Fundamentals Of Diagnosis & Diagnosis Tests

• What is the definition of diagnosis?

  “the identification of the nature of an illness or other problem byexamination of the symptoms”
• What factors contribute to a diagnosis?

  *observations *physical examination*patient history *results of diagnostic test*clinical experience & prof judgement
• What are the 8 stages of history taking?

  1. Introduction

  b) PC: Presenting complaintc) HxPC: History of the presenting complaintd) PMHx: Past medical (and surgical) historye) FHx: Family historyf) SHx: Social historyg) DHx: Drug history* Allergiesh) System review
• a of history taking

  • Wash hands / don correct PPE
  • Introduce yourself (name, job role)
  • Identify you are speaking to the correct individual (name, address / dob)
  • Purpose / permission: explain the purpose of the consultation / history taking
  • Position: eye level with the patient, 1m away
• b of history taking (PC)

  • Why has the patient come to see you?
  • Open questions:
  • “What has brought you into hospital today?”
  • “What can I help you with today?”
  • “What seems to be the problem”
• c of history taking (HxPC)

  • Details relating to the presenting complaint
  • These questions depend on the presenting complaint or body system being affectedSiteOnsetCharacter RadiationAssociated symptomsTimeExacerbating or relievingfactorsSeverity
• d of history taking (PMHx)

  • Identifying what underlying conditions and surgical procedures the patient has had
  • Why?
  • Risk factors associated with PCe.g. Type II diabetes  heart attack risk
  • Myocardial infarction
  • Jaundice
  • Tuberculosis
  • Hypertension
  • Rheumatic fever
  • Epilepsy
  • Asthma
  • Diabetes
  • Stroke
  • CancerD) Past Medical / Surgical History (PMHx)
• e of history taking (FHx)

  *family history * Some conditions have a genetic element
• f of history taking (SHx)

  social history
• g of history taking (DHx)

  • Confirming the name and dose of all the patients medication
  • Confirming compliance is also essential  how does the patient actually take the medication
• Why is DHx important?

  • Side-effects / Adverse drug reactions
  • Drug – drug interaction
  • Drug – patient interaction
  • Drug – disease interaction
  • Compliance
• H in history taking

  • systems review
  • Specific questions relating to all body systems:2. Respiratory3. Gastrointestinal4. Genitourinary5. Neurological6. Locomotor

  1. Cardiovascular
• What is meant by professional judgement?

  “Professional judgement could be described as the use of accumulated knowledge andexperience, in order to make an informed decision.”“It takes into account the law, ethical considerations and all other relevant factors related to thesurrounding circumstances.”
• Why is professional judgement important?

  • Needed day to day when working as a pharmacist in all sectors
  • Part of the decision making process
  • Easy concept to understand but often exercising professional judgement takes consideration
• What steps are involved in professional judgement?

  1. Identify the ethical dilemma / professional problem
  2. Gather all the relevant information
  3. Obtain advice from support services, seniors
  4. Identify the possible options
  5. Weight up the risk vs benefits and advantages and disasvantages of each options
  6. Make a decision  must be able to justify it
  7. Where appropriate or significant document your decision making process and reasoning
• What are the different diagnostic tests?

  • blood pressure
  • heart rate/ pulse
  • respiratory rate
  • temperature
  • oxygen levels/ saturation
  • ear examination / visualisation
  • BMI/ weight
  • blood sugar monitoring
  • peak flow
  • throat swabs
  • urine dip testing
  • Pregnancy testing /STI home testing kits
• Why would you check BP?

  • Routine observation in hospital
  • Routine as part of BP medication check
  • High BP = headache
  • Low BP = light headed, falls
• Why would you check heart rate?

  • Routine observation in hospital
  • Dizziness
  • Fainting / light headed
  • Palpitations
• When would you check respiratory rate?

  • Routine observation in hospital
  • Shortness of breath
  • Respiratory assessment (e.g. Asthma)
• When would you check temperature?

  • Routine observation for patients in hospital
  • Infection
• How does taking oxygen levels work? + % levels for healthy + unhealthy

  • Health patient O2 sat: >95%
  • Respiratory conditions (COPD): 88 – 92%
  • Shines two types of light through your finger (one redlight, one infra-red light)
  • Red blood cells: Lots of oxygen
  •  absorption of infrared light
  • Allows red light to pass through
  • Red blood cells with low levels of oxygen:
  •  absorption of red light
  • Allows infrared light to pass through
• When would you check someones oxygen level?

  • Routine in hospital setting as part of patientsobservations
  • Respiratory clinics / conditions
  • Covid-19
• When would you do an ear check?

  • Dizziness / ringing / crackling sound in ear
  • Ear infection
  • Hearing assessment: hearing loss / changes inhearing
• When would you do a BMI check/ weight check?

  When would you want to check some ones BMI / weight?* Weight loss clinic* Diabetes or cardiovascular clinic* high BMI is a risk factor
• When would you do a blood sugar monitor check?

  • Diabetic patients
  • Patients who have collapsed
  • Recurrent urinary tract infections
• When would you do a peak flow test?

  • Respiratory conditions (e.g. Asthma) – monitor stability ,triggers, medication is work etc