LABORATORY AND PHYSICAL ASSESSMENT DATA (1)
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This document discusses the importance of laboratory and physical assessment data in delivering pharmaceutical care at the University of Calabar Teaching Hospital in Nigeria. It provides background on the hospital and defines pharmaceutical care. Laboratory tests, physical examinations, and the steps involved in patient assessment are described. The responsibilities of pharmacists are outlined. The document emphasizes that laboratory and physical data are essential for pharmacists to evaluate drug therapy, identify problems, and measure treatment outcomes, thereby ensuring appropriate patient care.
LABORATORY AND PHYSICAL ASSESSMENT DATA (1)
- 1. LABORATORY AND PHYSICAL ASSESSMENT DATA THEIR IMPORTANCE IN THE DELIVERY OF PHARMACEUTICAL CARE-UCTH EXPERIENCE.
- 2. BRIEF PROFILE OF UCTH • In the 19th century,the earliest known source of scientific medical treatment in old calabar came from the Presbyterian Mission • In 1855,Dr Hewan,the first full medical missionary physician arrived old calabar to join the mission team to help in educational and missionary work • Dr Hewan,like other missionaries,lived in the mission premises where he had closer contact with his colleagues to give attention to their ailments since no hospital was established in the whole of old calabar
- 3. • During this time,man’s life span on the coast was brief,people were dying of common diseases including these Europeans • In order to stem this tide,it was urgent for the government to have its own medical officers and these were Drs Mackinson and Allman. • Due to the absence of hospital during these periods,these government Doctors converted their residential building along Marina Beach to temporary clinic until 1897 when St Margaret’s Hospital was established.
- 4. • In 1978,the Federal Government of Nigeria conceived the need for a medical school and that was how St Margaret’s Hospital, established in 1897 by the British Colonial government, was taken over by the Federal Government and renamed as University of Calabar Teaching Hospital.
- 5. THE MISSION OF THE UCTH • Building infrastructure and manpower.
- 6. VISION FOR THE UCTH • Service and dedication to human
- 7. Eye Care Paediatric Care Chiropractics Care Nursing Care Dental Care Mental Health Care Medical Care Maternal Care Nutritional Care Surgical Care Pharmaceutical Care Geriatric Care Self Care
- 8. What is pharmaceutical care? • According to Hepler, PC is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve and maintain patient’s quality of life. • It is a patient-focussed, pharmacist-initiated service through which pharmacist,in collaboration with the patient and other health professionals,designs,implements and monitors a therapeutic outcome for the patient.
- 9. Philosophy of PC • Definition of philosophy: A philosophy is a particular theory that someone has about how to live or how to deal with a particular situation • Below are the philosophy of PC: • Social need, patient-centered,caring and pharmacist’s responsibilities
- 10. Pharmacist’s Responsibilities • To identify actual and potential drug therapy and health-related problems • To resolve actual and potential drug therapy and health-related problems.
- 11. Classification of Drug Therapy Problems • Unnecessary drug therapy • Wrong drug • Underdosage • Overdosage • Adverse drug reactions • Inappropriate compliance • Additional drug • Drug Interactions
- 12. • In carrying out pharmaceutical care activities by pharmacists, it may interest you to know that the functions of the pharmacists, the physicians and the nurses may seem overlap but our responsibilities are different. • So what are pharmacist’s responsibilities? • (See above). • All the knowledge we have gathered in the basic pharmaceutical sciences is what has been translated into a product called the ‘drug’,using that product as a medium to render service is what PC represents.
- 13. STEPS INVOLVED IN THE PROVISION OF PC • Establish a professional relationship • Collect patient specific data • Evaluate data to identify drug therapy problems and classify them • Develop and implement a PC plan(Intervention) • Monitor and follow up(Outcome measurement)
- 14. • Documentation. • Dimensions Or Outcomes of PC • -Clinical • -Economic • -Humanistic
- 15. PHARMACEUTICAL CARE SKILLS • Knowledge of pathophysiology of diseases • Interpretations of routine clinical laboratory tests and physical assessment • Knowledge of Medical abbreviations and terminologies • Clinical use of drugs • Pharmacology of drugs • Knowledge of behavioral sciences(Health-belief and decision making models)
- 16. • Cognitive skills(critical thinking skill and problem- solving skill) • Listening and communication skills • Skills in diplomacy • Problem-solving skills using the IDEAL model • I-Identification • D-Definition • E-Exploration • A-Action • L-Looking and learning
- 17. LABORATORY TESTS • BLOOD CHEMISTRY: • A)Electrolytes content e.g.serum potassium,sodium,chloride and CO2 content • B) Chemical components e.g calcium,magnesium,phosphorus,glucose,total protein/protein differential,blood urea nitrogen(BUN),creatinine and creatinine clearance,uric acid,bilirubin(Direct,indirect,total and new born total),cholesterol and HBA1c
- 18. • C) Enzymes components, e.g. Alkaline phosphatase,serum glutamic oxaloacetic transaminase(SGOT),serum glutamic pyruvic transaminase(SGPT),lactic dehydrogenase(LDH),creatine phosphokinase(CPK),acid phosphatase,amylase. • D) Acid-base components, e.g. Bicarbonate,CO2 content,CO2 combining power,arterial PH,arterial PCO2,chloride,anion gap, and arterial PO2
- 19. • The discussion of these acid-base components would eventually lead to the discussion on acid-base disorders namely: • Metabolic acidosis • Metabolic alkalosis • Respiratory acidosis • Respiratory alkalosis
- 20. • E) Cerebrospinal fluid(CSF) biochemistry and Microbiology. Parameters to note will include: • CSF opening pressure • Microscopy/macroscopy • Glucose level • Protein level
- 21. HORMONES LEVEL EVALUATIONS • A)Thyroid Function Test: These are tests for initial evaluation of thyroid status,e.g. TT4 by Murphy-Patte test, Resin T3-uptake test, Protein-bound iodine(PBI) test, Free thyroxine index(FTI) test, radioactive iodine uptake (RAIU) test, thyroid scan, antibodies,thyrotropin-stimulating hormone(TSH) test,T3-suppression test, thyroxine-releasing hormone(TRH) test.
- 22. • Other hormonal evaluation tests, e.g.prolactin,male and female hormonal immunoassy tests,etc,
- 23. HEMATOLOGY SCREENING • Routinely,a complete blood count includes the determination of the following: • RBC count • Hemoglobin concentration • PCV • Retic count • WBC count • Differential WBC count or FBC/Differntial • ESR
- 24. • RBC indices for determining the types of anemia, examples are: • Mean cell volume(MCV) • Mean cell hemoglobin(MCH) • Mean cell hemoglobin concentration(MCHC)
- 25. URINALYSIS • A)Gross examination of the urine sample for: • -appearance or color • -PH • -specific gravity • -presence or absence of glucose • -presence or absence of ketones • -Presence or absence of proteins
- 26. • B) Microscopic examination of the urine sample for WBCs, RBCs, casts,yeasts,crystals and epithelial cells. • Other laboratory tests that may not involve the use of bodily fluids but the use of imaging and electrical techniques are radiologic and electrocardiographic respectively, e.g. ultrasound scan, ECG,X-ray, Endoscopy,etc,
- 27. PHYSICAL ASSESSMENTS OR EXAMINATIONS • The following techniques are employed in the generation of physical assessment data: • INSPECTION • PALPATION • PERCUSSION • AUSCULTATION • (IPPA)
- 28. STEPS IN CLINICAL ASSESSMENT OF PATIENTS • Step 1: History taking • Step 2: Physical examination or assessment • Step 3: Develop a working diagnosis • Step 4: Obtaining supportive information(This is usually laboratory data for differential diagnosis) • Step 5:Develop final diagnosis • Step 6: Treatment initiation
- 29. GENERAL PHYSICAL EXAMINATION • Facies • Overall appearance • The gait • The temperature • Attitude • Conjunctival • Buccal mucosa • Lymph nodes
- 30. • Peripheral edema • The nails
- 31. SYSTEMATIC PHYSICAL EXAMINATION • 1) THE CARDIOVASCULAR SYSTEM • -Heart rate or pulse rate • -Blood pressure • -Heart sound{S1,S2(A2 and P2),S3,S4} • -Heart murmur(Grades 1,2,3,4 murmur),mid- systolic, pansystolic,innocent,late systolic and diastolic murmurs. • Apex beat(AB)
- 32. • 2) THE RESPIRATORY SYSTEM • -Respiratory rate • -Location of the trachea • -Chest movement with respect to respiration • -Percussion of the lungs, which may be described as resonant, hyper-resonant,dull note or stony dull note. • Breath sound(normal is vesicular)
- 33. • -Bronchial sound • -Crepitations or rales
- 34. • 3) THE GASTROINTESTINAL SYSTEM(This involves the examinations of the liver, the pancreas, the spleen, the Kidneys) • -Rectum examination • -Anus examination • -peritoneal space examination(ascites, if their is fluid) • -Movement of the abdomen with respect to respiration
- 35. • -measurement of tenderness at the epigastrium, hypogastrium,right epigastrium and left epigastrium • -measurement of tenderness at the left and right renal angles
- 36. • 4) EXAMINATIONS OF THE SKIN. • -examine for pigmentation • -examine for hemorrhages (bleeding into the skin- purpura) • -examine for rashes or eruptions • -for light skin patient, examine the skin for pallor, jaundice and cyanosis • 5)EXAMINATIONS OF THE CNS. • -Alert and conscious or unconscious • -Orientation to time ,place and person(TPP) • -examination of tones in the limbs,etc.
- 37. IMPORTANCE OF LABORATORY AND PHYSICAL ASSESSMENT DATA IN THE DELIVERY OF PC • They can be used to determine the appropriateness of the instituted drug therapy • Can be used to evaluate drug therapy effectiveness(Used to develop objective monitoring parameters in drug therapy outcome measurements) • To assess drug toxicity(side effects,ADRs)
- 40. SUCCESS RATE OF PC IN UCTH 0 100 200 300 400 500 600 700 2009 2010 2011 No.ofDrugtherapyProblems Year Number of Drug Therapy Problems against Years
- 41. • Thank you • Dr Agbenin Andrew(Bpharm,PharmD,MPH,MPCPharm)