Chapter 28 Patient Assessment Flashcards

(100 cards)

1
Q

PPCP

A

Pharmacists’ Patient Care Process

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2
Q

developed by the Joint Commission of Pharmacy Practitioners alongside other
major pharmacy organizations and key stakeholders.

A

Pharmacists’ Patient Care Process

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3
Q

five elements that should be incorporated by pharmacists practicing patient-centered
care:

A
Collect
Assess
Plan
Implement
Follow-up:Monitor/Evaluate
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4
Q

reason for the

patient’s visit.

A

Chief complaint (CC)

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5
Q

the onset of the

illness and modifying factors.

A

History of present illness (HPI)

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6
Q

all medications taken by any route

A

Medications, allergies, and immunizations:

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7
Q

patient’s family medical

history,

A

Family history

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8
Q

patient’s social activities

that may relate to the presented illness

A

Social history

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9
Q
This information is usually arranged by
organ system (i.e. gastrointestinal, respiratory, musculoskeletal)
A

ROS

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10
Q

Problem-Focused Interview

A

open-ended questions
and statements.
this method allows the patient to elaborate on his or her
condition

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11
Q

Seven basic screening questions

may be used in the interview

A
LAST QSM
Location
Quality
Severity
Timing
Setting
Modifying factors
Associated symptoms
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12
Q

Where is the symptom?

A

Location:

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13
Q

What is it like? Describe it.

A

Quality:

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14
Q

How bad is it? How does it interfere with your life?

A

Severity:

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15
Q

How long has it been present? When did it start? How often does it occur?

A

Timing:

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16
Q

How did it happen? What were you doing when it started?

A

Setting:

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17
Q

What makes it better or worse? What did you use to

treat it?

A

Modifying factors:

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18
Q

What other things have you noticed?

A

Associated symptoms:

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19
Q

four identifiable sections that interview information should be organized to:

A

SOAP

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20
Q

all the information

reported by the patient as presented.

A

Subjective

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21
Q

health care provider’s
physical or mental observations,
Medications may be listed here
if not reported by the patient.

A

Objective

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22
Q

health care provider’s evaluation

and diagnosis of the case presented

A

Assessment:

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23
Q

the health care provider’s treatment plan
and recommendations, the medication prescribed or discontinued, and
the patient counseling performed. It should include follow-up visits and
monitoring recommendations for the patient.

A

PLAN

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24
Q

Follow-up visits should include an

A

interim interview

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25
4 main issues in an interim interview
control adherence complications symptoms range
26
general observation of the patient
Inspection
27
use of the of touch for evaluation-brevity
palpation
28
skin surfaces
light touch
29
organs or masses
deeper touch
30
fine, tactile sensation
fingertips
31
temperature
dorsal surface of the hand
32
Vibrations
palm surface at the metacarpal joints
33
deep palpation, including the palpation | of organs.
finger pads
34
assessing strength
two fingers or whole hand
35
used to produce sounds, elicit tenderness, or assess reflexes in a patient. locating organ borders, identifying organ shape and position, and determining whether an organ is solid or filled with gas. direct or indirectly
Percussion
36
tapping a finger against the middle finger
Indirect percussion
37
striking a fist
blunt percussion
38
tympanic-drum sound
gas bubble
39
hyperresonant/boom-like
emphysematous lung
40
resonant/hollow
healthy lung
41
thud-like sound
liver
42
flat/very dull sound
normal muscle tissue
43
Stethoscope | carried out last
Auscultation
44
measures various physiological functions | should be included in every patient case presentation
Vital signs
45
Vital signs
``` Weight RR Pulse Temp BP ```
46
Adults: 12–20 newborns: 30–60 children: 20–40
Respiratory rate
47
absence of breathing
Apnea
48
difficult breathing or | shortness of breath
Dyspnea
49
difficulty breathing in | supine position
Orthopnea
50
deep, rapid breathing; | hyperventilation
hyperpnea
51
deep, regular breathing with rate slow, normal, or fast Severe metabolic acidosis
Kussmaul breathing | Severe Metabolic AUSSidosis
52
unpredictably irregular breathing
Ataxic respiration
53
cyclic pattern of apnea and varied breathing | dying process
Cheyne-Stokes respiration
54
Normal body temp
37 C /98.6 F
55
rectal
1 F higher
56
axillary
1 F lower
57
normal pulse
60-100
58
pulse generally is taken _______
at the radial artery
59
normal BP
<120/80mmHg
60
135-145 mEq/L
Normal Sodium | Na i3s-iqs
61
3.5-5 mEq/L
K | K-3.s-s
62
95-106 mEq/L
Cl | CIgs-loG
63
8.2-10.8 mg/dL
Ca | CaB.z-lo.B
64
2.6-4.5 mg/dL
P (phosphate)
65
8-20 mg/dL
BUN-B-ZO
66
cause false | high Na level.
Hypertriglyceridemia and hyperglycemia
67
low K can be caused by
LOW Key ihi amp | diuretics and ampho B
68
can cause a false increase in K
hemolysis | Hi! moLIEsis? K
69
meds that can increase K
``` potaTESAHAT TRIamterine EPLErenone SPIROnolactone AmiloRIDE HEParin ACEi TRImethoprim ```
70
Chloride loss thru prox tubule in kidney can cause
Metab al(Ch)alLOSSis
71
can cause decrease Mg
to lose Mg Vomitting/diarrhea Mgsuka/Mg-tae-tae
72
1.5-2.2 mEq/L
Mg | i.s-Z.Z
73
increased Mg levels
increase MgHAR Hemolysis Antacids Renal insuff
74
_____ inCreases Ca protein binding
Alkalosis | Sa Alcala madaming naka-bind
75
_____Decreases Ca protein binding
Acidosis Achi(Decrease)osis Ac(High free calcium)
76
Abnormal phosphate is associated with
MaDR PO4(police) Malnutrition Diarrhea Refeeding syndrome
77
Medications that can increase BUN
Tetracycline Corticosteroids high BUN in the CT steroid cycle
78
false elevation of BUN
Chloral hydrate false high BUN sa corals~ pretending mataas nasa corals naman
79
false decrease in BUN
chloramphenicol Streptomycin Strip/colored Ramp false low BUN kala mo low~mayaman pala
80
Normal SCr
0.7-1.5 | SCr0.T-I.S
81
directly related to muscle mass and muscle | metabolism.
SCr
82
Scr is high with these meds
``` SCaredy- CATS ATA Cimetidine Amiloride Triamterine Spironolactone ``` ACEi Trimethoprin Aminogly-high dose
83
Blood Glucose
Fasting <100 if >=126~diagnosis for diabetes dyabet1ZG
84
Total cholesterol
less than 200
85
LDL
less than 100
86
HDL
MEN: greater than or equal to 40 WOMEN: greater than or equal to 50
87
A1c
<5.7 | HbA1c Less than a S.T(Saint)
88
INR
<1 | 2-3 on warfarin
89
causes of High INR
``` High levels ThroPro-EC TOF-azole T-three EryTHROmycin CiPROfloxacin THREEmethoprim, OmeprAZOLE FluconAZOLE ```
90
Low INR causes
``` LOW INNER~ Tyred Barbi Cyclo Rif Vit K Cholestyramine Barbiturates Cyclosporine Rifampin Vit K ```
91
AST
8-42 AYT saTWO 8 42 patabaan nalang ng utak
92
ALT
3-30 | ALT3-30
93
LD
100-225 | Loo-zzs
94
False high liver transaminase
false liver enzyme"Riso" or ISO my FAM so nagkaroon ako ng false hopes for my liver??WHAT??! Isoniazid Rifampin
95
important information about the current status of the kidneys electrolytes and acid–base balance
Basic metabolic panel (BMP)
96
BMP
Na Cl BUN Glucose K CO SCr 135-145 95-105 8-20 <100~126 3-3.5 ? 0.7-1.5
97
disorders such as infection and anemia. Laboratory values measured include hematocrit (Hct), hemoglobin (Hgb), red blood count (RBC), white blood cell (WBC) count
CBC w or w/o diff
98
risk for | atherosclerotic cardiovascular disease
Lipid panel:
99
tests various activities of the liver, | synthetic function, and hepatic disease
Liver function:
100
interference is caused by the pharmacological or the toxicological drug effect
In vivo