1. Diagnostic Procedures, Nuclear Medicine & Pharmacology Chapter 15

2. Temperature
Pulse
Respirations
Blood Pressure
SaO2
Pain
VITAL SIGNS

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

4. PULSE Heart beating Detectable at surface points
Timing: beats per minute (BPM)
Normal rates
--adult
--newborn

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

6. 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

7. 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

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

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

10. 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 figure 15.7
PERCUSSION

11. EXAMINATION INSTRUMENTS
Ophthalmoscope – examines the interior of the eye. p. 477, fig 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.

12. 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

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

14. 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)

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

16. 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

17. 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

18. 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

19. 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

20. 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)

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

22. 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

23. 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.

24. 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.

25. Laparoscopy

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

27. 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 -

28. 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

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

30. 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 years - e.g. Lipitor - generic

31. Drug
Administration
Abbreviations
P. 488
Table 15.2

32. 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

33. 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