Question

CRITICAL THINKING

1. Julie is a new patient who brings a list of her current medications to her first appointment. She indicates in her health history that she has several conditions for which she is taking medications prescribed by her previous physician, but she is unaware of which medication is associated with a particular condition. Her medical records have been requested from her previous physician, but have not yet arrived. What steps can you take to attempt to match her medications with the disorders that she reports? 2. Phil arrives at the medical office complaining of fatigue, weakness, and mild discomfort in the chest. He also reports that his weight has recently decreased and he has difficulty sleeping because he feels feverish at night. The physician requests that you perform tuberculin testing to determine whether Phil has a tuberculosis infection. What general steps do you follow to administer a Mantoux test and to interpret the results?

Answer 1

Answers

1. For some medical conditions, a list of previously tried medicines are very important in future prescription of medications.

The previous medical records contains list of all medicines that a patient was taking prior to their admission to hospital.

In addition to this, details of allergies or sensitivities to medicines, recently stopped medicines , and recent short courses of antimicrobials or corticosteroids should also be included.

Without an accurate medication history, prescribers may inadvertently make incorrect decisions about a patient’s treatment, causing harm if previously discontinued medicines are restarted, or if current medicines are omitted or prescribed at the wrong dose for the patient.

Although doctors usually obtain medication histories during their initial patient interview, there is evidence that those obtained from medical records are more accurate

The doctor will also have to take a full clinical history, examine the patient, order investigations, formulate an initial diagnosis and prescribe a patient’s medicines.

When doctors review a patient on admission, the patient may not be able to provide an accurate list of medicines, especially if they are confused or particularly distressed by the cause of their admission.

Two or more sources are often required in case of absence of medical records. That means asks to the patient bystander.

2. The injection should be made with a tuberculin syringe, with the needle bevel facing upward. It is an intradermal injection. When placed correctly, the injection should produce a pale elevation of the skin (a wheal) 6 to 10 mm in diameter.

Locate and clean injection site 5–10 cm (2–4 inches) below elbow joint. Place forearm palm-up on a firm, well-lit surface.

Prepare syringe. Check expiry date on vial and ensure vial contains tuberculin (5 TU/0.1 ml).

Inject tuberculin.

Check injection site.

Record information.

Interpretation of results

Baseline test: ≥10 mm is positive (either first or second step); 0 to 9 mm is negative.

Serial testing without known exposure: Increase of ≥10 mm is positive.

Known exposure: ≥5 mm is positive in patients with baseline of 0 mm.