Diagnostic Procedures, Nuclear Medicine & Pharmacology Chapter 15

Temperature Pulse Respirations Blood Pressure SaO2 Pain VITAL SIGNS

TEMPERATURE Fahrenheit or Celsius Normal: 98.6 but varies – pp. 473 Abnormal: --Hyperthermia --Hypothermia TEMPERATURE

PULSE Heart beating Detectable at surface points Timing: beats per minute (BPM) Normal rates --adult 60-110 --newborn 100-160

RESPIRATIONS Air in (oxygen) and out (carbon dioxide) Timing - respirations per minute Normal rates – 12-20 breaths per minute (higher in children) Involuntary/Voluntary control

BLOOD PRESSURE Blood pressure – Assessed by occluding an artery with blood pressure cuff and then listening for the return of pulse sounds. Two measurements – Systolic & Diastolic  next slide definitions Type and reading of BP from equipment

Systolic – the upper number measures arterial pressure when the ventricles are pumping. Normal below 120 Diastolic – the lower number measures arterial pressure when the ventricles are resting. Normal below 80 BLOOD PRESSURE

PAIN Subjective information – different with each person Pain rating scale – based on scale from 1 to 10. page: 475 Types: Acute and Chronic PAIN

PALPATION Palpation (touch) uses the hands to feel texture, size, consistency and location of body parts. p. 476. figure 15.6

Percussion (tap) assesses the density of a body area by tapping the surface with the finger or an instrument. Helps determine if area is filled with air, fluid or solid mass. p. 476. figure 15.7 PERCUSSION

EXAMINATION INSTRUMENTS Ophthalmoscope – examines the interior of the eye. p. 477, fig.15.8 - picture PERRLA also used. Otoscope – examines the auditory canal and the tympanic membrane (ear drum) Speculum – Placed in a canal or cavity to enlarge the area for inspection.

Recumbent examination positions Recumbent/decubitus:- lying down Face Up: Horizontal Recumbent (aka Supine) – lying on back Dorsal Recumbent – back with legs drawn up (partial lithotomy) Lithotomy (full) – back with feet in stirrups Face Down or Side-Lying Prone - face down Sims’ – Side-lying (left or right) Knee Chest – face down with knees and chest on table

Lab/Diagnostic Testing Blood Urinalysis Endoscopy Centesis Imaging Techniques - Specialized diagnostic testing with specific equipment Other specialized testing

Blood Sampling Purpose: obtain samples of blood for analysis in specialized machine Phlebotomy (incision into a vein) Phleb/o = vein Phlebotomist (person who draws blood from a vein)

Types of Blood Cells Red blood cells erythrocytes (“cyte” = “cell” ) White blood cells (leukocytes) (5 different white cells) Platelets (thrombocytes)

RED BLOOD CELLS Red Blood Cell Count (RBC) - # - anemia/polycythemia Hematocrit (Hct) - % by volume of red blood cells Hemoglobin (Hb) – measures oxygen carrying capacity of red blood cells Platelet (Thrombocyte) Count – measures the quantity or number of clotting cells

WHITE BLOOD CELLS White Blood Cells (WBC) identifies infection and immune system function WBC with Diff (Differential) (5 cell groups – neutrophils, eosinophils, basophils, monocyte, lymphocyte) - next slide

Common blood tests – p 479 Basic metabolic panel – measures functioning of different organs by specific tests e.g. potassium, sodium, blood urea nitrogen, glucose (sugar), etc. etc Agglutination testing (Type & Crossmatch) - determine blood type and compatibility of donor blood Thyroid stimulating hormones – thyroid gland

Other blood tests (cont) C-Reactive Protein (CRP) - detects inflammation in the body Erythrocyte sedimentation rate (Sed rate or ESR) – separation of cells from fluid component. Inflammation also. Prothrombin time – assesses clotting ability of the blood and effectiveness of anticoagulant therapy

Other blood tests (cont) Lipid Profiles – measure amounts of fats in blood including cholesterol and triglycerides Enzyme tests – measure enzymes produced by muscle tissue and are used to evaluate muscle damage. Serum Bilirubin – measures breakdown of red blood cells (liver function) Other blood tests (cont)

URINALYSIS Routine Urinalysis (UA)-used to detect urinary or systemic disorders -Dipstick Testing p. 479 Fig. 15.10 – picture -Microscopic Analysis

Urine Testing pH value – acid level of urine -below 7 indicate acidosis or excessive acid in the urine -above 7 indicates alkaline and possible UTI Specific Gravity (SG) is a measure of solutes (solids) in urine Low SG = dilute urine – diabetes insipidus High SG = Concentrated urine – dehydration, shock, liver failure

Some abnormal findings in Urine Albuminuria-high protein or possible kidney problems Glycosuria (CHO)- high glucose possible diabetes Ketonuria (body fat)-possible starvation or diabetes Calciuria, Creatinuria (muscle)-high means hyperparathyroidism, low means osteomalacia Bacteriura and Pyuria-presence of bacteria Culture and Sensitivity (specific pathogen)-specific cause of UTI Hematuria (blood)- possible kidney contusion Drug Testing etc, etc.

ENDOSCOPY The visual examination of the interior of a body cavity (endo=within, scopy=visual examination) Endoscopic Surgery –Surgical procedure that is performed through small incisions with the use of a endoscope.

Laparoscopy

- CENTESIS Surgical puncture to remove fluid Abdominocentesis Amniocentesis Cardiocentesis Pericardiocentesis Thoracocentesis Arthrocentesis

IMAGING CONTRAST MEDIA Radiographic contrast medium makes structures visible, which are otherwise hard to see p. 482 – Table 15.1 pp.482/483 – x-ray views Intravenous- i.e. iodine Ingestion -

NUCLEAR MEDICINE Known as radionuclide imaging Looks at physiological processes to determine how well body organs or systems are functioning Radiopharmaceuticals are injected, ingested or inhaled Contains a radioactive tracer that is specific to the part being examined

PHARMACOLOGY All Medications are potentially dangerous and lethal !!!! -perscription or over the counter Risk versus Benefit e.g. Black Box -all have side effects

PHARMACOLOGY (Cont) Generic vs Brand Extensive research/testing precedes use Research used real and placebo meds Expensive/time consuming process (R&D) Formal application to FDA for approval -Post marketing research e.g. Vioxx problem Original Drug company retains exclusive use for 12-15 years - e.g. Lipitor - generic

Drug Administration Abbreviations P. 488 Table 15.2

Pharmacology Terminology Addiction – compulsive, uncontrolled dependence Adverse drug reaction (side effect) is an undesirable drug response (ID in research) Contraindication – Factor which makes use of a drug dangerous or ill advised

Routes of Administration INHALATION-within minutes ORAL – 30 min. INTRAMUSCULAR- with in a few minutes SUBCUTANEUOS- within 10 min INTRAVENOUS- within seconds TRANSDERMAL- over a period of time