Bloods 

Blood tests provide crucial insights into your overall health by measuring components like cells, chemicals, and proteins. They are used to diagnose conditions, monitor chronic diseases, check organ function (liver, kidneys, thyroid), screen for infections, and assess nutrient levels

Beyond the ordinary

Presenting complaint, observations, investigations, monitoring

  1. Which observations on admission are of note or concern? Vital observations
  2. On admission, which laboratory test results would have been of concern to you, and why? What does the range indicate? What causes this abnormality? what can it cause
  3. What comments do you have on the presenting complaint?
  4. What potential differential diagnoses were there? CKS
  5. What do you understand about the investigations that have been carried out on this patient? Talk about blood results

 

Beyond the ordinary

Pharmaceutical Care and treatment recommendations

  1. Are there any immediate pharmaceutical issues you would like to deal with? Allergies, check renal + pregnancy + breastfeeding + hepatic on BNF against blood results, severe urgent change if interaction, important safety info
  2. Are there any drug interactions on the patient's prescription? Stockleys
  3. What medicines reconciliation checks might you wish to undertake regarding the patient’s admission medications?

Check GP summary, previous discharge letters, community pharmacy to see if they have blister packs, repeat prescription record to see if they have been taking the medication, check adherence, e.g. time, dose, allergies, check dose appropriate for impairments, OTC / herbal meds, side effects, recent changes

  Check EGFR tolerance for drugs.  Mention you would speak to the pt and ask about their adherence to drugs.

  1. Is there any more information about the drug history you would like to ask the patient for? Cautions and advisory labels
  2. What are the potential side effects of the medications the patient is currently taking? Check EMC + BNF
  3. What non-pharmacological treatments could complement the patient's medication regimen? Align patient social history with the NICE guideline (alcohol, diet, smoking, exercise, family support)
  4. Is the treatment plan in line with recommended guidelines? Checking plan against NICE – TREATMENT
  5. What issues might occur if renal function was reduced? Check each drug, drug accumulation, toxicity, what can it cause?
  6. What issues might occur if there is hepatic impairment? ? Check each drug, drug accumulation, toxicity, what can it cause?
  7. Comment on the suitability of formulations for this patient? Blister packs? Swallowing difficulty, adherence. Potentially start with IV then when pt gets better, switch to oral (less risk of infection). Antibiotic stewardship.

Beyond the ordinary

Self-care, health promotion, follow up

  1. What counselling would you offer your patient before discharge? Medicine adherence at home, family or friend support (potentially refer to PTOT) “Foot care” specific to the case but tell pt to improve that part of their life, e.g., exercise. Safety netting.
  2. How would you manage a patient with a history of non-compliance to medication? Identify the reason for non-compliance, Assess understanding of disease and treatment, Simplify the medication regimen, Use adherence aids (blister packs, phone reminder), address side effects (potential reason pt isn’t taking medication), asses pt understanding of medication.
  3. How would you educate this patient about their condition and treatment plan? Explain pt condition in layman's terms without alarming language as well as explain the seriousness. Give treatment education, safety netting and “teachback” and MDT support.
  4. How would you address the patient's concerns about the potential side effects of their medications? Acknowledge and validate pt concerns, explore what the pt is specifically worried about. Reassure there is monitoring and support. Explain the benefit vs risk of medication, safety netting, all while using layman’s terms.

🩺 OBSERVATIONS (Vitals)

 

Temperature (Temp)

 

High

 

Indicates infection or inflammation

Causes: sepsis, fever, increased metabolic demand

 

Low

 

Indicates severe infection, exposure, or shock

Causes: deterioration, organ failure

 

βΈ»

 

Heart Rate (HR)

 

High (Tachycardia)

 

Indicates pain, fever, shock, anxiety

Causes: reduced cardiac efficiency

 

Low (Bradycardia)

 

Indicates medication effect, heart block, athletic baseline

Causes: dizziness, syncope

 

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Blood Pressure (BP)

 

High

 

Indicates cardiovascular disease risk or chronic hypertension

Causes: stroke, heart disease

 

Low

 

Indicates shock, dehydration, sepsis

Causes: collapse, dizziness

 

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Respiratory Rate (RR)

 

High

 

Indicates respiratory distress, infection, acidosis

Causes: fatigue, respiratory failure

 

Low

 

Indicates CNS depression or overdose

Causes: respiratory arrest

 

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Oxygen Saturation (SpOβ‚‚)

 

Low

 

Indicates hypoxia from respiratory or cardiac cause

Causes: organ hypoxia, deterioration

🩸 Haematology

 

Haemoglobin (Hb)

 

Low

 

Suggests anaemia

Common causes: iron deficiency, chronic disease, bleeding

Clinical effects: fatigue, pallor, shortness of breath, reduced exercise tolerance

 

High

 

Suggests dehydration or polycythaemia

Clinical risks: increased blood viscosity → thrombosis risk, headaches

 

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White Blood Cells (WBC)

 

High

 

Suggests infection or inflammation (often bacterial)

Also seen in stress response, trauma, steroids

Clinical effects: fever, possible sepsis if significantly raised

 

Low

 

Suggests bone marrow suppression or viral infection

Causes: chemotherapy, immunosuppression

Clinical risk: increased susceptibility to infection

 

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Platelets

 

Low

 

Suggests thrombocytopenia

Causes: sepsis, bone marrow suppression, drugs, autoimmune disease

Clinical effects: bruising, petechiae, bleeding risk

 

High

 

Suggests reactive inflammation or malignancy

Clinical risk: increased clot formation

 

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CRP (C-Reactive Protein)

 

High

 

Sensitive marker of inflammation

Common causes: bacterial infection, sepsis, inflammatory conditions, tissue injury

Used to monitor severity and response to treatment

 

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⚑ Electrolytes

 

Sodium (Na⁺)

 

Low (Hyponatraemia)

 

Suggests excess water relative to sodium

Causes: SIADH, heart failure, liver failure, renal failure, diuretics

Clinical effects: confusion, seizures, reduced consciousness

 

High (Hypernatraemia)

 

Suggests dehydration or water loss

Causes: poor fluid intake, diabetes insipidus

Clinical effects: confusion, irritability, seizures

 

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Potassium (K⁺)

 

Low (Hypokalaemia)

 

Causes: vomiting, diarrhoea, diuretics, poor intake

Clinical effects: muscle weakness, cramps, constipation

Cardiac risk: arrhythmias (can be serious)

 

High (Hyperkalaemia)

 

Causes: renal failure, acidosis, tissue breakdown, certain medications

Clinical effects: muscle weakness

Cardiac risk: life-threatening arrhythmias

 

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πŸ«€ Kidney Function

 

Urea

 

High

 

Suggests dehydration or impaired renal function

Can also rise with high protein breakdown or GI bleed

Indicates reduced ability to clear waste products

 

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Creatinine

 

High

 

Suggests reduced kidney filtration (AKI or CKD)

More specific marker of renal function than urea

Indicates reduced clearance of waste products

 

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eGFR

 

Low

 

Indicates reduced kidney filtration capacity

Used to stage chronic kidney disease

Suggests impaired ability to remove drugs, fluids, and waste

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