Understanding Lab Investigations and their interpretations in the delivery of Pharmaceutical Care

1. LABORATORY AND PHYSICAL
ASSESSMENT DATA
THEIR IMPORTANCE IN THE DELIVERY
OF PHARMACEUTICAL CARE-UCTH
EXPERIENCE.

2. BRIEF PROFILE OF UCTH
• In the 19th century,the earliest known source of
scientific medical treatment in old calabar came
from the Presbyterian Mission
• In 1855,Dr Hewan,the first full medical missionary
physician arrived old calabar to join the mission
team to help in educational and missionary work
• Dr Hewan,like other missionaries,lived in the
mission premises where he had closer contact
with his colleagues to give attention to their
ailments since no hospital was established in the
whole of old calabar

3. • During this time,man’s life span on the coast was
brief,people were dying of common diseases
including these Europeans
• In order to stem this tide,it was urgent for the
government to have its own medical officers and
these were Drs Mackinson and Allman.
• Due to the absence of hospital during these
periods,these government Doctors converted
their residential building along Marina Beach to
temporary clinic until 1897 when St Margaret’s
Hospital was established.

4. • In 1978,the Federal Government of Nigeria
conceived the need for a medical school and
that was how St Margaret’s Hospital,
established in 1897 by the British Colonial
government, was taken over by the Federal
Government and renamed as University of
Calabar Teaching Hospital.

5. THE MISSION OF THE UCTH
• Building infrastructure and manpower.

6. VISION FOR THE UCTH
• Service and dedication to human

7. Eye Care
Paediatric Care
Chiropractics Care
Nursing Care
Dental Care
Mental Health Care
Medical Care
Maternal Care
Nutritional Care
Surgical Care
Pharmaceutical Care
Geriatric Care
Self Care

8. What is pharmaceutical care?
• According to Hepler, PC is defined as the
responsible provision of drug therapy for the
purpose of achieving definite outcomes that
improve and maintain patient’s quality of life.
• It is a patient-focussed, pharmacist-initiated
service through which pharmacist,in
collaboration with the patient and other health
professionals,designs,implements and monitors a
therapeutic outcome for the patient.

9. Philosophy of PC
• Definition of philosophy: A philosophy is a
particular theory that someone has about
how to live or how to deal with a particular
situation
• Below are the philosophy of PC:
• Social need, patient-centered,caring and
pharmacist’s responsibilities

10. Pharmacist’s Responsibilities
• To identify actual and potential drug therapy
and health-related problems
• To resolve actual and potential drug therapy
and health-related problems.

11. Classification of Drug Therapy
Problems
• Unnecessary drug therapy
• Wrong drug
• Underdosage
• Overdosage
• Adverse drug reactions
• Inappropriate compliance
• Additional drug
• Drug Interactions

12. • In carrying out pharmaceutical care activities by
pharmacists, it may interest you to know that the
functions of the pharmacists, the physicians and the
nurses may seem overlap but our responsibilities are
different.
• So what are pharmacist’s responsibilities?
• (See above).
• All the knowledge we have gathered in the basic
pharmaceutical sciences is what has been translated
into a product called the ‘drug’,using that product as a
medium to render service is what PC represents.

13. STEPS INVOLVED IN THE PROVISION OF
PC
• Establish a professional relationship
• Collect patient specific data
• Evaluate data to identify drug therapy
problems and classify them
• Develop and implement a PC
plan(Intervention)
• Monitor and follow up(Outcome
measurement)

14. • Documentation.
• Dimensions Or Outcomes of PC
• -Clinical
• -Economic
• -Humanistic

15. PHARMACEUTICAL CARE SKILLS
• Knowledge of pathophysiology of diseases
• Interpretations of routine clinical laboratory tests
and physical assessment
• Knowledge of Medical abbreviations and
terminologies
• Clinical use of drugs
• Pharmacology of drugs
• Knowledge of behavioral sciences(Health-belief
and decision making models)

16. • Cognitive skills(critical thinking skill and problem-
solving skill)
• Listening and communication skills
• Skills in diplomacy
• Problem-solving skills using the IDEAL model
• I-Identification
• D-Definition
• E-Exploration
• A-Action
• L-Looking and learning

17. LABORATORY TESTS
• BLOOD CHEMISTRY:
• A)Electrolytes content e.g.serum
potassium,sodium,chloride and CO2 content
• B) Chemical components e.g
calcium,magnesium,phosphorus,glucose,total
protein/protein differential,blood urea
nitrogen(BUN),creatinine and creatinine
clearance,uric acid,bilirubin(Direct,indirect,total
and new born total),cholesterol and HBA1c

18. • C) Enzymes components, e.g. Alkaline
phosphatase,serum glutamic oxaloacetic
transaminase(SGOT),serum glutamic pyruvic
transaminase(SGPT),lactic
dehydrogenase(LDH),creatine
phosphokinase(CPK),acid phosphatase,amylase.
• D) Acid-base components, e.g. Bicarbonate,CO2
content,CO2 combining power,arterial PH,arterial
PCO2,chloride,anion gap, and arterial PO2

19. • The discussion of these acid-base components
would eventually lead to the discussion on
acid-base disorders namely:
• Metabolic acidosis
• Metabolic alkalosis
• Respiratory acidosis
• Respiratory alkalosis

20. • E) Cerebrospinal fluid(CSF) biochemistry and
Microbiology. Parameters to note will include:
• CSF opening pressure
• Microscopy/macroscopy
• Glucose level
• Protein level

21. HORMONES LEVEL EVALUATIONS
• A)Thyroid Function Test: These are tests for
initial evaluation of thyroid status,e.g. TT4 by
Murphy-Patte test, Resin T3-uptake test,
Protein-bound iodine(PBI) test, Free thyroxine
index(FTI) test, radioactive iodine uptake
(RAIU) test, thyroid scan,
antibodies,thyrotropin-stimulating
hormone(TSH) test,T3-suppression test,
thyroxine-releasing hormone(TRH) test.

22. • Other hormonal evaluation tests,
e.g.prolactin,male and female hormonal
immunoassy tests,etc,

23. HEMATOLOGY SCREENING
• Routinely,a complete blood count includes the
determination of the following:
• RBC count
• Hemoglobin concentration
• PCV
• Retic count
• WBC count
• Differential WBC count or FBC/Differntial
• ESR

24. • RBC indices for determining the types of
anemia, examples are:
• Mean cell volume(MCV)
• Mean cell hemoglobin(MCH)
• Mean cell hemoglobin concentration(MCHC)

25. URINALYSIS
• A)Gross examination of the urine sample for:
• -appearance or color
• -PH
• -specific gravity
• -presence or absence of glucose
• -presence or absence of ketones
• -Presence or absence of proteins

26. • B) Microscopic examination of the urine
sample for WBCs, RBCs, casts,yeasts,crystals
and epithelial cells.
• Other laboratory tests that may not involve
the use of bodily fluids but the use of imaging
and electrical techniques are radiologic and
electrocardiographic respectively, e.g.
ultrasound scan, ECG,X-ray, Endoscopy,etc,

27. PHYSICAL ASSESSMENTS OR
EXAMINATIONS
• The following techniques are employed in the
generation of physical assessment data:
• INSPECTION
• PALPATION
• PERCUSSION
• AUSCULTATION
• (IPPA)

28. STEPS IN CLINICAL ASSESSMENT OF
PATIENTS
• Step 1: History taking
• Step 2: Physical examination or assessment
• Step 3: Develop a working diagnosis
• Step 4: Obtaining supportive information(This
is usually laboratory data for differential
diagnosis)
• Step 5:Develop final diagnosis
• Step 6: Treatment initiation

29. GENERAL PHYSICAL EXAMINATION
• Facies
• Overall appearance
• The gait
• The temperature
• Attitude
• Conjunctival
• Buccal mucosa
• Lymph nodes

30. • Peripheral edema
• The nails

31. SYSTEMATIC PHYSICAL EXAMINATION
• 1) THE CARDIOVASCULAR SYSTEM
• -Heart rate or pulse rate
• -Blood pressure
• -Heart sound{S1,S2(A2 and P2),S3,S4}
• -Heart murmur(Grades 1,2,3,4 murmur),mid-
systolic, pansystolic,innocent,late systolic and
diastolic murmurs.
• Apex beat(AB)

32. • 2) THE RESPIRATORY SYSTEM
• -Respiratory rate
• -Location of the trachea
• -Chest movement with respect to respiration
• -Percussion of the lungs, which may be
described as resonant, hyper-resonant,dull
note or stony dull note.
• Breath sound(normal is vesicular)

33. • -Bronchial sound
• -Crepitations or rales

34. • 3) THE GASTROINTESTINAL SYSTEM(This
involves the examinations of the liver, the
pancreas, the spleen, the Kidneys)
• -Rectum examination
• -Anus examination
• -peritoneal space examination(ascites, if their
is fluid)
• -Movement of the abdomen with respect to
respiration

35. • -measurement of tenderness at the
epigastrium, hypogastrium,right epigastrium
and left epigastrium
• -measurement of tenderness at the left and
right renal angles

36. • 4) EXAMINATIONS OF THE SKIN.
• -examine for pigmentation
• -examine for hemorrhages (bleeding into the skin-
purpura)
• -examine for rashes or eruptions
• -for light skin patient, examine the skin for pallor,
jaundice and cyanosis
• 5)EXAMINATIONS OF THE CNS.
• -Alert and conscious or unconscious
• -Orientation to time ,place and person(TPP)
• -examination of tones in the limbs,etc.

37. IMPORTANCE OF LABORATORY AND
PHYSICAL ASSESSMENT DATA IN THE
DELIVERY OF PC
• They can be used to determine the
appropriateness of the instituted drug therapy
• Can be used to evaluate drug therapy
effectiveness(Used to develop objective
monitoring parameters in drug therapy
outcome measurements)
• To assess drug toxicity(side effects,ADRs)

40. SUCCESS RATE OF PC IN UCTH
0
100
200
300
400
500
600
700
2009 2010 2011
No.ofDrugtherapyProblems
Year
Number of Drug Therapy Problems against Years

41. • Thank you
• Dr Agbenin
Andrew(Bpharm,PharmD,MPH,MPCPharm)