exercising, eating, talking, or moving
before checking BP.
PRINCIPLES OF ELECTROCARDIOGRAPHY;
An electrocardiogram, abbreviated as ECG or EKG
Recording the electrical activity of the heart
Performing- attaching skin electrodes to the patient produce electrocardiograph
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12 leads- 12 different views of the electrical activity of the heart

6 limb leads- heart frontal plane
6 chest leads to view the heart anteriorly and posteriorly
P- Contraction of atria
PR- PR interval- conduction of atrioventricular (AV) node
medications can affect the PR interval, Eg. beta blockers, verapamil, digoxin,
clonidine, diltiazem, and amiodarone
Largest spike – QRS COMPLEX- ventricular contraction
Downward slope spike- QT Interval- ventricular repolarization
medications can affect the QT interval- quinolones, clarithromycin, erythromycin,
and tricyclic antidepressants
T- Repolarization of the ventricle
SINUS RHYTHM: -
Electrocardiogram paper contains small squares that are 1 mm in height and
width
5 of these smaller squares are contained within a larger square – darker inked
boundaries
Each smaller square represents – 0.04 seconds
Each larger square represents – 0.2 seconds (0.04 seconds X 5)
Regular rhythm of the heart classified - fast, normal, slow
“P” wave, QRS complex & T wave will appear the same at regular intervals
Sinus Bradycardia
 Increased vagal tone (seen mostly in athletes, but also caused by straining
at stool or vomiting)
 Sleep
 Increased intracranial pressure
 Certain medications (beta blockers)
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SINUS TACHYCARDIA
Sinus tachycardia is classified as any heart rate that exceeds 100 beats per minute
Causes of sinus tachycardia include stress, dehydration, blood loss, systemic
infection, and certain medications (e.g., stimulants, caffeine, and cocaine).
Rapid heart rates, in addition to tachycardia, could also include atrial tachycardia,
atrial flutter, and ventricular tachycardia
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ATRIAL FIBRILLATION
 Atrial fibrillation is the most clinically encountered arrhythmia.
 Atrial fibrillations, also known as supraventricular arrhythmias,
 characterized by unorganized electrical activity between the atria and the
ventricles.
 Irregular rhythms are usually classified by their appearance
on an electrocardiograph
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Atrial flutter

 Atrial flutters are characterized by rapid atrial rates that could exceed 250
beats per minute
 They occur when the AV node does not allow some of the electrical
impulses to travel to the ventricles.
 Both atria and ventricles are in regular rhythm.
 Although T waves cannot be identified, P waves often appear to have a
saw-tooth configuration. QRS complexes are normal.
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Ventricular tachycardia;
 Ventricular tachycardias occur when three or more consecutive premature
ventricular contractions occur.
 The heart rate is typically regular, with ventricular rate measuring between
100 and 200 beats per minute
 The QRS complex, which has a saw-tooth appearance, is widened, and P
and T waves are usually absent
 One type of ventricular tachycardia is referred to as torsades de pointes, or
"twisting of the points." Although the electrocardiograph in torsades is
similar to ventricular tachycardia, the former has a distinctive twisting of
the QRS complex around an isoelectric point.
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VENTRICULAR Fibrillation

 During a ventricular arrhythmia, organized electrical or mechanical activity

of the heart is absent
 The rate is irregular, and P and T waves and QRS complexes are
indiscernible on an electrocardiograph
 This arrhythmia requires electrocardioversion, ordeath will ultimately
result.
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ST SEGMENT CHANGES; -

Changes in the area between the QRS complex and T wave can signify
myocardial problems

When ST segment depression occurs, → signifies myocardial ischemia without

heart tissue damage.

ST segment elevation →indicates injury to the myocardium, typically a

myocardial infarction. During a heart attack, ST segment elevation

can appear anywhere between immediately and a few hours after injury.

Cardiopulmonary arrest occurs when ventilation and circulation spontaneously

terminate.

Causes;

Bradyarrhythmias, Asystole, Electrocution, Drowning, Choking, Trauma

Illegal drug use, Myocardial infarctions that result in ventricular fibrillation

Cardiopulmonary arrest- 4 to 6 minutes of onset

CPR – cardio pulmonary resuscitation, early defibrillation, pharmacological

therapy

CPR – administrated by ABCD SEQUENCE

A- Airway
B- Breathing
C- Circulation
D- Defibrillations
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Pharmacological therapy; -
Vasopressors and agents to control rhythm – epinephrine & vasopressin
Resuscitation- 1mg epinephrine I.V push every 3-5 minutes
Antiarrhythmic agents to restore sinus rhythm; - lidocaine, amiodarone,
procainamide, adenosine, atropine