Clinical Diagnostic Process and Approaching patient and vital signs and skin screening

Lecture 1 - 8/3

Diagnostic Process - 3 Steps

3 broad categories

1. initial diagnostic assessment - evaluate chief complaints

   1. patient history

   2. physical exam

   3. evaluation of patient chief complaint and symptoms

   4. form differential diagnosis

   5. order test and diagnostics

2. Diagnostic testing

   1. performance interpretation and communication

3. Referral, consultation, treatment and follow-up

Assessment

act of determining the patient health status and evaluatung the factors influencing that status

Diagnostic Process

History most important then physical examination then lab tests

• lab should confirm diagnosis, NOT MAKE IT

• Diagnosis from history and physical examination - 90% most important part of process

Order of patient Visit

1. History

2. Review systems and physical examination

   1. review systems (how you are currently feeling that day)

3. lab test diagnostics

4. education and counseling

5. referrals

6. F/U plan

7. emergency precaution

8. confirm patient understanding

History- Comprehensive assessment VS focused assessment

Comprehensive Assessment:

• annual physical

• medicare wellness

• new patient/ estabishing visit

Focused Assessment:

• follow-up

• review

• chronic just coming in

What is included in history?

Chief complaint

HPI

Past Medical history

family history

social history

Review of current systems (how currently feeling)

Physical Exam

inspection, palpation, percussion, and auscultation (in this order)

Modifiers in diagnostic process

Emergency

Clinical vs Hospital

Special Situations

• occupational medicine

• work comp

• prison

• street medicine

Peds

Geriatric

Unresponsive patient

Social Determinants (language barriers, financial)

Vital Signs

Heigh

weight

BMI (kg/m²)

Temp (F)

heart rate (bpm)

respiratory rate (bpm)

oxygen saturation (on room air)

blood pressure (mmHg)

Pain

BMI- underweight

BMI less than 18.5

BMI- NORMAL

18.5-24.9

BMI- overweight

25- 29.9

BMI- OBESE

30 and greater

BMI- Morbidly Obese

40 or greater

Pyrexia - fever

100.4

Hyperthermia - fever

104

Pulse name and location to take

radial (Wrist) and brachial (elbow) pulse

Irregular Pulse Rates

count for 1 full minute

use stethoscope to listen to apical pulse - find apex of heart and listen right over that area

bradycardia

slow heart rate

tachycardia

fast heart rate

bounding pulse

sharp brisk pulse seen in hyperkinetic states, anemia, hyperthyroidism

irregular pulse findings

irregular beats indicate dysrhythmias

pulsus alternans

alternating pulse strength suggests heart failure and cardiac tamponade

thready

weak easily obliderated pulse indicating blood loss decreased cardiac output or peripheral arterial disease

Respirations

inhale and exhale is 1 respiration

apnea

temporarty absense in breathing

tachypnea

rapid breathing

bradypnea

slow breathing

dyspnea

difficult or painful breathing

hyperpnea/ hyperventilation

deep rapid breathing

orthopnea

difficulty breathing when laying flat

elevated blood pressure

120-129 systolic AND less than 80 diastolic

Stage 1 hypertension (High blood pressure)

Systolic: 130-139 AND Diastolic 80-89

Stage 2 Hypertension

Systolic: 140 or higher AND Diastolic 90 or higher

Severe Hypertension

Systolic: higher than 180 AND Diastolic: higher than 120

Hypertensive Emergency

Systolic: higher than 180 AND Diastolic: higher than 120

Orthostatic Hypotension (Postural hypotension)

form of low blood pressure that occurs when a person stands up

• dizziness, lightheadedness, and potential fainting