W21 Fundamentals of Prescribing, Diagnosis and Diagnostic Tests Flashcards

Question

Diagnostic tests – Blood pressure When would you check BP? (4) How do you take a BP?

Answer 1

* Routine observation in hospital * Routine as part of BP medication check * ?High BP = headache * ?Low BP = light headed, falls Using a sphygmomanometer, or a blood pressure cuff.

Answer 2

* Number of beats / min * Count number of radial pulses over 60 seconds (30 seconds x 2) (The radial pulse is felt on the wrist just under the thumb) When would you check heart rate: * Routine observation in hospital * Dizziness * Fainting / lightheaded * Palpitations

Answer 3

Number of breaths / min * Count the number of times the patients chest rises in 60 seconds (30 seconds x 2) When would you check heart rate: * Routine observation in hospital * Shortness of breath * Respiratory assessment (e.g. Asthma)

Answer 4

* Multiple types of thermometers * Routine observation for patients in hospital * ? Infection

Answer 5

* Measures the amount of oxygen in a patients blood as a percentage: * Health patient O2 sat: >95% * Respiratory conditions (COPD): 88 – 92% * Shines two types of light through your finger (one red light, one infra-red light) * Red blood cells: Lots of oxygen * Inc absorption of infrared light * Allows red light to pass through * Red blood cells with low levels of oxygen: * Inc absorption of red light * Allows infrared light to pass through

Answer 6

* Routine in hospital setting as part of patients observations * Respiratory clinics/conditions * Covid-19

Answer 7

* Wouldn’t routinely see this being used in a community pharmacy setting * When would you see it? * Dizziness/ringing / crackling sound in the ear * Ear infection * Hearing assessment: hearing loss/changes in hearing

Answer 8

BMI= Weight (kgs) / [Height (m)]^2

Answer 9

* Weight loss clinic * Diabetes or cardiovascular clinic * High BMI is a risk factor

Answer 10

* Continuous glucose monitoring – devices fitted under the patient's skin which they can scan using smartphone to check BMs * Blood glucose monitoring – single-use blood tests used to check BMs where patient pricks finger, collects blood and runs the test * Diabetic patients * Patients who have collapsed * Recurrent urinary tract infections

Answer 11

* Measures how quickly you can blow air out of your lungs How to use: * Take a deep breath in * Blow as hard and fast as you can into the peak flow meter = Peak Expiratory Flow (PEF) * Plot on the chart to see where your PEF score sits * Helps identify changes in your airways * When would you see it being used: * Respiratory conditions (e.g. Asthma) – monitor stability, triggers, medication is work etc

Answer 12

* Sore throat test and treat service * Patients with a sore throat can have a throat swab undertaken by a community pharmacist; * Bacterial: antibiotics provided OTC * Viral: self-help advice

Answer 13

* Urinary tract infection service * Pilot in Hywel Dda – Jan 2022 * Allows urine to be tested to look for infection markers- Abx provided if needed * Also can highlight excessive glucose, blood which may warrant further investigation and referral

Answer 14

* Now available in community pharmacies * STI kits: * HIV * Chlamydia / gonorrhoea * Syphilis * Tend to be provided in community pharmacy (charge) and sent to be tested and the patient contacted by external company

Answer 15

Peak flow Respiratory rate (sats) Pulse

Answer 16

Symptoms are getting worse (cough, breathlessness) Blue inhaler is not helping Peak flow score is lower than normal - Regular review with GP/nurse - Check if pt uses the appropriate inhaler technique

Answer 17

Urine analysis Body temperature

Answer 18

1.Take radial pulse 2. Place sphygmanometer on brachial artery

Answer 19

* Your radial pulse can be taken on either wrist. * Use the tip of the index and third fingers of your other hand to feel the pulse in your radial artery between your wrist bone and the tendon on the the thumb side of your wrist. * Apply just enough pressure so you can feel each beat. * When you feel your pulse, look at your watch and count the number of beats in 60 seconds.

Answer 20

* Sinus Rhythm: 70 – 100 BPM * Sinus Bradycardia: <60 BPM * Sinus tachycardia: >100 BPM

Answer 21

* Introduce yourself and role * Identify patient * Wash/gel hands * Explain procedure and consent patient * Ensure correct cuff size * Attach cuff to upper arm – align correctly * Palpate radial pulse (take measurement) * Inflate cuff and estimate systolic blood pressure and verbalise/write (then deflate cuff) * Palpate brachial pulse * Place diaphragm of stethoscope over brachial pulse * Inflate cuff to about 20 mmHg above estimated systolic pressure * Slowly deflate cuff * When pulsatile sound appears (1st Korotkoff sound) this is actual systolic pressure * When pulsatile sound disappears (5 th Korotkoff sound) this is diastolic pressure * Quickly deflate cuff and remove * Verbalise/write BP in the format, e.g. 120/75mmHg * Thank patient and ask if any questions Checklist

Answer 22

1. Close the valve on the blood pressure cuff. 2. Position the diaphragm of your stethoscope over the brachial artery. 3. Re-inflate the cuff 20-30 mmHg above the systolic blood pressure you previously estimated. 4. Slowly deflate the cuff at around 2-3 mmHg per second. 5. Using your stethoscope, listen carefully for the onset of a pulsatile noise (Korotkoff sound) = systolic blood pressure. 6. Continue to deflate the cuff while listening through your stethoscope until the pulsatile sound completely disappears (fifth Korotkoff sound) = diastolic blood pressure.

Answer 23

Ensure the valve on the blood pressure cuff is closed. * Palpate the volunteer’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery. * Inflate the blood pressure cuff until you can no longer feel the volunteer’s radial pulse. * Record the reading on the sphygmomanometer at the point at which the radial pulse becomes impalpable. This reading is an approximate estimate of the volunteer’s systolic blood pressure. * Deflate the blood pressure cuff.

Answer 24

Hi im Hana the pharmacist. Today I would like to take your blood pressure so that will entail me taking this cuff, inflating it around your arm, feeling and listening to your pulse It might feel uncomfortable but it shouldn't hurt. Is that ok with you? If you pop your arm on the table. Align cuffmaker with brachial artery Approximate Systolic BP (where you no longer feel pulse) Note reading. Palpate brachial artery, place stethoscope on brachial artery Reinflate cuff 20-30mmHg above systolic BP Slowly deflate cuff 2-3mmHg per second Listen for first Korotkoff sound and note the BP (this is Systolic BP) When this sound disappears you have found the Diastolic BP Deflate cuff, Remove it That completes the procedure. Thank patient.