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7/26/2019 3 Assessment http://slidepdf.com/reader/full/3-assessment 1/105  ASSESSMENT May Magtoto Faculty of Pharmacy University of Santo Tomas

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Page 1: 3 Assessment

7262019 3 Assessment

httpslidepdfcomreaderfull3-assessment 1105

ASSESSMENTMay Magtoto

Faculty of Pharmacy

University of Santo Tomas

7262019 3 Assessment

httpslidepdfcomreaderfull3-assessment 2105

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

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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

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

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

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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

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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

Page 2: 3 Assessment

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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

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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

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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

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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

Page 3: 3 Assessment

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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

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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

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

Page 4: 3 Assessment

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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

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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

Page 5: 3 Assessment

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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

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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

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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

Page 7: 3 Assessment

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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

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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

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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

Page 9: 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

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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 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

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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

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

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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

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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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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

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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 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

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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

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

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

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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

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 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 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

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

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

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

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

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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 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

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

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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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

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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

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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

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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

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

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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

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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

Page 24: 3 Assessment

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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

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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

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

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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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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

Page 25: 3 Assessment

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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

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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

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)

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

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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

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

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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

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

Page 26: 3 Assessment

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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

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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

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

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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

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

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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

Page 27: 3 Assessment

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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

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

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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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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

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

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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

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

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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

Page 30: 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)

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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

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

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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

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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

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

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

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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

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

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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

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

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

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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

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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

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

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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

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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

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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

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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

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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

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

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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

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

Page 33: 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

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

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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

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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

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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

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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

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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

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

Page 34: 3 Assessment

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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

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

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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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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

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

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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

Page 35: 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

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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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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

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

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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

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

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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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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

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

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

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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

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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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

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

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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

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

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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

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

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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

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

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)

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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

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

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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

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

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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

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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

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

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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

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

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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

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

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

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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

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

Page 39: 3 Assessment

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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

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

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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

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

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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

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

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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

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

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

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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

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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

Page 41: 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

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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

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

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

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

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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

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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

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

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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

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

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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

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

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)

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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

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

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E N D

Page 43: 3 Assessment

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

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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

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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

Page 44: 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

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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

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

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

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

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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

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

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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

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)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

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

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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

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

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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

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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

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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

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

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

Page 46: 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

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

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

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

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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

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

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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

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

Page 47: 3 Assessment

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

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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

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

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 )

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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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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

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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

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

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

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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

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

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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

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

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

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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

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

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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

Page 49: 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

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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

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

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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

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

Page 50: 3 Assessment

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

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

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

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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

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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

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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

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

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

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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

Page 51: 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

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

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

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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 )

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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

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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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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

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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

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

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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

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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

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

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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

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

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

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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

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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

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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

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

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E N D

Page 53: 3 Assessment

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

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

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

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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 )

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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

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

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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

Page 54: 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

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

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

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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 )

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 )

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

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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

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

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

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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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

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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

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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

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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

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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

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

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E N D

Page 56: 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

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

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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

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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

Page 57: 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

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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

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

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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

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

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

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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

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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

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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

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

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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

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

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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

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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

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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

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

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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

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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

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

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

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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

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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

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

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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

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

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

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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

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

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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

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)

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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

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 )

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

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E N D

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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

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

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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

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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

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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

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

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

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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

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

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

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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

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

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

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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

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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

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

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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

Page 63: 3 Assessment

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

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

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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

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

Page 64: 3 Assessment

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

Page 65: 3 Assessment

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

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

Page 66: 3 Assessment

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

Page 67: 3 Assessment

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

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

Page 68: 3 Assessment

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

Page 69: 3 Assessment

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

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

Page 70: 3 Assessment

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

Page 71: 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

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

Page 72: 3 Assessment

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

Page 73: 3 Assessment

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

Page 74: 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

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

Page 75: 3 Assessment

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

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

Page 76: 3 Assessment

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

Page 77: 3 Assessment

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

Page 78: 3 Assessment

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

Page 79: 3 Assessment

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

Page 80: 3 Assessment

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

Page 81: 3 Assessment

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

Page 82: 3 Assessment

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

Page 83: 3 Assessment

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

Page 84: 3 Assessment

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

Page 85: 3 Assessment

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

Page 86: 3 Assessment

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

Page 87: 3 Assessment

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

Page 88: 3 Assessment

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

Page 89: 3 Assessment

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

Page 90: 3 Assessment

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

Page 91: 3 Assessment

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

Page 92: 3 Assessment

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

Page 93: 3 Assessment

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

Page 94: 3 Assessment

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

Page 95: 3 Assessment

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

Page 96: 3 Assessment

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

Page 97: 3 Assessment

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

Page 98: 3 Assessment

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

Page 99: 3 Assessment

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

Page 100: 3 Assessment

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

Page 101: 3 Assessment

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

Page 102: 3 Assessment

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

Page 103: 3 Assessment

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

Page 104: 3 Assessment

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

Page 105: 3 Assessment

7262019 3 Assessment

httpslidepdfcomreaderfull3-assessment 105105

E N D