PHAR616: Introduction to the Health Care System
related physical pathology that causes those
Unit II: Overview of Health Care
Patient
 recipient of medical attention, care or treatment
 originally meant “one who suffers”
Alternative Terms
1. Health Consumer
2. Health Care Consumer
3. Client
Types of Patients
1. Patient as Consumer
 patient views you (professional) as a competitor
who has something he or she wants or needs
 views you as willing to give as little as possible for
the amount of money
 consumer shops around for the commodity (i.e.
health care services, pharmaceuticals)
2. Patient as Dominated by Professional
 patient views him or herself as powerless in
decision making
 hands over in a highly dependent way the
decisions to be made to you (health professional)
3. Patient as Autonomous and Interdependent with the
Professional
 patient views him or herself as vulnerable
 seeks care in an interdependent fashion
 patient wants to trust the professional’s expertise
 he or she wants to participate in, rather than hand
over decisions to the professional
Outpatients and Inpatients
Outpatient
 patient who is not hospitalized for 24 hours or more
 who visits a hospital, clinic or associated facility for
diagnosis or treatment
Inpatient (In-Patient)
 who is admitted to the hospital and stays overnight or
for an indeterminate time, usually several days or
weeks
 some cases, like coma patients, have been in
hospitals for years
Patient
 central reason for your work
 only reason for health profession
Values, Beliefs, Attitudes and Concepts
 defines us as people
Critical Frame
 determines the patients’ beliefs about their health
and health-related needs
Disease Concept
Disease
 abnormal condition
 affecting either whole body or any of its parts
 impairs normal functioning
 negative symptoms combined with the directly
symptoms
Concept of Health
 represented by “the absence of disease” in this
model
Measures of Health
 changing today
Increasingly, we see writings about recognition of:
1. Diversity
2. Value of Whole Person and Richness of Life
3. Broad Concern about Person
4. Need of Inclusion of Spirituality
Conceptual Factors
 each of us has our own concept, but it is formed by
many factors like: cultural influences, values and
beliefs
Cultural Influences
 Culture: property of society
 no such thing as pure culture
 there is diversity often recognizable as subcultures
Variation may exist in:
1. Education
2. Socioeconomic Status
3. Practiced Religions
Access to care will continue to be segregated into 3
identifiable groups of patients:
1. Empowered Consumers
 who have resources, use technology and want to
share in health decision making
2. Worried Consumers
 who have health insurance but no choice in plan
3. Excluded Consumers
 who have no form of health insurance or method
of payment other than out of pocket
Model of Cultural Competence in Health Care Delivery
Campinha-Bacote
 described model of cultural competence in health
care delivery as a “framework for developing and
implementing the culturally responsive care”
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3. Diagnosis and Treatment
4. Rehabilitation
Model of Cultural Competence in Health Care Delivery
 assumes that cultural competence is a “process, not
an event”
 recognizes that “there is variation within ethnic
groups than across groups”
This model defines the concept as follows:
1. Cultural Awareness
 self-understanding of one’s own cultural and
professional background
2. Cultural Knowledge
 process of seeking and obtaining an educational
foundation about different cultural and ethnic
groups
3. Cultural Skill
 ability to collect relevant cultural data about the
patient’s problem as well as performing a
culturally based physical assessment
4. Cultural Encounter
 health professional engaging in cross-cultural
interactions with individuals from diverse
backgrounds
5. Cultural Desire
 motivation of the health care provider to engage
in the process of culturally responsive care
How does one become culturally competent:
1. Living with the group.
2. Learning can be accomplished through reading,
convening focus groups and participating in
community activities.
 Controlling Breeding of Insects
 Education Programs on AIDS Prevention
 Immunization
 commonly used services of health care
 usually sought once a person feels ill or a problem
is indicated
Examples:
 Teaching about Breast (?)
 Self-Breast Examination (Early Diagnosis)
 Vision-Screening Programs at Schools
 Treatments Provided in any Health Care Setting
Restoration of a person to their:
1. Highest Level of Functioning
2. Maximizing Abilities and Independence
 programs have extended beyond helping those
with illness or injuries to the nervous system
 involves the patient, family and entire health team
who will individualize a rehabilitation program for
the patient
Provided in various settings like:
 Hospital
 Home
 Healthcare Home
 Outpatient Setting
Rehabilitation Programs:
 Cardiovascular
 Pulmonary
 Chemical-Induced Impairments (drug addicts,
etc.)

Health Care Strategies

1. Health Promotion
 services designed to reduce risk of illness,
maintain maximal function and promote good
health habits
Examples:
 Prenatal Nutrition Classes
 Exercises Classes
 Stress Management Classes
2. Illness Prevention
 services designed to reduce risk factors in an
effort to avoid primary, secondary or tertiary
health prevention
Examples:
 No Smoking Programs
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 Unit III: General Health Care
Health Problem Identification
Wellness
 integrated method of functioning
 oriented toward maximizing the potential of which
individual is capable within the environment where he
is functioning
Illness
 individual’s perception any condition that cases
individual to be concerned and seek help
 legitimate excuse for not going to work or school
Basic Human Needs
 each individual has unique characteristics
 certain needs are common to all people
 these needs are called basic human needs
Human Needs
 physiologic and psychologic conditions that the
individual must meet to achieve a state of health and
well-being
Need Hierarchy
Abraham Maslow
 developed most popular version in the management
 filed in the 1940’s
 proposed that people want to satisfy various needs
and these needs can be arranged in a hierarchy of
importance
 ranked basic human needs according to what is
crucial for survival
 assumed that there are 5 that must be satisfied
sequentially
 suggested that physiologic needs are to be given
highest priorities over a higher-level need
1. Physiologic Needs
 air, food, rest and sleep
In the Workplace:
 Adequate Wages
 Satisfactory Work Environment
 Adequate Lighting Temperature
 Ventilation
2. Safety and Security Needs
 secure physical and emotional environment,
physiological safety
 need to be from worry about money and job
security
 need for shelter and freedom from harm and
danger
In the Workplace:
 Job Continuity (no layoffs)
 Grievance System (protect against arbitrary
action)
 Adequate Health Insurance and Retirement
Package (security against illness and eventual
retirement)
3. Love and Belongingness Needs
 social processes: to associate or to belong
 need for affection
 need to love and be loved
 need to be accepted by one’s peers, combination
of family and community relationships outside the
job
 friendship on the job, need to establish fruitful and
meaning relationships with people, institution or
organization
In the Workplace:
 Encourage Social Interaction
 Involvement of Employee/Team/ Group Work
 Sensitivity to an Employee’s Family Problems
4. Self-Esteem Needs
 self-worth, self-identity, self-respect and body
image
2 Different Sets of Needs:
1. Need for a Positive Self-Image or Self-Respect
2. Need for Recognition and Respect from Others
In the Workplace:
 Signs of Accomplishment: extrinsic rewards (ex.
job titles, public recognition, praise)
 More Challenging Assignments
 More Opportunities: feel a sense of
accomplishments
5. Self-Actualization Needs
 need to learn, create and understand or
comprehend
 need to be self-fulfilled
 need of spiritual fulfillment
In the Workplace:
 Employees to Participate in Decision Making
 Opportunities to Learn New Things about Their
Work
Abraham Maslow
5 Need Categories
 constitute a hierarchy
1. People are motivated first to satisfy lower-level needs
beginning with physiological needs.
2. Remained unsatisfied, individual is motivated only to
fulfill them.
3. Needs are satisfied, they cease to motivate people
and they move up the hierarchy and become
sequentially concerned with each higher level in turn.
4. Continued until the self-actualization level is reached.
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 Measuring Health or Health Status Indicator
 trying to qualify the amount of health an individual or
population possesses is not easy
 because of this difficulty, most measures of health are
expressed using health statistics based on the
traditional medical model of describing ill health
(injury, disease and health) instead of well health

Presence of Injury, Disease and Level of Health

Death Indicators
higher lower
lower higher

Why measure health?

1. To establish priorities
 collection and evaluation of information about
health status and health problems of a community
 important way of identifying needs
2. To assist planning
 health promoters need information to assist the
planning and evaluation of health promotion
programs
3. To justify resources
 health promoters need information on the health
status of population to make a claim for resources
for their activities
4. To assist development of professions
 measurements of health gain are important in a
community for proper funding, resources for
benefit of health promoters
Measures of Health as an Objective Attribute
1. Health Measures
2. Health Behavior Indicators
3. Environmental Indicators
4. Socio-Economic Indicators
Measures of Health as a Subjective Attribute
1. Measures of Physical Well-Being
2. Measure of Physiological Well-Being
3. Measures of Social Well-Being
4. Measures of Quality of Life

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 Unit IV: Assessment Guidelines for Measuring Vital Signs
1. Part of Database/ Record: pharmacy collects during
Vital Signs assessment
 most frequent measurement obtained by health 2. Baseline for Future Assessments: tells the patient’s
practitioners needs and condition
 indicators of health status 3. Patient’s Needs and Condition: determines when,
Indicate the effectiveness of functions: where, how and by whom vital signs are measured
1. Circulatory 4. Vital Signs Analysis: interpret their significance and
2. Respiratory make decisions about interventions
3. Nervous I. Equipment
4. Endocrine 1. Appropriate for size and age of patient
Vital Signs 2. Functional to ensure accurate findings
1. Temperature 3. Selected based on patient’s condition
2. Blood Pressure II. Patient
3. Pulse Rate/ Cardiac Rate 1. Usual range of vital signs should be established.
4. Respiratory Rate 2. Must know medical history, therapied and
5. Pain prescribed medications
 Joint Commission on Accreditation of Healthcare III. Control and Minimize Environmental Factors
Organizations (JCAHO) and Pain Management Affecting Vital Signs
Experts: decided pain as fifth vital sign IV. Organized, Systematic Approach when Taking Vital
Signs
Acceptable Ranges for Adults

Temperature Thermometer:
Range Oral/Tympanic: 36C to 37C
Rectal: 37.5C
Axillary: 36.5C
Pulse Rate 60 to 100 beats per minute
Respiratory Rate Stethoscope/ Sphygmomanometer:
Factors Causing Vital Signs to Change 12-16 breaths per minute
1. Temperature of the Environment Blood Pressure 110/70 mmHg
2. Patient’s Physical Exertion
3. Effects of Illness Parts of Thermometer
Changes in Vital Signs Oral (slim and long bulb)
 indicates a change in physiological function
Allows pharmacist to: Rectal (round and short bulb)
1. Assess Response to Drug and Non-Drug Therapy
2. Identify Diagnoses Parts of Stethoscope
3. Implement Planned Intervention Headset
Eartip
4. Evaluate Success: when vital signs have returned to
Eartube
acceptable values

Importance of Vital Signs Tunable Diaphragm

1. Essential ingredient when pharmacists, nurse and
physicians collaborate to determine the patient’s Chestpiece
Stem
health status.
2. Need for hands-on proficiency in specific physical Tubing
assessment skills varies according to the type of Parts of Sphygmomanometer
patient care setting. Dial
 numbered dial or column of
3. All pharmacists should have at least basic Pump mercury can be used to record
 inflates the cuff to stop the blood pressure reading
understanding of these skills. the blood flow in your
Cuff
artery for a few seconds
 wrapped

Basic Techniques to Determine Vital Signs (IPPA) Valve around upper

 lets some air out of the arm
1. Inspection (Check-Up) cuff, which allows the
blood flow to start again
2. Palpation (Feel)
Stethoscope
3. Percussion (Beating)  hear the sound of blood rushing
4. Auscultation (Stethoscope) back through the artery
 first thumping sound is the systolic
blood pressure
 when thumping sound is no longer
heard that is the diastolic pressure
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Complete Physical Examination
 subjective (personal/individual)
 everything is important depending on the chief
complaint
 consider everything
 document the essential
 last ECG/stress test, CHF (congestive heart failure).
History of Present Illness (HPI)
Pray Queen Rests So That Mary Does Shit For RC More
Now, No?
1. P: What provokes discomfort?
2. Q: What is the quality of discomfort?
3. R: Where is the region of discomfort?
4. S: What is the severity of discomfort?
5. T: What is the time sequence?
6. M: What was the mechanism of injury?
7. D: What was the patient doing prior to incident?
8. S: Are there any associated symptoms?
9. F: Are there any aggravating/ relieving factors?
10. R/C: Is this a recurrent/continuing illness or
injury?
11. M: Is the patient on any medications?
12. Note patient’s eating habits, caffeine and
smoking habits.
13. Note allergies.
I. Review of System (ROS)
General
 nutritional status, weight gain/loss, weakness,
fatigue, hydration status, overall condition
Skin
 changes in skin/nail/hair texture, appearance and
color, rashes, itching, lumps or infection
Head
 loss of consciousness, lightheadedness/vertigo
(dizziness), headaches, history of injury, sinus, pain,
visual disturbances
Eyes
 visual changes, diplopia, pain, discharge, trauma
photophobia, glaucoma, cataracts, last eye exam,
use of eyeglasses/ contact lenses
Ears
 hearing loss, tinnitus, drainage, pain, infection,
discharge, vertigo, hearing aids
Nose/Sinuses
 stuffiness drainage, olfactory changes, itching,
obstruction, history of trauma, hay fever, nosebleeds,
sinus problems
Throat
 hoarseness, dysphagia, enlarged tonsils, bleeding
gums, sores, dental condition, caries, tongue
changes, dry mouth, history of sore throat, history of
trauma
Neck
 goiter, pain, masses, nodules, adenopathy, thyroid
problems, stiffness, history of injury
Respiratory
 cough, dyspnea, sputum amount, type and color,
asthma, bronchitis, COPD (chronic obstructive
pulmonary disease), emphysema, TB, last CXR
(chest x-ray), smoking history
Cardiac
 hypertension, hyperlipidemia, rheumatic fever,
murmurs, chest pain/discomfort, dyspnea, edema,
history of surgeries, procedures, monitors
Peripheral Vascular
 nocturnal pain, varicose veins, leg cramps, CHF
(congestive heart failure), swelling, tenderness
Gastrointestinal
 heartburn, dysphagia, appetite, indigestion,
belching, flatulence, stool changes, melena,
diarrhea, constipation, nausea, regurgitation,
vomiting, history of gallbladder or liver disease
Genital (Male)
 hernias, sores, lesions, penile discharge, pain,
testicular/mass discomfort, scrotal mass/discomfort,
history of STD’s, sexual history, function, problems
Genital (Female)
 birth control, sexual history/function, STD’s, itching,
sores, discharge, dyspareunia, last PAP/pelvic exam,
menarche, menopause, LMP (last menstrual period),
obstetric history, menstrual regularity, frequency,
duration, amount, dysmenorrhea, PMS (pre-
menstrual syndrome)
Urinary
 dysuria, polyuria, frequency, stones, pattern,
change, incontinence, nocturia, STD, hesitancy,
dribbling, hematuria, infections, flank discomfort
Hematologic
 bleeding, bruising, anemia, history of transfusion
Endocrine
 thyroid, adrenal, hormonal, heat/cold intolerance,
edema, hirsutism, sweating, excessive thirst, hunger,
polyuria, pigment changes
Musculoskeletal
 myalgia, stiffness, gout, arthritis, backache, swelling,
pain, erythema, tenderness, history of trauma
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
II. Past Medical History (PMH)
 consider: any other currently active problems
 comments should include: functional, impairment,
history of trauma, childhood illnesses, surgeries and
hospitalizations
III. Family History (FH)
IV. Complete Physical Examination
Always start your objective with an opening statement
concerning the patient’s general appearance and condition.
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 1. Well-developed, well-nourished male, not in distress.
2. Patient is ambulatory/moving, alert, cooperative and
shows no gross mental status changes.
3. Vital signs noted.
4. Consider listing a minimum of 3-4 physical exam
findings for each complaint
5. Check the system above and below and include
possibility of cutaneous, musculoskeletal and occult
findings.
6. Document the absence of critical findings.
V. Laboratory and Diagnostic Tests
1. Biochemical, chemical or physical methods of
measuring biologic or physiologic functions of the
body.
2. Important part of health care and have become
indispensable for routine screening and the diagnosis
of disease.
3. Used routinely to assess compliance, monitor both
the efficacy of prescribed treatment and the
advent/start of adverse or toxic reactions, diagnosis
of specific disease and at times, to help determine
the drug choice.
4. Ordered appropriately and performed and
interpreted correctly.
5. Results of initial screening or diagnostic tests usually
suggests the specific follow-up tests necessary for a
definitive diagnosis.
The Pharmacist’s Role
 involved in monitoring patient care and a growing
number now have input into the management of
patient therapy
 understand why laboratory tests are used and of the
information to be gained from them
 drugs may influence the results of laboratory tests in
a variety of ways, they are in good position to
anticipate and advise on such interactions
Endoscopy
 visual examination of internal structures using optical
scopes
Paracentesis
 puncturing the skin and withdrawing fluid from the
abdominal cavity
Lumbar Puncture
 inserting 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
Sonogram or Echogram
 examination of soft tissue using soundwaves beyond
human hearing
 visual image produced by the reflection of the
soundwaves back from the tissues being assessed
and into the machine
Electrographic Graphic Recordings
1. Electrocardiography (ECG)
 examination of the electrical activity in the heart
2. Electroencephalography (EEG)
 examination of the energy emitted by the brain
3. Electromyography (EMG)
 examination of the energy produced by stimulated
muscles
Culture
 to collect from the body a sample suspected to
contain infectious microorganisms, growing the
microbes in a nutrient substance and examining the
resulting growth under a microscope
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

Definition Factors that Invalidate Test Results

 using word beginnings (prefixes) and endings 1. Incorrect Diet Preparation
(suffixes) as clues to procedures 2. Failure to Remain Fasting
-Graphy 3. Insufficient Bowel Cleansing
 to record an image 4. Drug Interactions
-Scopy 5. Inadequate Specimen Volume
 to look through a lensed instrument 6. Failure to Deliver Specimen to Lab in Timely Manner
-Centesis 7. Incorrect or Missing Request Form
 to puncture
-Metry Common Diagnostic Procedures
 to measure with an instrument 1. Radiography or Roentgenography (X-Ray)
Sono- 2. Fluoroscopy
 to asses using sound 3. Computerized Tomography (CT Scan)
Electro- 4. Magnetic Resonance Imaging (MRI)
 to assess using electrical impulses 5. Endoscopic Examinations
Gluco- Bronchoscopy
 sugar  inspection of the bronchi
Endo- Gastroscopy
 inside  inspection of stomach
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 Colonoscopy
 inspection of colon
Laparoscopy
 inspection of the abdominal cavity
Cystoscopy
 inspection of urinary bladder

Powerpoint Notes
Chest Percussion (Chest Physiotherapy)
 airway clearance technique
 involves clapping on the chest and/or back to help
loosen thick secretions.
 makes mucus easier to expel, or cough up

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