Pemeriksaan Fisik

(Interpretasi)
Fundamental Physical Assesment
Technique

1. Inspection
2. Palpation
3. Auscultation
4. Percussion
Physical Assesment Equipment

 Flashlight
 Ophthalmoscope
 Otoscope
 Tongue depressor
 Watch
 Thermometer
 Stethoscope
 Sphygmomanometer
 Reflex Hammer
Remember
Pharmacist
is not
Doctor
Physical Assesment Skills for
Pharmacist?
 Standar Pelayanan Kefarmasian adalah tolok
ukur yang dipergunakan sebagai pedoman
bagi tenaga kefarmasian dalam
menyelenggarakan pelayanan kefarmasian.
 a. Pengelolaan sediaan farmasi, alat kesehatan,
dan bahan medis habis pakai; dan
 b. Pelayanan farmasi klinik.
 Permenkes no 72 tahun 2016 tentang Standar
Pelayanan Kefarmasian di Rumah Sakit
Permenkes no 72 tahun 2016

 Pelayanan farmasi klinik meliputi:

 a. pengkajian dan pelayanan Resep;
 b. penelusuran riwayat penggunaan Obat;
 c. rekonsiliasi Obat;
 d. Pelayanan Informasi Obat (PIO);
 e. konseling;
 f. visite;
 g. Pemantauan Terapi Obat (PTO);
Permenkes no 72 tahun 2016

 h. Monitoring Efek Samping Obat (MESO);

 i. Evaluasi Penggunaan Obat (EPO);
 j. dispensing sediaan steril; dan
 k. Pemantauan Kadar Obat dalam Darah (PKOD).
Physical Assesment Skills for
Pharmacist?
 Permenkes no 73 tahun 2016 tentang Standar
Pelayanan Kefarmasian di Apotek
 Meliputi:
 a. pengkajian Resep;
 b. dispensing;
 c. Pelayanan Informasi Obat (PIO);
 d. konseling;
 e. Pelayanan Kefarmasian di rumah (home pharmacy care);
 f. Pemantauan Terapi Obat (PTO); dan
 g. Monitoring Efek Samping Obat (MESO).
Physical Assesment Skills for
Pharmacist?
 Permenkes no 74 tahun 2016 tentang Standar
Pelayanan Kefarmasian di Puskesmas
 Pelayanan farmasi klinik meliputi:
 a. pengkajian resep, penyerahan Obat, dan pemberian
informasi Obat;
 b. Pelayanan Informasi Obat (PIO);
 c. konseling;
 d. ronde/visite pasien (khusus Puskesmas rawat inap);
 e. pemantauan dan pelaporan efek samping Obat;
 f. pemantauan terapi Obat; dan
 g. evaluasi penggunaan Obat.
Physical Assesment Skills for
Pharmacist?

SOAP Note

 Subjective
 Objective
 Assessment
 Plan
Vital Sign

 provide important screening and diagnostic

information
 monitoring data for assessment of short-
term and long-term response to medication
therapy.
Vital Sign :

 heart rate
 respiratory rate
 blood pressure
 and temperature. Along
 height and weight
Heart Rate (Nadi)

 The normal 60 to 100

beats/min
 Bradycardia (<60 beats/min)
betablocker drugs and digoxin and by
sinus node or atrioventricular (AV)
node dysfunction
 Tachycardia (>100
beats/min) anxiety, volume
depletion, fever, exercise, and
inotropic drugs such as epinephrine
and dobutamine
Respiration Rate

 The normal 12 to 20
breaths/min (bpm)
 Tachypnea (>20bpm)
pain, anxiety, exercise,
and respiratory failure.
 Bradypnea (<12 bpm)
is caused by medications such as narcotics
and medical conditions associated with
elevated carbon dioxide levels.
Blood Pressure

 JNC 8
Temperature
 Normal oral 37° C (98.6° F)
 Fever is generally accepted
to be an oral body
temperature of 38° C
(100.4° F) or higher
 Oral body temperature is 1°
lower than rectal body
temperature and axillary
temperature is 2° lower
than rectal body
temperature.
Height and Body Weight

 useful screening and monitoring parameters

and are components of the body mass index
(BMI)
BMI(metric)=weight in kilograms÷2(height in meters)
Waist/Hip Ratio (Rasio
pinggang/panggul)
 A waist circumference of more than
40 inches (101,6 cm) in men and
more than 35 inches (88,9 cm) in
women is associated with increased
risk for cardiovascular and
metabolic disease.
 A WHR of less than 0.85 for men
and less than 0.75 for women is
considered excellent and is
associated with low risk; WHRs of 1
or higher are associated with
increased risk
Kanker

 B.C. is a 39-year-old man with an aggressive

non-Hodgkin lymphoma (NHL). At the time
of diagnosis, B.C. had enlarged cervical
lymph nodes, dyspnea, and a large
mediastinal mass noted on chest x-ray
examination.
Acute Staphylococcal Endocarditis

 A.G., a 57-year-old, 60-kg man with chief complaints of fatigue, a

persistent low-grade fever, night sweats, arthralgias, and a 7-kg
unintentional weight loss, is admitted to the hospital for
evaluation.
 Visual inspection reveals a cachectic, ill-appearing man in no
acute distress.
 Physical examination on admission is significant for a grade III/IV
diastolic murmur with mitral regurgitation (insufficiency) that has
increased from pre-existing murmur, a temperature of 100.5F,
petechial skin lesions, subungual splinter hemorrhages, and
Janeway lesions on the soles of both feet (Figs. 59-1, 59-2, and 59-
5). Nail clubbing, Roth spots, or Osler's nodes are not evident
(Figs. 59-3 and 59-4).
Heart Failure
 C.S., a 58-year-old woman, has had complaints of fatigue,
ankle swelling, and SOB, especially when lying down, for
the past week. Physical examination shows distended
neck veins, bilateral rales, an S3 gallop rhythm, and
lower extremity edema. A chest radiograph shows an
enlarged heart. She is diagnosed as having HF and is
being treated with furosemide and digoxin. What is/are
the primary problem(s)? What subjective and objective
data support the problem(s)? What additional subjective
and objective data are not provided but usually are
needed to define this (these) particular problem(s)?
Diabetes

 P.J., a 45-year-old woman of normal height

and weight, states that she has diabetes.
What questions might the practitioner ask of
P.J. to determine whether type 1 or type 2
disease should be documented in her medical
history?
 How old were you when you were told you had diabetes?
 Do any of your relatives have diabetes mellitus? What do
you know of their diabetes?
 Do you remember your symptoms? Please describe them
to me.
 What medications have you used to treat your diabetes?
 Even simple assessments such as the observation of a
patient's body size can provide information useful for
therapeutic interventions. For example, a person with
type 2 diabetes is more likely to be an overweight
HIV
 E.J. is a 27-year-old man who presents to your clinic
with new complaints of fevers, night sweats, weight
loss, and a white exudate in his mouth. He states that
these symptoms have been present for the past 4 to 6
weeks. On physical examination, it is concluded that
E.J. has thrush caused by Candida albicans. E.J. admits
to intravenous drug use in the past; however, he states
that he has been “clean” for 3 years. HIV infection is
suspected and consent for an HIV test is obtained. Why
is HIV suspected and how is it confirmed?
 In otherwise healthy, immunocompetent individuals, the appearance of
opportunistic infections, such as thrush, is rare. This is because an intact cell-
mediated immunity protects against infection. In immunosuppressed
individuals, such as those infected with HIV or cancer, the immune system is
significantly damaged and places patients at risk for opportunistic
infections. Infections such as shingles (Herpes zoster), active tuberculosis,
oral thrush, and recurrent candidal vaginal infections in an otherwise healthy
person warrant further evaluation. More advanced diseases, such as
Pneumocystis jirovecii pneumonia, Mycobacterium avium bacteremia, and
Cytomegalovirus retinitis infections, among others, generally occur in
patients with severely depressed immune systems and strongly suggest HIV
infection. This is especially true for those patients with risk factors for HIV
infection. Despite E.J.'s discontinuation of intravenous drugs, his prior use
places him at risk for HIV infection. Given his social history and current
clinical presentation, an HIV test is warranted.
Pain
 E.T. is a 36-year-old woman recovering from the surgical repair of a left tibia
fracture following a motor vehicle accident. She is otherwise healthy, with
no other medical conditions. Her medication history reveals no drug
allergies or history of recreational drug use, and occasional use of oral
ibuprofen 400 mg every 6 hours as needed for menstrual cramps.
Postoperatively, E.T. received acetaminophen 325 mg with codeine 30 mg,
two tablets orally every 3 hours for pain; however, this analgesic regimen
was inadequate for controlling her pain. After extensive complaints, E.T.'s
analgesic medication was replaced with two tablets of hydrocodone 5 mg
with acetaminophen 500 mg every 4 hours. Despite these changes, E.T.
continues to complain of pain. Vital signs indicate the following:
respiratory rate, 24 breaths/minute; heart rate, 110 beats/minute; blood
pressure (BP), 140/85 mmHg. She rates the intensity of her pain as 8 on a
10-point scale. What is your assessment of E.T.'s pain and what are
reasonable analgesia goals for E.T.?
 The current analgesic regimen has not provided E.T.
with adequate pain relief based on her pain evaluation
rating of 8 on a 10-point scale. Physiologic responses to
pain include autonomic findings, such as increased
respirations, heart rate, and BP.
 Appropriate goals for E.T. would be a pain rating of <4
of 10-point scale, a return of vital signs toward her
baseline values, and reduced anxiety. Only appropriate
analgesic selection, careful follow-up evaluations, and
rational analgesic dosage adjustments can accomplish
these goals.
Acne
 L.Y., a fair-skinned, 15-year-old, Caucasian girl presents to her physician complaining of
worsening “acne.” Several of her classmates are taking antibiotics for acne, and she wants to
move up from nonprescription treatments to “strong medicine.” The problem began when she
was 13 and has progressively worsened. At first, lesions occasionally appeared on her chin and
forehead; now she consistently has four to eight lesions, which have spread to her cheeks and
nose. She uses a nonprescription 10% benzoyl peroxide gel as needed on lesions when her acne
“gets really bad,” but it is too drying for everyday use. She tried a “medicated” soap in the past,
but stopped because it caused excessively dry skin. She has no other medical problems and
takes no chronic prescription medications. She has had normal menstrual periods since
menarche at age 12. Both her older brothers have acne, one mild and one severe. L.Y. denies
alcohol, tobacco, or illicit drug use. She has a boyfriend but denies sexual intercourse. After
school, she works part time at a fast food restaurant, plays varsity tennis, and practices violin.
She wears a sweatband around her head while playing tennis and uses a hair styling gel.
 Examination reveals three pustules and two closed comedones on her forehead, three papules
on her cheeks and chin (which are covered with makeup), two well-healing areas on her nose,
and no open comedones or nodules. Her skin is only slightly oily. Her chest, back, and arms are
clear. She has no facial hair, and her voice is normal in pitch. What are the key components in the
clinical assessment of L.Y.'s acne?
 The clinical assessment of L.Y.'s acne should include evaluating each of the following
factors:
 Type, number, and distribution of lesions. This patient has relatively few lesions that are
mostly inflammatory (pustules) and located on the face.
 Contributing factors such as family history of acne (noted in brothers), work-related
exposures (oils from fast food restaurant), systemic or topical medications, cosmetic or
hair care products (makeup and hair gel), or mechanical pressure on the skin (sweatband
and violin chin rest).
 Hormonal influences that indicate androgen excess or atypical menstrual cycles. This
patient has no signs of virilization (normal voice and lack of facial hair), and her
menstrual periods are normal.
 A detailed medical history. This patient is healthy and does not have epilepsy, liver
disease, alcohol abuse, or dyslipidemia.
 Effectiveness of current or past treatments. This patient's response to two therapies was
suboptimal, but because she used them erratically, effectiveness is difficult to assess.
 Psychosocial impact of acne on her quality of life. This appears to be very important to
her based on her plea for effective therapy.