UNIT v Assessment

8/3/2019 UNIT v Assessment

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ASSESSMENTASSESSMENTASSESSMENTASSESSMENT

ASSO. PROF. MA. CRISTINA C.ASSO. PROF. MA. CRISTINA C. DORIADORIA

Faculty of PharmacyFaculty of Pharmacy

University of Santo TomasUniversity of Santo Tomas


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ASSESSMENTASSESSMENT

VITAL SIGNSVITAL SIGNS

MostMost frequent measurementfrequent measurement obtained byobtained by

health practitionershealth practitioners

IndicatorsIndicators of health statusof health status

Indicate theIndicate the effectiveness of functions:effectiveness of functions:

circulatory, respiratory, nervous and endocrinecirculatory, respiratory, nervous and endocrine

ProvidesProvides datadata to determine a clients usual stateto determine a clients usual stateof health (baseline data)of health (baseline data)


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VITAL SIGNSVITAL SIGNS TemperatureTemperature

Blood pressureBlood pressure

Pulse rate/cardiac ratePulse rate/cardiac rate Respiratory rateRespiratory rate


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PainPain

FifthFifthvital signvital sign

As decided by the Joint Commission onAs decided by the Joint Commission onAccreditation of Healthcare OrganizationsAccreditation of Healthcare Organizations

(JCAHO) and pain management experts(JCAHO) and pain management experts


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FACTORS CAUSING VITAL SIGNS TOFACTORS CAUSING VITAL SIGNS TO

CHANGECHANGE

Temperature of the environmentTemperature of the environment

Patients physical exertionPatients physical exertion

Effects of illnessEffects of illness


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Change in vital signsChange in vital signs

-- indicates a change in physiological functionindicates a change in physiological function

Allows the pharmacistAllows the pharmacist

Assess responseAssess response to drug and nonto drug and non--drugdrugtherapytherapy

Identify Identifydiagnosesdiagnoses ImplementImplement planned interventionsplanned interventions

Evaluate successEvaluate successwhen vital signs havewhen vital signs have

returned to acceptable valuesreturned to acceptable values


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VITAL SIGNSVITAL SIGNS Essential ingredient whenEssential ingredient when pharmacists, nursespharmacists, nurses

and physicians collaborateand physicians collaborate to determine theto determine the

patients health statuspatients health status


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Need for handsNeed for hands--on proficiency in specificon proficiency in specific

physical assessment skillsphysical assessment skillsvaries accordingvaries according

to the type of patient care settingto the type of patient care setting

All pharmacists should have at least a basicAll pharmacists should have at least a basicunderstanding of these skillsunderstanding of these skills


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BASIC TECHNIQUES TO DETERMINEBASIC TECHNIQUES TO DETERMINEVITAL SIGNS (IPPA)VITAL SIGNS (IPPA)

Inspection (checkInspection (check--up)up)

Palpation (feel)Palpation (feel) Percussion (beating)Percussion (beating)

Auscultation (stethoscope)Auscultation (stethoscope)


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GUIDELINES FOR MEASURING VITALGUIDELINES FOR MEASURING VITAL

SIGNSSIGNS

Part of thePart of the database/recorddatabase/record that a pharmacistthat a pharmacist

collects during assessmentcollects during assessment

Baseline forBaseline for future assessmentsfuture assessments


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SIGNSSIGNS Patients needs and condition determinePatients needs and condition determine

when, where, how and by whom vital signswhen, where, how and by whom vital signs

are measuredare measured Pharmacist mustPharmacist must analyze vital signsanalyze vital signs to interpretto interpret

their significance and make decisions abouttheir significance and make decisions about

interventionsinterventions


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SIGNSSIGNS

1.1. EquipmentEquipment

Appropriate for the size and the age of theAppropriate for the size and the age of the

patientpatient Functional to ensure accurate findingsFunctional to ensure accurate findings

Selected based on the patients conditionSelected based on the patients condition


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SIGNSSIGNS

2.2. PatientPatient

Usual range of vital signs should be establishedUsual range of vital signs should be established

Medical history, therapies and prescribedMedical history, therapies and prescribed

medications should be knownmedications should be known


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GUIDELINES FOR MEASURING VITALGUIDELINES FOR MEASURING VITALSIGNSSIGNS

3.3. Control and minimizeControl and minimize environmental factorsenvironmental factorsaffecting vital signsaffecting vital signs

4.4. Organized, systematic approachOrganized, systematic approachwhen takingwhen takingvital signsvital signs..


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ACCEPTABLE RANGES FOR ADULTS Temperature range 36 to 37 C

Oral/tympanic 37C Rectal 37.5C Axillary 36.5C

Pulse rate 60 to 100 beats per minute Respiratory rate 12 to 16 breaths per minute Blood pressure 110/70 mm Hg


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VITAL SIGNSVITAL SIGNSEQUIPMENTSEQUIPMENTS

ThermometerThermometer StethoscopeStethoscope

SphygmomanometerSphygmomanometer


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COMPLETE PHYSICAL EXAMINATIONCOMPLETE PHYSICAL EXAMINATION

SubjectiveSubjective Everything is important, depending on theEverything is important, depending on the

chief complaintchief complaint

Consider everythingConsider everything Document the essentialDocument the essential


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HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS (HPI)(HPI)PP WhatWhatprovokesprovokes discomfort?discomfort?

QQ What is theWhat is the qualityquality of the discomfort?of the discomfort?

RR Where is theWhere is the regionregion of the discomfort?of the discomfort?SS What is theWhat is the severityseverity of the discomfort?of the discomfort?

TT What is theWhat is the timetime sequence?sequence?


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HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS (HPI)(HPI) What was theWhat was the mechanism of injurymechanism of injury??

What was theWhat was the patient doing prior to incidentpatient doing prior to incident?? Are there any associatedAre there any associated symptomssymptoms??

Are there anyAre there anyaggravating/relieving factorsaggravating/relieving factors??

Is this aIs this a recurrent illness or injuryrecurrent illness or injury?? Is the patientIs the patient on any medicationson any medications??

Notes patientsNotes patients eating habits, caffeine andeating habits, caffeine and

smoking habitssmoking habits

Allergies?Allergies?ASK FOR YOURSELFASK FOR YOURSELF


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REVIEW OF SYSTEMREVIEW OF SYSTEM (ROS)(ROS)

GeneralGeneralNutritional status, weight gain/loss, weakness,Nutritional status, weight gain/loss, weakness,

fatigue, hydration status & overall conditionfatigue, hydration status & overall condition

SkinSkinChanges in skin/nail/hair texture appearanceChanges in skin/nail/hair texture appearance

and color, rashes, itching, lumps or infectionand color, rashes, itching, lumps or infection


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COMPLETE PHYSICAL EXAMINATIONCOMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEMREVIEW OF SYSTEM (ROS)(ROS)

HeadHead

Loss of consciousness, lightheadedness,Loss of consciousness, lightheadedness,vertigo (dizziness), headaches, history ofvertigo (dizziness), headaches, history ofinjury, sinus, pain, visual disturbancesinjury, sinus, pain, visual disturbances

EyesEyesVisual changes,Visual changes, diplopiadiplopia, pain, discharge,, pain, discharge,trauma, photophobia, glaucoma, cataracts, lasttrauma, photophobia, glaucoma, cataracts, lasteye exam, use of eyeglasses/contacts lenseseye exam, use of eyeglasses/contacts lenses


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EarsEarsHearing loss,Hearing loss, tinnitustinnitus, drainage, pain,, drainage, pain,

infection, discharge, vertigo, hearing aidsinfection, discharge, vertigo, hearing aids

Nose/SinusesNose/Sinuses

Stuffiness, drainage, olfactory changes,Stuffiness, drainage, olfactory changes,

itching, obstruction, history of trauma,itching, obstruction, history of trauma,

hay fever, nosebleeds, sinus problemshay fever, nosebleeds, sinus problems


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ThroatThroat

Hoarseness,Hoarseness, dysphagidysphagiaa, enlarged tonsils,, enlarged tonsils,bleeding gums, sores, dental condition, caries,bleeding gums, sores, dental condition, caries,

tongue changes, dry mouth, history of soretongue changes, dry mouth, history of sore

throat, history of traumathroat, history of traumaNeckNeck

Goiter, pain, masses, nodules,Goiter, pain, masses, nodules, adenopathyadenopathy,,

thyroid problems, stiffness, history of injurythyroid problems, stiffness, history of injury


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REVIEW OF SYSTEMREVIEW OF SYSTEM (ROS)(ROS)RespiratoryRespiratory

Cough,Cough, dyspneadyspnea, sputum (amount, type, color),, sputum (amount, type, color),

asthma, bronchitis, COPD (asthma, bronchitis, COPD (chronicchronicobstructive pulmonary disease)obstructive pulmonary disease), emphysema,, emphysema,

TB, last CXR (TB, last CXR (chest xchest x--ray)ray), smoking history, smoking history


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CardiacCardiac

Hypertension,Hypertension, hyperlipidemiahyperlipidemia, rheumatic fever,, rheumatic fever,

murmursmurmurs, chest pain/discomfort,, chest pain/discomfort, dyspneadyspnea,,

edema, last ECG/stress test, CHF (edema, last ECG/stress test, CHF (congestivecongestiveheart failure)heart failure), history of surgeries, procedures,, history of surgeries, procedures,monitorsmonitors


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ASSESSMENTASSESSMENTCOMPLETE PHYSICAL EXAMINATIONCOMPLETE PHYSICAL EXAMINATION

REVIEW OF SYSTEMREVIEW OF SYSTEM (ROS)(ROS)Peripheral vascularPeripheral vascular

Nocturnal pain, varicose veins, leg cramps,Nocturnal pain, varicose veins, leg cramps,

CHF (CHF (congestive heart failure)congestive heart failure), swelling,, swelling,tendernesstenderness

GastrointestinalGastrointestinal

Heartburn,Heartburn, dysphagiadysphagia, appetite, indigestion,, appetite, indigestion,belching, flatulence, stool changes,belching, flatulence, stool changes, melenamelena,,

diarrhea, constipation, nausea,diarrhea, constipation, nausea, regurgitationregurgitation,,

vomiting, history of gallbladder or liver diseasevomiting, history of gallbladder or liver disease


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Genital (male)Genital (male)

HerniasHernias, sores, lesions, penile discharge, pain,, sores, lesions, penile discharge, pain,testicular/mass discomfort, scrotaltesticular/mass discomfort, scrotal

mass/discomfort, history of STDs, sexualmass/discomfort, history of STDs, sexualhistory, function, problemshistory, function, problems


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Genital (female)Genital (female)

Birth control, sexual history/function, STDs,Birth control, sexual history/function, STDs,itching, sores, discharge,itching, sores, discharge, dyspareuniadyspareunia, last, last

PAP/pelvic exam,PAP/pelvic exam, menarchemenarche, menopause,, menopause,

LMP (LMP (last menstrual period)last menstrual period), obstetric history,, obstetric history,menstrual regularity, frequency, duration,menstrual regularity, frequency, duration,amount,amount, dysmenorrheadysmenorrhea,, amenorrheaamenorrhea, PMS, PMS(pre(pre--menstrual syndrome)menstrual syndrome)


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UrinaryUrinary

DysuriaDysuria,, polyuriapolyuria, frequency, stones, pattern, frequency, stones, patternchange, incontinence,change, incontinence, nocturianocturia, STD,, STD,

hesitancy, dribbling,hesitancy, dribbling, hematuriahematuria, infections,, infections,

flank discomfortflank discomfortHematologicHematologic

Bleeding, bruising, anemia, history ofBleeding, bruising, anemia, history of

transfusionstransfusions


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EndocrineEndocrine

Thyroid, adrenal, hormonal, heat/coldThyroid, adrenal, hormonal, heat/cold

intolerance, edema,intolerance, edema, hirsutismhirsutism, sweating,, sweating,excessive thirst, hunger,excessive thirst, hunger, polyuriapolyuria, pigment, pigment

changeschanges

MusculoskeletalMusculoskeletalMyalgiaMyalgia, stiffness, gout, arthritis, backache,, stiffness, gout, arthritis, backache,

swelling, pain,swelling, pain, erythemaerythema, tenderness, history, tenderness, history

of traumaof trauma


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NeurologicNeurologic

Syncope, vertigo, seizures, blackouts,Syncope, vertigo, seizures, blackouts,paresthesiasparesthesias, paralysis, tremors, weakness,, paralysis, tremors, weakness,

involuntary movements, equilibriuminvoluntary movements, equilibrium

PsychiatricPsychiatricAnxiety, mood swings, mania, depression,Anxiety, mood swings, mania, depression,

memory loss, insomnia, suicidal ideations,memory loss, insomnia, suicidal ideations,

delusions, hallucinationsdelusions, hallucinations


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PAST MEDICAL HISTORYPAST MEDICAL HISTORY (PMH)(PMH)

Consider any other problems which areConsider any other problems which are

currently active, comments should includecurrently active, comments should include

functional impairment, childhood/adultfunctional impairment, childhood/adult

illnesses, history of trauma, surgeries, andillnesses, history of trauma, surgeries, and

hospitalizationshospitalizations

FAMILY HISTORYFAMILY HISTORY (FH)(FH)


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Always start your objective with an opening statementAlways start your objective with an opening statement

concerning the patientsconcerning the patients general appearance and conditiongeneral appearance and condition

WellWell--developed, welldeveloped, well--nourished male not in distress.nourished male not in distress.

Patient is ambulatory, alert , cooperative, and showsPatient is ambulatory, alert , cooperative, and showsno gross mental status changes. Vital signs noted.no gross mental status changes. Vital signs noted.

Consider listing a minimum ofConsider listing a minimum of33--4 physical exam4 physical exam

findings for each complaintfindings for each complaint

Check the system above and below, and include theCheck the system above and below, and include thepossibility ofpossibility of cutaneouscutaneous, musculoskeletal and occult, musculoskeletal and occult

findingsfindings

Document the absence of critical findingsDocument the absence of critical findings


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LABORATORY & DIAGNOSTIC TESTSLABORATORY & DIAGNOSTIC TESTS

Biochemical, chemical, or physical methodsBiochemical, chemical, or physical methods

of measuring biologic or physiologic functionsof measuring biologic or physiologic functions

of the bodyof the body

Important part of health care and haveImportant part of health care and have

become indispensable forbecome indispensable for routineroutine

screening and the diagnosis of diseasescreening and the diagnosis of disease


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Used routinely toUsed routinely to assess complianceassess compliance,,

monitor both the efficacymonitor both the efficacyof prescribedof prescribedtreatment and thetreatment and the advent of adverse oradvent of adverse or

toxic reactionstoxic reactions, diagnosis of specific disease, diagnosis of specific disease

and at times, to help determine the drug ofand at times, to help determine the drug of

choicechoice


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Ordered appropriatelyOrdered appropriatelyandand performedperformed andandinterpreted correctlyinterpreted correctly

Results of initial screening or diagnostic testsResults of initial screening or diagnostic tests

usually suggest theusually suggest the specific followspecific follow--up testsup testsnecessary for a definitive diagnosisnecessary for a definitive diagnosis


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THE PHARMACISTS ROLETHE PHARMACISTS ROLE

Involved inInvolved in monitoring patient caremonitoring patient care, and a, and a

growing number now have input into thegrowing number now have input into the

management of patient therapymanagement of patient therapy

Understand why laboratory tests are usedUnderstand why laboratory tests are used

and of the information to be gained fromand of the information to be gained from

themthem


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THE PHARMACISTS ROLETHE PHARMACISTS ROLE Drugs may influence the results of laboratoryDrugs may influence the results of laboratory

tests in a variety of ways, they are in goodtests in a variety of ways, they are in good

position toposition to anticipate and advise on suchanticipate and advise on suchinteractionsinteractions


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DEFINITION: Using word beginnings (prefixes)DEFINITION: Using word beginnings (prefixes)

and endings (suffixes) as clues to proceduresand endings (suffixes) as clues to procedures--GraphyGraphy To record anTo record an imageimage

--ScopyScopy To look through aTo look through a lensed instrumentlensed instrument

--CentesisCentesis ToTo puncturepuncture

--MetryMetry ToTo measuremeasurewith an instrumentwith an instrumentSonoSono-- To assess using To assess usingsoundsound

ElectroElectro-- To assess using To assess usingelectrical impulseselectrical impulses

GlucoGluco-- SugarSugar

EnEndodo-- InsideInside


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DEFINITIONDEFINITION

EndoscopyEndoscopyVisual examination ofVisual examination ofinternal structuresinternal structures

using optical scopesusing optical scopes

ParacentesisParacentesisPuncturing the skin and withdrawing fluidPuncturing the skin and withdrawing fluid

from thefrom the abdominal cavityabdominal cavity


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Lumbar PunctureLumbar PunctureInserting a needle betweenInserting a needle between lumbar vertebraelumbar vertebrae

in the spinein the spine but below the spinal cordbut below the spinal cord

Positron Emission Tomography (PET)Positron Emission Tomography (PET)Combines technology ofCombines technology ofradionuclideradionuclide scanningscanning

with the layered analysis ofwith the layered analysis oftomographytomography


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Sonogram or EchogramSonogram or Echogram Examination ofExamination ofsoft tissuesoft tissue using sound wavesusing sound waves

beyond human hearingbeyond human hearing

Visual image produced by the reflection ofVisual image produced by the reflection ofthe sound waves back from the tissues beingthe sound waves back from the tissues being

assessed and into the machineassessed and into the machine


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Electrical Graphic RecordingsElectrical Graphic Recordings Electrocardiography (ECG)Electrocardiography (ECG)

Examination of the electrical activity in theExamination of the electrical activity in the heartheart

Electroencephalography (EEG)Electroencephalography (EEG)

Examination of the energy emitted by theExamination of the energy emitted by the brainbrain

Electromyography (EMG)Electromyography (EMG)

Examination of the energy produced by stimulatedExamination of the energy produced by stimulated

musclesmuscles


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CultureCulture

To collect from the body a sample suspectedTo collect from the body a sample suspectedto contain infectious microorganisms, growingto contain infectious microorganisms, growing

the microbes in a nutrient substance, andthe microbes in a nutrient substance, andexamining the resulting growth under aexamining the resulting growth under amicroscopemicroscope


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Pelvic examinationPelvic examinationPhysical inspection of thePhysical inspection of thevagina and cervixvagina and cervix

and palpation of uterus and ovariesand palpation of uterus and ovaries

PapanicolaouPapanicolaou (Pap Smear)(Pap Smear)Screening ofScreening ofcells from the cervix and canalcells from the cervix and canal

to detect abnormal cells, hormonal status,to detect abnormal cells, hormonal status,

and presence of abnormal microorganismsand presence of abnormal microorganisms


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FACTORS THATFACTORS THAT INVALIDATEINVALIDATETESTTEST

RESULTSRESULTS IncorrectIncorrect dietdiet preparationpreparation

Failure to remainFailure to remain fastingfasting

InsufficientInsufficient bowel cleansingbowel cleansing

Drug interactionsDrug interactions

InadequateInadequate specimen volumespecimen volume

Failure to deliver specimen to lab inFailure to deliver specimen to lab in timely mannertimely manner

Incorrect or missingIncorrect or missingrequest formrequest form


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COMMON DIAGNOSTIC PROCEDURESCOMMON DIAGNOSTIC PROCEDURES Radiography or Roentgenography (XRadiography or Roentgenography (X--ray)ray)

FluoroscopyFluoroscopy

Computerized Tomography (CT Scan)Computerized Tomography (CT Scan) Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)


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COMMON DIAGNOSTIC PROCEDURESCOMMON DIAGNOSTIC PROCEDURES

Endoscopic examinationsEndoscopic examinations BronchoscopyBronchoscopy inspection of theinspection of the bronchibronchi

GastroscopyGastroscopy inspection ofinspection ofstomachstomach

ColonoscopyColonoscopy inspection ofinspection ofcoloncolon

LaparoscopyLaparoscopy inspection of theinspection of the abdominalabdominalcavitycavity

Cystoscopy Cystoscopy inspection ofinspection ofurinary bladderurinary bladder


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HematologyHematology oror haematologyhaematology

-- branch of biology (physiology),branch of biology (physiology), pathologypathology,,

clinical laboratoryclinical laboratory,, internal medicineinternal medicine, and, andpediatricspediatrics that is concerned with the study ofthat is concerned with the study ofbloodblood, the blood, the blood--forming organs, and bloodforming organs, and blood

diseases.diseases.

-- includes the study ofincludes the study ofetiologyetiology,, diagnosisdiagnosis,,treatment,treatment, prognosisprognosis, and, and preventionprevention of bloodof blooddiseases.diseases.


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LABORATORY TESTSLABORATORY TESTSHEMATOLOGY *HEMATOLOGY *

Test Normal Values

White Blood Cell (WBC) 5 x 109/L

Red Blood Cell (RBC) 4-6 x 1012/L

Hemoglobin (Hb) Male: 140-170 g/L

Female: 120-170 g/L

Hematocrit (Hct) Male: 37 54%

ESR (erythrocyte sedimentation rate) Female: 0 20 mm/hr

Differential Count Neutrophils: 54 75%

Eosinophils: 0 4%

Lymphocytes: 2 35%Monocytes: 6%

Basophils: 0 0.5%

Mean Corpuscular Volume 75 97 fl

Mean Corpuscular Hemoglobin 26 33 pg


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Classification of hematologic diseasesClassification of hematologic diseases

Major categories ofMajor categories of hematologic diseasehematologic disease include:include:

HemoglobinopathiesHemoglobinopathies (congenital abnormality(congenital abnormality

of theof the hemoglobinhemoglobin molecule or of the rate ofmolecule or of the rate of

hemoglobinhemoglobin synthesis)synthesis) AnemiasAnemias (lack of(lack ofred blood cellsred blood cells oror

hemoglobinhemoglobin))

HematologicalHematological malignanciesmalignancies CoagulopathiesCoagulopathies (disorders of(disorders ofbleedingbleedingandand

coagulationcoagulation))

T dT d


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Treatments include:Treatments include:

DietDiet adviceadvice

OralOral medicationmedication -- tablets or liquid medicinestablets or liquid medicines

AnticoagulationAnticoagulation therapytherapy

Intramuscular injections (for example,Intramuscular injections (for example,Vitamin B12Vitamin B12

injections)injections) Blood transfusionBlood transfusion (for(for anemiaanemia))

VenesectionVenesection also known asalso known as therepeutictherepeutic phlebotomy (forphlebotomy (foriron overloadiron overload oror polycythemiapolycythemia))

Bone marrow transplantBone marrow transplant (for example, for(for example, for leukemialeukemia))

ChemotherapyChemotherapy(for example, for(for example, for leukemialeukemia))

RadiotherapyRadiotherapy(in decline, for example, for(in decline, for example, for leukemialeukemia))


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CoagulationCoagulation

complex process by whichcomplex process by which bloodblood formsforms clotsclots..

important part ofimportant part ofhemostasishemostasis (the cessation of(the cessation ofblood loss from a damaged vessel), wherein ablood loss from a damaged vessel), wherein a

damageddamaged blood vesselblood vesselwall is covered by awall is covered by aplateletplatelet andand fibrinfibrin--containing clot to stopcontaining clot to stop

bleedingbleedingand begin repair of the damaged vessel.and begin repair of the damaged vessel.

Disorders can lead to an increased risk ofDisorders can lead to an increased risk ofbleeding (bleeding (hemorrhagehemorrhage) and/or clotting) and/or clotting((thrombosisthrombosis).).


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CoagulationCoagulation

begins almost instantly after an injury to thebegins almost instantly after an injury to theblood vessel has damaged theblood vessel has damaged the endotheliumendothelium

(lining of the vessel).(lining of the vessel).

PrimaryPrimary hemostasishemostasis --PlateletsPlatelets immediately form aimmediately form aplug at the site of injury;plug at the site of injury;

SecondarySecondary hemostasishemostasisoccurs simultaneously:occurs simultaneously:

Proteins in theProteins in the blood plasmablood plasma, called, called coagulationcoagulationfactorsfactorsoror clotting factorsclotting factors, respond in a complex, respond in a complexcascade to formcascade to form fibrinfibrin strands, which strengthenstrands, which strengthen

the platelet plug.the platelet plug.[1][1]


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LABORATORY TESTSLABORATORY TESTSCOAGULATION *COAGULATION *

Test Normal Values

ACT (activated coagulation time) 70 120 seconds

APTT(activated partial thromboplastin time) 30 40 seconds

Bleeding time (BT) 1 3 min

Clotting time 8 -15 mins

FDP (d-dimmer) < 25 mg/dl

Fibrinogen level 200 400 mg/dl

Partial thromboplastin time (PTT) 30 40 seconds

Platelet Count 200 400 x 109 L

Prothrombin time (PT) 12 15 seconds

Thrombin time 10 14 seconds


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Problems with coagulation may dispose toProblems with coagulation may dispose to

hemorrhagehemorrhage, thrombosis, and occasionally both,, thrombosis, and occasionally both,depending on the nature of the pathology.depending on the nature of the pathology.

ThrombosisThrombosis is the pathological development ofis the pathological development ofblood clots. These clots may break free andblood clots. These clots may break free and

become mobile, forming anbecome mobile, forming an embolusembolus or grow toor grow to

such a size that occludes the vessel in which itsuch a size that occludes the vessel in which itdeveloped.developed.


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Most cases of thrombosis are due to acquiredMost cases of thrombosis are due to acquired

extrinsic problems (extrinsic problems (surgerysurgery,, cancercancer,, immobilityimmobility,,obesityobesity,, economy class syndromeeconomy class syndrome), but a small), but a small

proportion of peopleproportion of people harborharbor predisposingpredisposingconditions known collectively asconditions known collectively as thrombophiliathrombophilia

C fC f


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CofactorsCofactors

Various substances are required for the properVarious substances are required for the proper

functioning of the coagulation cascade:functioning of the coagulation cascade:

CalciumCalcium andand phospholipidphospholipid (a(a plateletplatelet membranemembraneconstituent)constituent)

VitaminVitamin KK

BLOOD CHEMISTRYBLOOD CHEMISTRY


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BLOOD CHEMISTRYBLOOD CHEMISTRYTypes:Types:

Serum albuminSerum albumin-- most abundantmost abundant blood plasmablood plasma protein and is producedprotein and is produced

in thein the liverliver and forms a large proportion of all plasmaand forms a large proportion of all plasmaprotein.protein.

-- human serum albuminhuman serum albumin, and it normally, and it normally

-- constitutes about 70% ofconstitutes about 70% ofhumanhuman plasma protein;plasma protein;

-- GlobulinsGlobulins -- all other proteins present in blood plasmaall other proteins present in blood plasma

bovine serum albuminbovine serum albumin (cattle serum albumin) or BSA,(cattle serum albumin) or BSA,often used in medical and molecular biology labs.often used in medical and molecular biology labs.


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Low albumin (Low albumin (hypoalbuminaemiahypoalbuminaemia) may be) may be

caused by liver disease,caused by liver disease, nephroticnephrotic syndromesyndrome,,

burns,burns, proteinprotein--losinglosing enteropathyenteropathy,,malabsorptionmalabsorption, malnutrition, late pregnancy,, malnutrition, late pregnancy,

artefact, genetic variations and malignancy.artefact, genetic variations and malignancy. High albumin is almost always caused byHigh albumin is almost always caused by

dehydrationdehydration

AmylaseAmylase is anis an enzymeenzyme that breaksthat breaks starchstarch downdownintointo sugarsugar. Amylase is present in human. Amylase is present in human salivasaliva,,

where it begins the chemical process ofwhere it begins the chemical process of

digestiondigestion


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Blood serumBlood serum amylaseamylase may be measured formay be measured for

purposes ofpurposes ofmedical diagnosismedical diagnosis. A normal. A normalconcentration is in the range 21concentration is in the range 21--101 U/L. A101 U/L. A

higher than normal concentration may reflecthigher than normal concentration may reflectone of several medical conditions, includingone of several medical conditions, including

acuteacute inflammationinflammation of the pancreas,of the pancreas,

macroamylasemiamacroamylasemia, perforated, perforated peptic ulcerpeptic ulcer, and, andmumpsmumps. Amylase may be measured in other. Amylase may be measured in other

body fluids, includingbody fluids, includingurineurine andand peritonealperitoneal fluid.fluid.


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Blood sugar regulationBlood sugar regulation is the process by which theis the process by which thelevels oflevels ofblood sugarblood sugar, primarily, primarilyglucoseglucose, are maintained, are maintained

by the body.by the body. When levels of blood sugar rise, a different hormone isWhen levels of blood sugar rise, a different hormone is

released fromreleased from beta cellsbeta cells found in thefound in the Islets ofIslets ofLangerhansLangerhans in the pancreas. This hormone,in the pancreas. This hormone, insulininsulin,,

causes the liver to convert more glucose into glycogencauses the liver to convert more glucose into glycogen(this process is called(this process is called glycogenesisglycogenesis), and to force about), and to force about2/3 of body cells (primarily2/3 of body cells (primarilymusclemuscle and fat tissue cells)and fat tissue cells)to take up glucose from the blood, thus decreasingto take up glucose from the blood, thus decreasing

blood sugar levels. Insulin also provides signals toblood sugar levels. Insulin also provides signals toseveral other body systems, and is the chief regulatoryseveral other body systems, and is the chief regulatorymetabolic control in humans.metabolic control in humans.

LABORATORY TESTSLABORATORY TESTS


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BLOOD CHEMISTRY *BLOOD CHEMISTRY *

Test Normal Values*

Albumin 30 50 g/L

Amylase 10 130 U/L

Fasting Blood Sugar 3.89 5.88 mmol/L

Glycosylated Haemoglobin < 7%

7 8 % Excellent Control

8 9 % Good Control

9 10% Fair Control

> 10% Poor Control

Globulins 23 35 g/L

Serum Ammonia : 11 -35 Umol/L


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RENAL PROFILE TESTSRENAL PROFILE TESTS

Nephrology concerns itself with the diagnosisNephrology concerns itself with the diagnosisand treatment of kidney diseases:and treatment of kidney diseases:

-- electrolyte disturbanceselectrolyte disturbances andand hypertensionhypertension, and, and

the care of those requiringthe care of those requiringrenal replacementrenal replacementtherapytherapy, including, includingdialysisdialysis andand renal transplantrenal transplant

patients. Many diseases affecting the kidney arepatients. Many diseases affecting the kidney are

systemic disorders not limited to the organ itself,systemic disorders not limited to the organ itself,

and may require special treatment. Examplesand may require special treatment. Examplesinclude systemicinclude systemic vasculitidesvasculitides andand autoimmuneautoimmunediseasesdiseases such assuch as lupuslupus..


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LABORATORY TESTSLABORATORY TESTSRENAL PROFILE TESTSRENAL PROFILE TESTS

Test Normal Values

Blood Urea Nitrogen * 3.2 8 mmol/L

Serum Bicarbonate 22 26 mEq/L

Serum Calcium* 2.02 2.60 mmol/L

Serum Chloride 99.9 110 mmol/L

Serum Creatinine* 53 133 mmol/L

Serum Magnesium 1.4 2.1 mmol/L

Serum Phosphorus 0.42 1.97 mmol/L

Serum Potassium* 4 4.5 mmol/L

Serum Sodium* 135 145 mmol/L

Serum Uric Acid* 0,13 0.44 mmol/L


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Conditions requiring aConditions requiring a nephrologistnephrologist Acute renal failureAcute renal failure, a sudden loss of renal function, a sudden loss of renal function

Chronic kidney diseaseChronic kidney disease, declining, decliningrenal functionrenal function, usually, usuallywith an inexorable rise inwith an inexorable rise in creatininecreatinine..

HematuriaHematuria, blood loss in the urine, blood loss in the urine

ProteinuriaProteinuria, the loss of, the loss ofproteinprotein especiallyespeciallyalbuminalbumin in thein the

urineurine

Kidney stonesKidney stones, usually only recurrent stone formers., usually only recurrent stone formers.

ChronicChronic or recurrentor recurrent urinary tract infectionsurinary tract infections

HypertensionHypertension that has failed to respond to multiple formsthat has failed to respond to multiple formsof antiof anti--hypertensivehypertensive medicationmedication or could have a secondaryor could have a secondarycausecause

ElectrolyteElectrolyte disorders or acid/base imbalancedisorders or acid/base imbalance


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TherapyTherapy

Many kidney diseases are treated with:Many kidney diseases are treated with: steroidssteroids,,DMARDsDMARDs (disease(disease--modifyingmodifying antirheumaticantirheumatic

drugs),drugs), antihypertensivesantihypertensives (many kidney diseases(many kidney diseasesfeaturefeature hypertensionhypertension). Often). Often erythropoietinerythropoietin andand

vitamin Dvitamin D treatment is required to replace thesetreatment is required to replace thesetwo hormones, the production of whichtwo hormones, the production of which

stagnates in chronic kidney disease.stagnates in chronic kidney disease.

WhenWhen chronic kidney diseasechronic kidney disease progresses to stageprogresses to stagefive,five, dialysisdialysis oror transplanttransplant is required.is required.


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LIPID PROFILELIPID PROFILE

The VAP (Vertical Auto Profile) is aThe VAP (Vertical Auto Profile) is a cholesterolcholesterol,, lipidlipidandand lipoproteinlipoprotein test. In addition to the basic scorestest. In addition to the basic scores(total cholesterol, high(total cholesterol, high--density lipoproteins, lowdensity lipoproteins, low--densitydensitylipoproteins, andlipoproteins, and triglyceridestriglycerides), the VAP test includes), the VAP test includes

categories of cholesterol measurement. The VAP has acategories of cholesterol measurement. The VAP has aunique ability to identify far more areas of risk than theunique ability to identify far more areas of risk than thestandard lipid panel.standard lipid panel.

People with a family history or an existing condition ofPeople with a family history or an existing condition of

diabetes, high blood pressure or heart diseasediabetes, high blood pressure or heart disease ---- or whoor whoare already taking cholesterol lowering medicationare already taking cholesterol lowering medication ---- arearecandidates for the comprehensive VAP (Vertical Autocandidates for the comprehensive VAP (Vertical AutoProfile) Test.Profile) Test.


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LABORATORY TESTSLABORATORY TESTSLIPID PROFILELIPID PROFILE **

Test Normal Values*

Serum cholesterol up to 200 mgs/dl

Borderline: Up to 239 mgs/dl

Elevated if>240 mgs/dL on repeated values

Serum triglycerides < 180 mgs/dlHDL Cholesterol 30 60 mgs/dl

LDL Cholesterol Borderline: 100 190 mgs/dl

Risk: > 190 mgs/dl

Note: Formula for calculating LDL Cholesterol

is INVALID if TGL > 400 mgs/dl

Total/HDL ratio : < 4

Low Risk: 4 6

High Risk: > 6

HEPATIC ENZYMESHEPATIC ENZYMES


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((Liver function tests)Liver function tests)

groups ofgroups ofclinical biochemistryclinical biochemistrylaboratory bloodlaboratory bloodassays designed to give information about theassays designed to give information about thestate of a patient'sstate of a patient's liverliver. Most. Most liver diseasesliver diseases causecause

only mild symptoms initially, but it is vital thatonly mild symptoms initially, but it is vital thatthese diseases be detected early. Hepatic (liver)these diseases be detected early. Hepatic (liver)

involvement in some diseases can be of crucialinvolvement in some diseases can be of crucial

importance.importance.


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LABORATORY TESTSLABORATORY TESTSHEPATIC ENZYMESHEPATIC ENZYMES **

Test Normal Values*

SGOT / Aspartate Aminotransferase (AST) Up to 34 34 U/L

SGP

T /A

lanineA

minotransferase (A

LT) Up to 30 U/L

Serum Alkaline Phospatase (ALP) 36 92 U/L


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Thyroid function tests (TFTs)Thyroid function tests (TFTs)

collective term forcollective term for blood testsblood tests used to check theused to check the

function of thefunction of the thyroidthyroid..

includesincludes thyroidthyroid--stimulating hormonestimulating hormone (TSH,(TSH,

thyrotropinthyrotropin) and) and thyroxinethyroxine (T4), and(T4), andtriiodothyroninetriiodothyronine (T3) depending on local(T3) depending on local

laboratory policy.laboratory policy.


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TFTTFT

requested if a patient is thought to suffer fromrequested if a patient is thought to suffer from

hyperthyroidismhyperthyroidism (overactive thyroid) or(overactive thyroid) orhypothyroidismhypothyroidism (underactive thyroid), or to(underactive thyroid), or to

monitor the effectiveness of either thyroidmonitor the effectiveness of either thyroid--suppression or hormone replacement therapy. Itsuppression or hormone replacement therapy. It

is also requested routinely in conditions linkedis also requested routinely in conditions linked

to thyroid disease, such asto thyroid disease, such as atrialatrial fibrillationfibrillation..



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LABORATORY TESTSLABORATORY TESTSTHYROID FUNCTION TESTTHYROID FUNCTION TEST

Test Normal Values

Free T4* 0.8 2.0 ng/dl

Free T3* 2.3 4.2 pg/ml

TSH * 0.25 4.30 microunits/ml

Serum T3 70 200 ng/dl

Serum T4 4.0 11.0 micrograms/dl


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Cardiac markersCardiac markers

evaluate heard function.evaluate heard function.

often discussed in the context ofoften discussed in the context ofmyocardialmyocardialinfarctioninfarction, but other conditions can lead to an, but other conditions can lead to an

elevation in cardiac marker level.elevation in cardiac marker level.

early markers identified wereearly markers identified were enzymesenzymes, and as a, and as a

result, the term "cardiac enzymes" is sometimesresult, the term "cardiac enzymes" is sometimes

used. However, not all of the markers currentlyused. However, not all of the markers currentlyused are enzymes.used are enzymes.


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LABORATORY TESTSLABORATORY TESTSCARDIAC ENZYMES AND PROTEINSCARDIAC ENZYMES AND PROTEINS

Test Normal Values

CPK* 25 2000 U/L

CK MB (creatine kinase isoenzyme MB)* 0 9 ng/ml or < 3% of total CPK

LDH 0 280 U/L

LDH - 1 20 36% of total LDH: LDH1

SGOT (Serum glutamic oxaloacetic *Transaminase)

< 42 U/L

SGPT (Serum glutamic pyruvic transaminase)* 0 48 U/L

Myoglobin * 0 85 ng/ml

Troponin 1 0,0 0.1 ng/ml

Troponin T < 0.18 ng/ml


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Urinalysis (or "UA")Urinalysis (or "UA")

array of tests performed onarray of tests performed on urineurine and one of theand one of the

most common methods ofmost common methods ofmedicalmedical diagnosisdiagnosis..[1][1]

A part of a urinalysis can be performed by usingA part of a urinalysis can be performed by using

urineurine dipsticksdipsticks, in which the test results can be, in which the test results can beread asread as colorcolor changes.changes.


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LABORATORY TESTSLABORATORY TESTSURINALYSIS *URINALYSIS *

Color Straw dark yellow

Odor Slightly aromatic

Appearance Clear

Specific gravity Infants: 1.002 1.006

Adult: 1.016 1.022pH 4.6 6.5

protein negative

Glucose negative

Na 10 40 mEq/L

K < 8 mEq/L


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LABORATORY TESTSLABORATORY TESTSURINALYSISURINALYSIS

Color Straw dark yellow

Cl < 8 mEq/L

bilirubin negative

Urobilinogen 0.1 1 EU/100 mlKetones * negative

Occult Blood * negative

RBCs * Female: 0 2/hpf, Male: 0/hpf

WBCs * Female: 0 5/hpf, Male: 0 2/hpf

Bacteria * Negative on spun specimenCasts * Hyaline, coarse, fine granular, RBC, WBC,

waxy casts

Crystals * Interpreted by physician

//


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numbers & types ofnumbers & types ofcellscells/material such as/material such as

urinary castsurinary castsyield a detail information andyield a detail information and

suggest a specific diagnosis.suggest a specific diagnosis.

HematuriaHematuria -- associated withassociated with kidney stoneskidney stones,, infectionsinfections,,tumorstumors and other conditionsand other conditions

PyuriaPyuria -- associated withassociated with urinary infectionsurinary infections

eosinophiluriaeosinophiluria -- associated withassociated with allergic interstitialallergic interstitialnephritisnephritis,, atheroembolicatheroembolic diseasedisease

RBCRBC castscasts -- associated withassociated with glomerulonephritisglomerulonephritis,,vasculitisvasculitis,, malignant hypertensionmalignant hypertension

numbers & types ofnumbers & types of cellscells/material such as/material such as


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numbers & types ofnumbers & types ofcellscells/material such as/material such as

urinary castsurinary castsyield a detail information andyield a detail information and

suggest a specific diagnosis.suggest a specific diagnosis.

WBC castsWBC casts -- associated withassociated with acute interstitial nephritisacute interstitial nephritis,,exudativeexudative glomerulonephritisglomerulonephritis, severe, severe pyelonephritispyelonephritis

((hemeheme) granular casts) granular casts -- associated withassociated with acute tubularacute tubularnecrosisnecrosis

crystalluriacrystalluria ---- associated withassociated with acuteacute urateurate nephropathynephropathy(or "Acute uric acid nephropathy", AUAN)(or "Acute uric acid nephropathy", AUAN)

calcium oxalatecalcium oxalate -- associated withassociated with ethylene glycolethylene glycol toxicitytoxicity


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FecalysisFecalysis/stool analysis/stool analysis

laboratory tests done on fecal samples to analyzelaboratory tests done on fecal samples to analyze

the condition of a person's digestive tractthe condition of a person's digestive tract

performed to check for the presence of anyperformed to check for the presence of any

reducing substances such as white blood cellsreducing substances such as white blood cells(WBCs), sugars, or bile and signs of poor(WBCs), sugars, or bile and signs of poor

absorption as well as screen for colon cancer.absorption as well as screen for colon cancer.


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LABORATORY TESTSLABORATORY TESTSFECALYSISFECALYSIS **

Parameter Results/Normal

Values

Parameter Results/Normal

Values

Character Formed Pus Negative

Color Brown Blood Negative

Mucus Negative Occult Blood Negative


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E N DE N D

Documents

UNIT v Assessment