Intro to Patient Care Lecture 1 - Introduction to Patient Care and the Pharmacists' Patient Care Process

physiology

the study of normal functions of the living organism and its parts

pathophysiology

the study of abnormalities in bodily functions as a cause or result of disease

idiopathic

describes a condition when the cause is unknown

pharmacotherapy

the pharmacological treatment of a disorder

etiology

the cause of a disease

epidemiology

the distribution (incidence, prevalence) and determinants (causes, risk factors) of a disease condition

incidence

the number of cases of a disease that are newly diagnosed within a population during a specific period of time

prevalence

the number of cases of a disease that are currently present within a population during a specific period of time

peripheral IV

IV access through a vein, generally in the hand, arm, foot, and sometimes the scalp

central IV

IV access through a larger vessel, generally placed in the neck, groin, or upper chest

peripherally inserted central catheter (PICC)

a form of central access that is achieved by threading a catheter from a peripheral site (generally the arm) to a larger vessel

things that can be given through an IV line

medications, fluids, nutrition

fluid bolus

an IV infusion (without medication) in which a large volume of fluid (0.5 - 2 L) given to patients over 1-2 hours

maintenance infusion

an IV infusion (without medication) in which fluids are given at a specific rate (ml/hr) to maintain adequate hydration for patients who cannot have fluids by mouth

continuous IV

IV infusion (with medication) in which:

• IV medications are infused continuously

• often used for medications with short half-lives or narrow therapeutic ranges

  • will commonly see this in intensive care units

intermittent IV piggyback

a type of IV infusion (with medication) in which:

• a smaller IV bag containing medication is connected to the patient’s main IV line

• the smaller bag is “piggy-backing” off the patients main IV line to provide the medication

• often used for medications that have long half-lives but can’t be given via IV push due to the drug properties (kinetics, toxicity, etc.)

IV push injection

a type of IV infusion (with medication) in which:

• a medication can be drawn up in a syringe and be given rapidly (15 minutes or less)

• the medication is “pushed” out of the syringe into an IV access point = IV push

• often used for medications with long half-lives or that act quickly

intramuscular (IM) injection

a parenteral site of administration in which:

• an injection given into deep muscle tissue (thigh, deltoid, gluteus)

• needle angle: 90 degrees

  • example: flu shot

subcutaneous (SQ) injection

a parenteral site of administration in which:

• an injection given into the subcutaneous fat tissue

• needle angle: 45 degrees

• example: insulin

intradermal injection

a parenteral site of administration in which:

• an injection given into the dermis

• not often used

• needle angle: 10-15 degrees

nasogastric (NG) tube

a form of enteral administration in which:

• a flexible, plastic tube is inserted through the nose down into the stomach

• used to administer nutrition and medications

percutaneous endoscopic gastrotomy (PEG) tube

a form of enteral administration in which:

• a tube is inserted through the abdomen into the stomach

• used to administer nutrition and medications

• balloon is inflated so it doesn’t fall out

jejunostomy (J) tube

a form of enteral administration in which:

• a tube is inserted through the abdomen into the jejunum (located in the small intestine)

• used to administer nutrition and medications

foley catheter

a type of urinary catheter in which:

• a flexible tube is placed through the urethra into the bladder

• used for patients who are unable to control their bladder (incontinence, retention, sedated patients, etc.)

Texas catheter

a type of urinary catheter in which:

• AKA a “condom” catheter

• a less invasive approach for patients who need a catheter

PureWick catheter

• type urinary catheter

• a non-invasive approach to catheterization in women

• uses suction to draw urine into a collecting system

health information technology

electronic health systems that health care professionals use to store, share, and analyze health information

• electronic health records (EHRs)

• electronic prescribing (E-prescribing)

Mobile Health (mHealth)

apps

• medication adherences

  • examples: Medisafe, mymeds, ROUNDhealth

• mental health

  • examples: Mindshift, QuitNow!, Headspace, PTSDCoach

wearables

• smartwatches

• continuous glucose monitors (CGM)

telemedicine and telehealth

• demand for these services grew because of the COVID-19 pandemic

  • providers relied on technology to deliver virtual services to patients

telemedicine

• Using telecommunications equipment to diagnose and treat illness remotely

• Exchanging treatment notes, lab reports and prescriptions

• Providing long-term care and treatment after hospitalization

telehealth

• Conducting remote patient monitoring

• Holding therapy sessions for mental and physical illness

• Reviewing and exchanging medical and lab reports

role of pharmacists

• to help identify digital health tools

• to set-up and configure medical devices and health apps

• to interpret data from digital health tools

the pharmacist’ patient care process (PPCP) definition

Definition: A process created and implemented to promote consistent, comprehensive patient care

PPCP components

Collect

Assess

Plan

Implement

Follow-up/Monitor

knowledge to perform the PPCP

• Pathophysiology

• Pharmacotherapy

• Diagnostic testing

• Laboratory testing

skills to perform the PPCP

• communication with pts

• communications with providers

• physical assessment

subjective info

• Information provided by the patient or patient's caregiver that cannot be perceived by the examiner

  • Information is obtained through patient interviewing

  • Patient interviews should utilize open ended questions

objective info

• information obtained from the pt’s medical record or that was identified by an examiner

  • vitals

  • physical exam

  • labs

  • other info: imaging, diagnostic testing, calculations

problem list

what collected information (PPCP) is assessed to create

“differential” diagnosis

• during Assess in CAPIF (PPCP)

• in which the subjective and objective info match more than one possible condition and requires further testing to make a definitive diagnosis

• additional testing can confirm or rule out a diagnosis

therapeutic plan characteristics (what they should be & components)

should be:

• patient-centered

• evidence-based

• cost-effective

components:

• non-pharmacological therapy

• pharmacological therapy

• safety monitoring

• efficacy monitoring

• pt education

• follow-up

who are the ppl involved & what does implementing the plan in CAPIF (PPCP) look like in different pharmacy settings

ppl involved:

• other members of the healthcare professional team

• pt

in hospital, looks like entering orders on behalf of the physician

in community, looks like counseling pts

in ambulatory, looks like conducting pt visits

why we follow-up in CAPIF (PPCP)

purpose:

• to ensure that the therapy is safe and effective

• to assess adherence to the therapeutic plan

timing depends on:

• setting

• therapy changes (time to see effect of therapy, risk of safety concerns)

• what you’re monitoring

actual body weight (ABW)

pt’s measured weight

ideal body weight (IBW)

a calculated value that estimates a pt’s lean tissue while considering sex and height

IBW equation male

IBW (kg) = 50 + 2.3(height in inches - 60 inches)

IBW equation female

IBW (kg) = 45.5 + 2.3(height in inches - 60 inches)

adjusted body weight (AdjBW)

a calculated value that estimates a pt’s lean tissue while considering the pt’s actual body weight, sex, and height (typically for obese ppl)

AdjBW equation

AdjBW (kg) = IBW + 0.4(ABW-IBW)

indications for use of AdjBW

indications:

• drug dosing for hydrophilic medications with a low Vd (i.e., aminoglycosides)

• calculating nutritional needs

intake and output

• comparisons of these values are used to measure fluid balance for pts

conditions where fluid balance matters

matters in these conditions:

• heart failure

• kidney failure

• septic shock

intake

• oral fluids

• IV solutions

• tube feedings

output

• urine

• stool

• vomiting

• insensible losses (surgical pts)

methods of measurement of temperature

methods:

• oral

• rectal

• axillary

• ear

• skin

normal oral temp

normal temp for this method of measurement: 98.6 F (37 C)

normal rectal temp

normal temp for this method of measurement: 0.5-1 F increase

tympanic temp

normal temp for this method of measurement: 0.5-1 degree F increase

axillary temp

normal temp for this method of measurement: 0.5-1 degree F decrease

temporal temp

normal temp for this method of measurement: 0.5-1 degree F decrease

Fahrenheit to Celsius conversion

C = [5(F-32)]/9

Celsius to Fahrenheit conversion

F = [9(C)/5] + 32

unit for blood pressure

measured in millimeters of mercury (mmHg)

normal blood pressure

greater than 120/80 mmHg

hypertension

greater than 130/80 mmHg

hypotension

less than 90/60 mmHg

laying down has this effect on blood pressure

blood pressure is higher in this body position

standing up has this effect on bp

blood pressure is lower in this body positiion

how bp changes when pts go from lying or sitting to standing

bp decreases

orthostasis

profound change in blood pressure (SBP decreases 20 mmHg OR DBP decreases 10 mmHg)

respiratory rate units

measured in breaths per minute

normal rate for respiratory rate

12-16 breaths/minute

tachypnea

greater than 20 breaths/minute

pulse units

measured in beats per minute

normal rate for pulse

60-100 BPM

bradycardia

less than 60 BPM

tachycardia

greater than 100 BPM

magnitude of the pulse scale

described on a scale from 0 (absent) to 4 (bounding)

oxygen saturation

percentage of oxygen-saturated hemoglobin in the blood relative to total hemoglobin

normal range of oxygen saturation

95-100%

numbers on this? (top to bottom)

numbers on this (top to bottom)

• heart rate

• bp

• oxygen saturation

• respiratory rate

physical exam

a review of each bodily system for abnormalities obtained during the pt interview

• considered objective date

review of systems

a review of each bodily system for abnormalities assessed by the pt

• considered subjective data

fever definition

100.4+ F for over one hour OR 101+ F for any period of time