3 assessment
TRANSCRIPT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 1105
ASSESSMENTMay Magtoto
Faculty of Pharmacy
University of Santo Tomas
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ASSESSMENT
VITAL SIGNS
bull Most frequent measurement obtained by
health practitionersbull Indicators of health status
bull Indicate the effectiveness of functions
circulatory respiratory nervous and endocrinebull Provides data to determine a clientrsquos usual state
of health (baseline data)
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ASSESSMENT
VITAL SIGNS
bull Temperature
bull Blood pressure
bull Pulse ratecardiac ratebull Respiratory rate
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ASSESSMENT
VITAL SIGNS
bull Pain
bull Fifth vital sign
bull As decided by the Joint Commission on
Accreditation of Healthcare Organizations(JCAHO) and pain management experts
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
bull Most frequent measurement obtained by
health practitionersbull Indicators of health status
bull Indicate the effectiveness of functions
circulatory respiratory nervous and endocrinebull Provides data to determine a clientrsquos usual state
of health (baseline data)
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ASSESSMENT
VITAL SIGNS
bull Temperature
bull Blood pressure
bull Pulse ratecardiac ratebull Respiratory rate
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ASSESSMENT
VITAL SIGNS
bull Pain
bull Fifth vital sign
bull As decided by the Joint Commission on
Accreditation of Healthcare Organizations(JCAHO) and pain management experts
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
7262019 3 Assessment
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
7262019 3 Assessment
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
7262019 3 Assessment
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
bull Temperature
bull Blood pressure
bull Pulse ratecardiac ratebull Respiratory rate
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ASSESSMENT
VITAL SIGNS
bull Pain
bull Fifth vital sign
bull As decided by the Joint Commission on
Accreditation of Healthcare Organizations(JCAHO) and pain management experts
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
bull Pain
bull Fifth vital sign
bull As decided by the Joint Commission on
Accreditation of Healthcare Organizations(JCAHO) and pain management experts
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
bull Pain
bull Fifth vital sign
bull As decided by the Joint Commission on
Accreditation of Healthcare Organizations(JCAHO) and pain management experts
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
FACTORS CAUSING VITAL SIGNS TO
CHANGE
bull Temperature of the environment
bull Patientrsquos physical exertion
bull Effects of illness
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNSbull Change in vital signs
- indicates a change in physiological function
bull Allows the pharmacistbull Assess response to drug and non-drug
therapy
bull Identify diagnosesbull Implement planned interventions
bull Evaluate success when vital signs have
returned to acceptable values
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNSbull Essential ingredient when pharmacists nurses
and physicians collaborate to determine the
patientrsquos health status
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
bull Need for hands-on proficiency in specificphysical assessment skills varies according
to the type of patient care setting
bull All pharmacists should have at least a basicunderstanding of these skills
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
BASIC TECHNIQUES TO DETERMINE VITAL SIGNS (IPPA)
bull Inspection (check-up)
bull Palpation (feel)bull Percussion (beating)
bull Auscultation (stethoscope)
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Percussion
Chest percussion also referred to as chest physiotherapy is an airwayclearance technique that involves clapping on the chest andor back tohelp loosen thick secretions Doing this makes mucus easier to expel
or cough up
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITALSIGNS
bull Part of the databaserecord that a pharmacist
collects during assessmentbull Baseline for future assessments
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNSbull Patientrsquos needs and condition determine
when where how and by whom vital signs
are measuredbull Pharmacist must analyze vital signs to interpret
their significance and make decisions about
interventions
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS1 Equipment
bull Appropriate for the size and the age of the
patientbull Functional to ensure accurate findings
bull Selected based on the patientrsquos condition
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS2 Patient
bull Usual range of vital signs should be established
bull Medical history therapies and prescribedmedications should be known
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
GUIDELINES FOR MEASURING VITAL
SIGNS
3 Control and minimize environmental factors affecting vital signs
4 Organized systematic approach when taking vital signs
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNS
ACCEPTABLE RANGES FOR ADULTS
bull Temperature range 36deg to 37deg Cbull Oraltympanic 37degCbull Rectal 375degCbull Axillary 365degC
bull Pulse rate 60 to 100 beats per minutebull Respiratory rate 12 to 16 breaths per minutebull Blood pressure 11070 mm Hg
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
VITAL SIGNSEQUIPMENTSbull Thermometerbull Stethoscope
bull Sphygmomanometer
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Thermometers
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Axillary thermometer
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Oral Thermometer
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 30105
Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
7262019 3 Assessment
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Thermometers
7262019 3 Assessment
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Axillary thermometer
7262019 3 Assessment
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Oral Thermometer
7262019 3 Assessment
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7262019 3 Assessment
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Stethoscope
7262019 3 Assessment
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Sphygmomanometer
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 30105
Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
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7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
7262019 3 Assessment
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Axillary thermometer
7262019 3 Assessment
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Oral Thermometer
7262019 3 Assessment
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Stethoscope
7262019 3 Assessment
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Sphygmomanometer
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
7262019 3 Assessment
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
7262019 3 Assessment
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
7262019 3 Assessment
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Diplopia
Cataract
7262019 3 Assessment
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
7262019 3 Assessment
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Nosebleeding
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
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Oral Thermometer
7262019 3 Assessment
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Stethoscope
7262019 3 Assessment
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Sphygmomanometer
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 30105
Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
7262019 3 Assessment
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
7262019 3 Assessment
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Diplopia
Cataract
7262019 3 Assessment
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
7262019 3 Assessment
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Nosebleeding
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Stethoscope
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Sphygmomanometer
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
bull Subjective (personalindividual)bull Everything is important depending on the
chief complaint
bull Consider everythingbull Document the essential
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Subjective Objective
1 ldquoI feel dizzyrdquo 1 Blood pressure 9060 Pulse110
2 ldquoMy bladder never seems
emptyrdquo 2Voids 100-150mlvoid q 1-2 h
3 ldquoI am too fatrdquo 3 14 yr old male 150 cm (5rsquo2rdquo)
36 Kg (80 lbs)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
HISTORY OF PRESENT ILLNESS (HPI)P ndash What provokes discomfort
Q ndash What is the quality of the discomfort
R ndash Where is the region of the discomfortS ndash What is the severity of the discomfort
T ndash What is the time sequence
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 32105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 33105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
7262019 3 Assessment
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Diplopia
Cataract
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
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7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONHISTORY OF PRESENT ILLNESS (HPI)bull What was the mechanism of injury
bull What was the patient doing prior to incidentbull Are there any associated symptoms
bull Are there any aggravatingrelieving factors
bull Is this a recurrentcontinuing illness or injury
bull Is the patient on any medications
bull Notes patientrsquos eating habits caffeine and
smoking habits
bull Allergies ASK FOR YOURSELF
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 33105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 34105
Chicken pox
Eczema
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 35105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
7262019 3 Assessment
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Diplopia
Cataract
7262019 3 Assessment
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
7262019 3 Assessment
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Nosebleeding
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 40105
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 42105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 33105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
General
Nutritional status weight gainloss weakness
fatigue hydration status amp overall condition
Skin
Changes in skinnailhair texture appearance
and color rashes itching lumps or infection
7262019 3 Assessment
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Chicken pox
Eczema
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
7262019 3 Assessment
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Diplopia
Cataract
7262019 3 Assessment
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
7262019 3 Assessment
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Nosebleeding
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 42105
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Chicken pox
Eczema
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Head
Loss of consciousness lightheadedness vertigo (dizziness) headaches history ofinjury sinus pain visual disturbances
Eyes Visual changes diplopia pain dischargetrauma photophobia glaucoma cataracts lasteye exam use of eyeglassescontacts lenses
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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Diplopia
Cataract
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Vertigo
Loss of consciousness
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
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Nosebleeding
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
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Vertigo
Loss of consciousness
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 39105
Nosebleeding
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 42105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 44105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 45105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 38105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Ears
Hearing loss tinnitus drainage pain
infection discharge vertigo hearing aids
NoseSinuses
Stuffiness drainage olfactory changes
itching obstruction history of trauma
hay fever nosebleeds sinus problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 39105
Nosebleeding
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 40105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 41105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 42105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 44105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 45105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
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Nosebleeding
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 42105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Throat
Hoarseness dysphagia enlarged tonsilsbleeding gums sores dental condition caries
tongue changes dry mouth history of sore
throat history of traumaNeck
Goiter pain masses nodules adenopathy
thyroid problems stiffness history of injury
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 44105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 45105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 43105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Respiratory
Cough dyspnea sputum (amount type color)
asthma bronchitis COPD (chronic
obstructive pulmonary disease) emphysema TB last CXR (chest x-ray) smoking history
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 44105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 45105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
CardiacHypertension hyperlipidemia rheumatic fever
murmurs chest paindiscomfort dyspnea
edema last ECGstress test CHF (congestiveheart failure) history of surgeries proceduresmonitors
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Peripheral vascular
Nocturnal pain varicose veins leg cramps
CHF (congestive heart failure) swellingtenderness
Gastrointestinal
Heartburn dysphagia appetite indigestionbelching flatulence stool changes melena
diarrhea constipation nausea regurgitation
vomiting history of gallbladder or liver disease
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7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 46105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 47105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (male)Hernias sores lesions penile discharge paintesticularmass discomfort scrotal
massdiscomfort history of STDrsquos sexualhistory function problems
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 48105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 49105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Genital (female)
Birth control sexual historyfunction STDrsquos
itching sores discharge dyspareunia last
PAPpelvic exam menarche menopause
LMP (last menstrual period) obstetric historymenstrual regularity frequency durationamount dysmenorrhea amenorrhea PMS(pre-menstrual syndrome)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 50105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONREVIEW OF SYSTEM (ROS)
Urinary
Dysuria polyuria frequency stones patternchange incontinence nocturia STD
hesitancy dribbling hematuria infections
flank discomfortHematologic
Bleeding bruising anemia history of
transfusions
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 51105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)Endocrine
Thyroid adrenal hormonal heatcold
intolerance edema hirsutism sweatingexcessive thirst hunger polyuria pigment
changes
MusculoskeletalMyalgia stiffness gout arthritis backache
swelling pain erythema tenderness history
of trauma
7262019 3 Assessment
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7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 52105
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 53105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
REVIEW OF SYSTEM (ROS)
Neurologic
Syncope vertigo seizures blackouts
paresthesias paralysis tremors weakness
involuntary movements equilibrium
Psychiatric Anxiety mood swings mania depression
memory loss insomnia suicidal ideations
delusions hallucinations
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 54105
ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 55105
ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
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E N D
7262019 3 Assessment
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ASSESSMENT
COMPLETE PHYSICAL EXAMINATIONPAST MEDICAL HISTORY (PMH)
Consider
bull any other currently active problemsbull comments should include
functional impairment history of trauma
childhoodadult illnesses surgeries
hospitalizations
FAMILY HISTORY (FH)
ASSESSMENT
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
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ASSESSMENTCOMPLETE PHYSICAL EXAMINATION
Always start your objective with an opening statementconcerning the patientrsquos general appearance and condition
bull Well-developed well-nourished male not in distress
Patient is ambulatorymoving alert cooperative andshows no gross mental status changes Vital signs noted
bull Consider listing a minimum of 3-4 physical exam
findings for each complaint
bull Check the system above and below and include thepossibility of cutaneous musculoskeletal and occult
findings
bull Document the absence of critical findings
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
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RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 56105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Biochemical chemical or physical methods
of measuring biologic or physiologic functionsof the body
bull Important part of health care and have
become indispensable for routinescreening and the diagnosis of disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 57105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 58105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
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Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
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Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
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2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
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E N D
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Used routinely to assess compliance
monitor both the efficacy of prescribedtreatment and the adventstart of adverse or
toxic reactions diagnosis of specific disease
and at times to help determine the drug ofchoice
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
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bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
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O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
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BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
bull Ordered appropriately and performed andinterpreted correctly
bull Results of initial screening or diagnostic tests
usually suggest the specific follow-up tests necessary for a definitive diagnosis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
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bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
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RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
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BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
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Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
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bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
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LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
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(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
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Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
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THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
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Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
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LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
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Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
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FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 59105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE
bull Involved in monitoring patient care and agrowing number now have input into the
management of patient therapy
bull Understand why laboratory tests are usedand of the information to be gained from
them
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 60105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
THE PHARMACISTrsquoS ROLE bull Drugs may influence the results of laboratory
tests in a variety of ways they are in good
position to anticipate and advise on suchinteractions
7262019 3 Assessment
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ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
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Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
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Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
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bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
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Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
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Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
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BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
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bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
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URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
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Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
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Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 61105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION Using word beginnings (prefixes)
and endings (suffixes) as clues to procedures-Graphy To record an image
-Scopy To look through a lensed instrument
-Centesis To puncture
-Metry To measure with an instrumentSono- To assess using sound
Electro- To assess using electrical impulses
Gluco- Sugar
Endo- Inside
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
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TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 62105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Endoscopy Visual examination of internal structures
using optical scopes
ParacentesisPuncturing the skin and withdrawing fluid
from the abdominal cavity
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 63105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Lumbar PunctureInserting a needle between lumbar vertebrae
in the spine but below the spinal cord
Positron Emission Tomography (PET)Combines technology of radionuclide scanning
with the layered analysis of tomography
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 64105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Sonogram or Echogrambull Examination of soft tissue using sound waves
beyond human hearing
bull Visual image produced by the reflection ofthe sound waves back from the tissues being
assessed and into the machine
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 65105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Electrical Graphic Recordingsbull Electrocardiography (ECG)
Examination of the electrical activity in the heart
bull Electroencephalography (EEG)
Examination of the energy emitted by the brainbull Electromyography (EMG)
Examination of the energy produced by stimulated
muscles
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 66105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Culture To collect from the body a sample suspectedto contain infectious microorganisms growing
the microbes in a nutrient substance andexamining the resulting growth under amicroscope
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 67105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
DEFINITION
Pelvic examination
Physical inspection of the vagina and cervix
and palpation of uterus and ovaries
Papanicolaou (Pap Smear)
Screening of cells from the cervix and canal
to detect abnormal cells hormonal status
and presence of abnormal microorganisms
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 68105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
FACTORS THAT INVALIDATE TEST
RESULTSbull Incorrect diet preparation
bull Failure to remain fasting
bull Insufficient bowel cleansing
bull Drug interactionsbull Inadequate specimen volume
bull Failure to deliver specimen to lab in timely manner
bull Incorrect or missing request form
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 69105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURESbull Radiography or Roentgenography (X-ray)
bull Fluoroscopy
bull Computerized Tomography (CT Scan)bull Magnetic Resonance Imaging (MRI)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 70105
ASSESSMENT
LABORATORY amp DIAGNOSTIC TESTS
COMMON DIAGNOSTIC PROCEDURES
bull Endoscopic examinationsbull Bronchoscopy inspection of the bronchi
bull Gastroscopy inspection of stomach
bull Colonoscopy inspection of colon
bull Laparoscopy inspection of the abdominalcavity
bull Cystoscopy inspection of urinary bladder
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 71105
bull Hematology or haematology
- branch of biology (physiology) pathology clinical laboratory internal medicine and
pediatrics that is concerned with the study ofblood the blood-forming organs and blooddiseases
- includes the study of etiology diagnosistreatment prognosis and prevention of blooddiseases
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 72105
LABORATORY TESTSHEMATOLOGY
Test Normal Values
White Blood Cell (WBC) 5 x 109L
Red Blood Cell (RBC) 4-6 x 1012L
Hemoglobin (Hb) Male 140-170 gL
Female 120-170 gL
Hematocrit (Hct) Male 37 ndash
54
ESR (erythrocyte sedimentation rate ) Female 0 ndash 20 mmhr
Differential Count Neutrophils 54 ndash 75
Eosinophils 0 ndash 4
Lymphocytes 2 ndash
35Monocytes 6
Basophils 0 ndash 05
Mean Corpuscular Volume 75 ndash 97 fl
Mean Corpuscular Hemoglobin 26 ndash 33 pg
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 73105
Hematocrit-Packed RBCs in whole blood
after centrifugation
bull Packed Cell Volume
bull Low Values-anemia overhydrationor blood loss
bull High Values-Polycythema vera or dehydration
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 74105
Hemoglobin- a estimate of the oxygen
carrying capacity of the blood
MCV- Mean Cell VolumeLow MCV indicates microcytic RBCs occurs
in Iron Deficiency
High MCV indicates macrocytic occurs in Vit B12 or folic acid deficiency
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 75105
bull Erythrocyte Sedimentation Rate-
measures the rate of RBC settling of wholeuncoagulated blood over time
High ESR indicates acute and chronic
infection tissue necrosis rheumatoidcollagen disease
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 76105
Coagulation
bull complex process by which blood forms clots
bull Disorders can lead to an increased risk ofbleeding ( hemorrhage ) andor clotting
( thrombosis )
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 77105
O O S SCOAGULATION
Test Normal Values
ACT (activated coagulation time) 70 ndash 120 seconds
APTT(activated partial thromboplastin time) 30 ndash 40 seconds
Bleeding time (BT) 1 ndash 3 min
Clotting time 8 -15 minsFDP (d-dimmer) lt 25 mgdl
Fibrinogen level 200 ndash 400 mgdl
Partial thromboplastin time (PTT) 30 ndash 40 seconds
Platelet Count 200 ndash 400 x 109 L
Prothrombin time (PT) 12 ndash 15 seconds
Thrombin time 10 ndash 14 seconds
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 78105
bull Problems with coagulation may dispose tohemorrhage thrombosis and occasionally bothdepending on the nature of the pathology
bull Thrombosis is the pathological development ofblood clots
bull clots may break free and become mobile
forming an embolus or grow to such a size thatoccludes the vessel in which it developed
Cofactors
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 79105
Various substances are required for the proper
functioning of the coagulation cascadebull Calcium and phospholipid (a platelet membrane
constituent)
bull Vitamin K
BLOOD CHEMISTRY Serum Proteins
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 80105
BLOOD CHEMISTRY-Serum Proteins
Types
bull Serum albumin
- most abundant blood plasma protein and is producedin the liver and forms a large proportion of all plasma
protein- human serum albumin and it normally
constitutes about 70 of human plasma protein
bull
Globulins - all other proteins present in blood plasma- bovine serum albumin (cattle serum albumin) or BSAoften used in medical and molecular biology labs
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 81105
bull Low albumin (hypoalbuminaemia) may be
caused by liver disease nephrotic syndromeburns protein-losing enteropathy malabsorption malnutrition late pregnancy
artefact genetic variations and malignancybull High albumin is almost always caused by
dehydration
bull Amylase is an enzyme that breaks starch downinto sugar Amylase is present in human saliva where it begins the chemical process ofdigestion
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 82105
BLOOD CHEMISTRY
Test Normal ValuesAlbumin 30 ndash 50 gL
Amylase 10 ndash 130 UL
Fasting Blood Sugar 389 ndash 588 mmolL
Glycosylated Haemoglobin lt 77 ndash 8 Excellent Control
8 ndash 9 Good Control
9 ndash 10 Fair Control
gt 10 Poor Control
Globulins 23 ndash
35 gL
Serum Ammonia 11 -35 UmolL
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 83105
RENAL PROFILE TESTS
bull Nephrology concerns itself with the diagnosisand treatment of kidney diseases
- electrolyte disturbances and hypertension andthe care of those requiring renal replacementtherapy including dialysis and renal transplant patients Many diseases affecting the kidney aresystemic disorders not limited to the organ itself
and may require special treatment Examplesinclude systemic vasculitides and autoimmunediseases such as lupus
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 84105
RENAL PROFILE TESTS
Test Normal ValuesBlood Urea Nitrogen 32 ndash 8 mmolL
Serum Bicarbonate 22 ndash 26 mEqL
Serum Calcium 202 ndash 260 mmolL
Serum Chloride 999 ndash
110 mmolLSerum Creatinine 53 ndash 133 mmolL
Serum Magnesium 14 ndash 21 mmolL
Serum Phosphorus 042 ndash 197 mmolL
Serum Potassium 4 ndash 45 mmolL
Serum Sodium 135 ndash 145 mmolL
Serum Uric Acid 013 ndash 044 mmolL
BUN
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 85105
BUN
bull Decreased BUN levels occur with significantliver disease
bull Increased BUN levels may indicate renal disease
C i i Cl (Cl )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 86105
Creatinine Clearance (ClCR )
bull The rate at which creatinine ( the metabolicbreakdown product of muscle creatinephosphate) is removed from the blood by thekidneys
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)ClCR -Creatinine Clearance CCR - serum creatinine
concentration
LIPID PROFILE
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 87105
bull VAP (Vertical Auto Profile)
- a cholesterol lipid and lipoprotein test
-VAP test includes categories of cholesterolmeasurement in addition to the basic scores (total
cholesterol high-density lipoproteins low-densitylipoproteins and triglycerides )
bull candidates for the comprehensive VAP (Vertical AutoProfile) Test
- with family history existing condition of diabeteshigh blood pressure or heart disease -- or who arealready taking cholesterol lowering medication -- are
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 88105
LIPID PROFILE Test Normal Values
Serum cholesterol up to 200 mgsdlBorderline Up to 239 mgsdl
Elevated ifgt240 mgsdL on repeated values
Serum triglycerides lt 180 mgsdl
HDL Cholesterol 30 ndash 60 mgsdl
LDL Cholesterol Borderline 100 ndash 190 mgsdl
Risk gt 190 mgsdl
Note Formula for calculating LDL Cholesterol
is INVALID if TGL gt 400 mgsdl
TotalHDL ratio lt 4
Low Risk 4 ndash 6
High Risk gt 6
HEPATIC ENZYMES(Li f i )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 89105
(Liver function tests)
bull groups of clinical biochemistry laboratory bloodassays designed to give information about thestate of a patients liver
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 90105
LABORATORY TESTSHEPATIC ENZYMES
Test Normal Values
SGOT Aspartate Aminotransferase (AST) Up to 34 34 UL
SGPT Alanine Aminotransferase (ALT) Up to 30 UL
Serum Alkaline Phospatase (ALP) 36 ndash 92 UL
Th id f ti t t (TFT )
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 91105
Thyroid function tests (TFTs)
bull collective term for blood tests
bull used to check the function of the thyroid
bull includes thyroid-stimulating hormone (TSHthyrotropin) and thyroxine (T4) andtriiodothyronine (T3) depending on locallaboratory policy
TFT
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 92105
TFT
bull requested if a patient is thought to suffer fromhyperthyroidism (overactive thyroid) orhypothyroidism (underactive thyroid)
bull monitor the effectiveness of either thyroid-suppression or hormone replacement therapy
bull requested routinely in conditions linked to
thyroid disease such as atrial fibrillation
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 93105
THYROID FUNCTION TEST
Test Normal ValuesFree T4 08 ndash 20 ngdl
Free T3 23 ndash 42 pgml
TSH 025 ndash 430 microunitsml
Serum T3 70 ndash
200 ngdlSerum T4 40 ndash 110 microgramsdl
C rdi c m rker
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 94105
Cardiac markers
bull evaluate heart function
bull often discussed in the context of myocardialinfarction but other conditions can lead to an
elevation in cardiac marker levelbull early markers identified were enzymes orcardiac
enzymes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 95105
LABORATORY TESTSCARDIAC ENZYMES AND PROTEINS
Test Normal ValuesCPK 25 ndash 2000 UL
CK ndash MB (creatine kinase isoenzyme MB) 0 ndash 9 ngml or lt 3 of total CPK
LDH 0 ndash 280 UL
LDH - 1 20 ndash 36 of total LDH ltLDH2
LDH - 2 32 ndash 50 of total LDH gt LDH1
SGOT (Serum glutamic oxaloacetic
Transaminase) lt 42 UL
SGPT (Serum glutamic pyruvic transaminase ) 0 ndash 48 UL
Myoglobin 0 ndash
85 ngmlTroponin 1 00 ndash 01 ngml
Troponin T lt 018 ngml
Urinalysis (or UA)
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 96105
Urinalysis (or UA)
bull array of tests performed on urine and one of themost common methods of medical diagnosis[1]
bull A part can be performed by using urine
dipsticks in which the test results can be read ascolor changes
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 97105
URINALYSIS
Color Straw ndash
dark yellowOdor Slightly aromatic
Appearance Clear
Specific gravity Infants 1002 ndash 1006
Adult 1016 ndash 1022
pH 46 ndash 65
protein negative
Glucose negative
Na 10 ndash 40 mEqL
K lt 8 mEqL
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 98105
URINALYSIS
Color Straw ndash dark yellow
Cl lt 8 mEqL
bilirubin negative
Urobilinogen 01 ndash 1 EU100 ml
Ketones negative
Occult Blood negative
RBCs Female 0 ndash 2hpf Male 0hpf
WBCs Female 0 ndash 5hpf Male 0 ndash 2hpf
Bacteria Negative on spun specimenCasts Hyaline coarse fine granular RBC WBC
waxy casts
Crystals Interpreted by physician
Fecalysisstool analysis
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 99105
Fecalysisstool analysis
bull laboratory tests done on fecal samples to analyzethe condition of a persons digestive tract
bull performed to check for the presence of any
reducing substances such as white blood cells (WBCs)
sugars or bile
signs of poor absorption as well as screen for
colon cancer
LABORATORY TESTS
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 100105
FECALYSIS
Parameter ResultsNormal
Values
Parameter ResultsNormal
Values
Character Formed Pus Negative
Color Brown Blood Negative
Mucus Negative Occult Blood Negative
Creatinine Clearane
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 101105
Creatinine Clearane
bull Normal values
Male 97 to 137 mlmin
Female 88 to 128 mlmin
Creatinine Clearance
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 102105
Creatinine Clearance
[140-age(in years)] X body weight (in kg)
= ______________________________________________________________________________________________________
72 X CCR (in mgdL)
ClCR -Creatinine Clearance CCR - serum creatinineconcentration
Note (Multiply result by 085 for femalesUsing this formula the unit of ClCr is
mLmin
Examples
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 103105
Examples
1 Given
Patient Angela Marie P Dela Cruz
Age 780 months
Weight 75kg
Height 5 ft
CCr 09mgdLQuestion Is the Creatinine Clearance of thepatient within the normal range Prove youranswer
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 104105
2 Given
Patient Gabriel Marie P Dela Cruz
Age 86
Weight 175 lb
Height 6 ft
CCr
18mgdLCompute for the Creatinine Clearance of thepatient Is it within the normal range
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D
7262019 3 Assessment
httpslidepdfcomreaderfull3-assessment 105105
E N D