PSD - Exam 2 Material

The 3 Components of a Health Assessment

Patient Interview

General Assessment

The Physical Examination

Purpose of a General Assessment

A quick overall impression of a patients health status via inspection and vital signs

4 Assessment Techniques used During Physical Examination

Inspection

Palpation

Auscultation

Percussion

Components of a General Assessment

Age, Visible Appearance, Consciousness, Behavior, Mobility, Height, Weight, Vital Signs (Pain is 5th Vital Sign)

The Pharmacists Role in Assessments

Mostly uses inspection

General assessment, health & medication history, vital sign measurement

Patient Factors Determining Vaccine Eligibility (S vs O)

Age

Past Medical History

Social History

Family History

Immunization Schedule

A list of vaccines and their recommended timing for a specific demographic including age, disease state, social history, and family history

CDC

A government agency that publishes the immunization schedule

Adult Vacc Schedule Age

19 years and Older

Vaccine Information Statement (VIS)

An information sheet that is federally required to be given to a patient before the vaccine is given (Informed Consent)

Includes benefits, risks, adverse reaction protocol

Document what version of paper was given out

When Does Routine Vaccination for Influenza Start

6 months of age`

5 Temperature Routes

Oral

Rectal

Axillary (Armpit)

Tympanic Membrane (Eardrum)

Temporal Artery (Forehead)

5th Vital Sign

Pain

Most accurate temperature route

Rectal

Temperature difference between routes

Oral = standard

Rectal = +1

Axillary = -1

Diurnal

Normal temperature fluctuation

Cyclical; core temperature is lower in the mornings than in the evenings

Age (Temperature)

Babies = Higher Temperature

Elderly = Lower Temperature

Average Oral Temperature

97.5-99F

Common Rsn Increase Body Temp

Hormones

Exercise

Hyperthyroidism

Medication

Infection

Common Rsns Decrease Body Temp

Extreme cold exposure

Alcohol consumption

Hypothyroidism

Antipyretics

Examples of Antipyretic Medication

NSAIDS (Ibuprofen, Aspirin, Naproxen)

Acetaminophen

Subjective Behaviors of Pain

Verbal complaints

Telling what medication they’re on

Scales (Pain / Face)

Changes in physical / social functioning

Objective Behaviors of Pain

Facial Expressions

Vocalizations

Body Movement Change

Acute Pain Indicators Measurement Wise: Sweating, redness, tachycardia, tachypnea, pallor, anxiety, swelling

HR

Heart rate - measured in BPM

The amount of times the heart beats in a minute

BP

Blood Pressure - a pressure wave, felt in a peripheral artery, created each time the heart contracts

Used to assess heart rate

Radial Artery

Location used to check heart rate

Located thumb side of wrist

Brachial Artery

Used to measure blood pressure

Inside elbow, pinky side

Normal Adult Heart Rate

60-100bpm

Tachycardia

>100bpm

Bradycardia

<60bpm

Substances that Increase HR & BP

Stimulants

Decongestants

Albuterol

Substances that Increase BP

NSAIDs

Estrogen contraceptives

Substances that Decrease HR & BP

ACEI, ARBs, Renin Inhibitors

Diuretics

B-blockers

A-blockers

C-blockers

Vasodilators

Diastole

Ventricles = Relaxed

Diastolic BP = Pressure of blood when relaxed

Systole

Ventricles = Contracted

Systolic BP = Pressure of blood when contracted

Situations that Increase HR

Fear

Anxiety

“White Coat Hypertension”

Pain

Hyperthyroidism

Hypoglycemia

3 things that contribute to Patients BP Goal Treatment

Age, past medical history, diet, 10 year % risk of CVD, weight, exercise amount, hormones, medications, emotion

4 Traditional Vital Sings

Temperature

Blood Pressure

Heart Rate

Respiratory Rate

RR & Units

Respiratory rate - respirations per minute (RPM)

Normal Adult RR

12-20RPM

Tachypnea

>20RPM

Bradypnea

<20RPM

Tachypnea Situations

COPD

Asthma

Pulmonary Embolism

Pneumonia

Pain

Stress / Anxiety / Fear

Bradypnea Situations

Opioid Drugs / Overdose

Ethanol Toxicity

Toxins

Head Injury

Hypothyroidism

Key Point When Taking RR

Do not tell the patient you are counting their breaths

Physical Examination Techniques for RR

Inspection - Cyanosis & Dysphnea

Auscultation - Lung sounds

Palpation - Sense of touch to measure & determine location

Percussion - Create sounds with hand to listen

Spirometry

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