Diagnostics and Treatment

1. Diagnostics and Treatment HS20-DT1 Evaluate the tools and procedures used to diagnose and monitor medical conditions. HS20-DT2 Recognize the importance of interpreting diagnostic findings to support treatment options.

2. Tools and Procedures • a. Pose questions about the importance of diagnosis. • b. Assess the significance of monitoring vital signs in health care, including accurate medical history and patient perception of pain. (K, S) • c. Identify examples of tools and procedures (e.g., stethoscope, octoscope, sphygmomanometer, and visual inspection) used for non-invasive observations in health care. (K) • d. Perform observations and record vital signs (e.g., heart rate, breathing rate, temperature, blood type and blood pressure) of self and/or other students. (S) • e. Explain the procedures and relevance of common laboratory tests (e.g., blood testing, blood glucose testing, culture swabs, urinalysis, biopsy, and microscopy) in medical diagnosis. (K,S) • f. Research the operation, risks, benefits, and imaging modalities (e.g., sound, light, radiation, and nuclear medicine) of medical imaging tools, including X-ray, magnetic resonance imaging [MRI], computerized tomography [CT], ultrasound, positron emission tomography [PET]). (K, A, STSE)

3. Tools and Procedures • g. Describe technological advances in diagnostic tools (e.g., X-ray, ultrasound, computerized tomography and magnetic resonance imaging). (K, S, STSE) • h. Provide examples of how technologies are used to provide information about certain symptoms to support a diagnosis including the differences between physiological and anatomical imaging (e.g., PET compared to CT, MRI compared to a Functional MRI and Ultrasound compared to an X-Ray). (K, STSE) • i. Discuss the factors (e.g., severity of illness, dose received, cost, and availability) that influence the use of a diagnostic tool or procedure. (K) j. Explain why medical practitioners often use multiple tools and procedures to establish a medical diagnosis. (STSE) • k. Discuss the responsibility, including preparation and expectations, of the patient in diagnostic and imaging procedures. (K, A, STSE) • l. Identify differences in tools and procedures used in diagnosing illness from the perspectives of Western, Indigenous, traditional, complementary, and alternative approaches. (K, A, S, STSE)

4. Importance of Diagnostics • A. Suggest explanations based on interpretation of data from diagnostic assessment tools. (e.g. identifying a broken bone in an x-ray, ultrasound of a pregnancy to determine number of fetuses and identifying high blood pressure based on given values) (K, S) • b. Describe how treatment options (e.g., dialysis, radiation therapy, surgery, and organ transplants) have been developed to address specific health care issues. (STSE) • c. Identify tools and procedures used to assist health care providers in monitoring the progression of a specific pathology and the treatment options available at each stage. (K) • d. Interpret diagnostic results and choose an appropriate course of action (e.g., role-play, simulation and case study). (K, S) • e. Discuss personal and societal implications of incorrect interpretation of diagnostic findings (e.g., incorrect diagnosis, improper treatment, and psychological effect on patient). (K, A, STSE) • f. Describe various treatments that might be prescribed in Western, traditional, and complementary and alternative approaches to health care with respect to a specific pathology. (K)

5. What is a diagnosis? • Diagnosis – • Why do we need it? • How does measuring vital signs connect to diagnosis?

6. What is a diagnosis? • Diagnosis –the process of determining by examination the nature and circumstances of a diseased condition and the subsequent decision reached. The MCP confirms or concludes that you have a particular disease, injury or illnessusing assessment tools/procedures • Why do we need it?We need a diagnosis (or confirmation of a disease), in order to properly treat it. • How does measuring vital signs connect to diagnosis?Certain vital signs (high or low) may correlate to particular illnesses. If certain vital signs are low or elevated this may provide clues as to the cause.

7. Scenario - Assessing a Patient • Think of the last time you were in ER (if you’ve ever been). • If you come in on your own, what are some of the questions they ask you? • Why do they do this (logically, financially)? This means:

8. Scenario – Assessing a Patient • Think of the last time you were in ER (if you’ve ever been). • If you come in on your own, what are some of the questions they ask you?“On a scale of one-to-ten how much pain are you in?” Why do hospitals ask this?For triage (the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties.) Severity assessment. They need to prioritize who needs help first. Triage!“Why are you here? Establish symptoms” • Why do they do this (logically, financially)?Deal with the worst, first.Spend money on the most important need. This means: if someone gets served before you – relax, they’re probably in worst shape than you are. HOWEVER – do you say it’s worse to jump the line?

9. Assess Yourself Using Your Waste!

10. When are diagnostic tools used? • Tools are used based on _________ of _________, _____, and ____________. • _______ received also _______. Why? • Wait lists, how are they organized?

11. When are diagnostic tools used? • Tools are used based on severity of illness,cost, and availability • Dose received also varies. • Wait lists, how are they organized?They are organized based on severity of illnesses and the availability and cost of using certain diagnostic tools and equipment.

12. Tools and Procedures to Diagnose • Pick two, summarize – what are they? What are they used for? How do they work? • Stethoscope • O(c)toscope • Visual inspection • Sphygmomanometer • Computerized tomography • X Ray • Ultrasound • Blood test • MRI (magnetic resonance imaging) • Vital signs • Blood glucose testing • Urinalysis • Culture swabs Is it a lab test [l]; invasive [inv] or non-invasive [niv] tool?

13. Tools and Procedures to Diagnose • Stethoscope [niv] – device for listening to the internal sounds of an animal or human body • Octoscope [niv] - a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms • Visual inspection [niv]- look at the patient/afflicted area. • Sphygmomanometer [niv] - an instrument for measuring blood pressure, typically consisting of an inflatable rubber cuff that is applied to the arm and connected to a column of mercury next to a graduated scale, enabling the determination of systolic and diastolic blood pressure by increasing and gradually releasing the pressure in the cuff. • Computerized tomography (CT) [niv] - is an imaging procedure that uses special x-ray equipment to create detailed pictures, or scans, of areas inside the body. Is it a lab test [l]; invasive [inv] or non-invasive [niv] tool?

14. Tools and Procedures to Diagnose • X Ray - X-rays are highly penetrating, ionizing radiation, therefore X-ray machines are used to take pictures of dense tissues such as bones and teeth. This is because bones absorb the radiation more than the less dense soft tissue. • Ultrasound - Ultrasound pictures are made from sound waves which are too high pitched to be heard by the human ear. The sound waves travel through your skin and are focused on a certain part of your body by a scanning device called a “transducer.” It picks up the sound waves as they bounce back from organs inside the body. Is it a lab test [l], or invasive [inv] or non-invasive [niv] tool?

15. Tools and Procedures to Diagnose • Blood test - A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick. The blood can be then tested for its contents that can indicate certain health conditions. • MRI (magnetic resonance imaging) - Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily realigns hydrogen atoms in your body. (Most are basically showing where water and fat is in your body, but this can help frame a picture). Is it a lab test [l], or invasive [inv] or non-invasive [niv] tool?

16. Tools and Procedures to Diagnose • Vital signs [niv] – analysis of respiratory rates, blood pressure, pulse, and O2 saturation. • Blood glucose testing - how much sugar is in your blood (two hours after meals, under 140 mg/dl is normal) • Urinalysis - analysis of urine by physical, chemical, and microscopical means to test for the presence of disease, drugs, etc. • Culture swabs - A throat swab culture, or throat culture, is a test commonly used to diagnose bacterial infections in the throat. These infections can include strep throat, pneumonia, tonsillitis, whooping cough, and meningitis. (Getting a sample of the bacterial and allowing it to grow and see what it is). Is it a lab test [l], or invasive [inv] or non-invasive [niv] tool?

17. Anatomy and Physiological Testing • What are some examples of tools that assess anatomy? • What are some examples of tools that assess physiology? • How do we separate one from the other?

18. Anatomy and Physiological Testing • What are some examples of tools that assess anatomy?X Ray, CT Scan, MRI, Ultrasound!<any tools that simply observe an areas appearance/structure> • What are some examples of tools that assess physiology?Blood test to see what is present infers the functions of the body!Culture swab** - tells us what is present in the body and how the body is functioning against it.Vital signs – simply observes functions of the body – abnormal = illness!<any tools that assess the body’s performance/function – blood testing, etc> • How do we separate one from the other?One focuses on structures in the body, one focuses on how the body is functioning.

19. Imaging Modality • For one the following imaging modalities (CT Scan, MRI, X Ray, Ultrasound)– research: • Operation (how it works, what happens) • Risks • Benefits • If you were providing informed consent – how would you explain the process to the patient?

20. Let’s diagnose! Looking at X Rays • There is a stress fracture in the fourth metatarsal. Can you find it? • What do you recommend as treatment?

21. Interpreting findings for treatment • Health care providers need to work with what symptoms and indicators are present and try to cross-reference this with typical illnesses or injuries (experience and schooling helps inform this). • Upon coming up with a “most likely” cause… a diagnosis is typically provided and a subsequent treatment may be given. Incorrect diagnosis • HCP need to provide a diagnosis to begin treatment as soon as possible… if an incorrect diagnosis is given and improper treatment follows, this can lead to further medical emergencies.

22. Story Time – Why Diagnosis is important/difficult) • Bob reported into the hospital and complained of not being able to keep food or liquids down for the past 24 hours. • Upon arrival at hospital individual HCP did blood work and noticed high levels of amylase and lipase. Characteristic of pancreatitis. • Typical causes of this are heavy alcohol drinking or gallstones, patient (male, age 23) stated they had two drinks two nights before symptoms began. • Males between age 30-40 typically get pancreatitis. • Symptoms of pancreatitis include, nausea and vomiting, fever, mild abdominal pain, increased heart rate. Patient had all of these except reported minimal abdominal pain.

23. Story time • HCP opted to keep patient in hospital overnight. • 12 hours into the next day, no official diagnosis had been provided yet. Patient then started complaining of sharp abdominal pain. HCP provided the patient with medicinal morphine. • Bob researched online and self-diagnosed symptoms as appendicitis. • HCP did a quick test, diagnosis was accurate, emergency surgery followed. • Patient made full recovery. Doctor commented stating it was the worst he’d seen without bursting or perforation.

24. Story time • Appendicitis happens to individuals between ages 10-30. • Symptoms include mild abdominal pain (not reported) and swelling (mildly observed). Nausea and vomiting (confirmed), loss of appetite (unconfirmed). • Sharp pains, usually starting point, was not observed until ~48 hours after symptoms began.

25. Activity – Cure Petlak • Mr. Petlak (male, age 27) is suffering from the following symptoms:- blood in stool (bright red)- cramping and severe abdominal pain- diarrhea and urge to have bowel movementsUpon looking at family history, on record it mentions his father having issues with “ulcers”.A blood test provided indicators of inflammation. • Analyzing this data, what does he most likely have (diagnosis)? • What is your proposed treatment? Provide a western form of treatment and an alternative form of treatment.

26. Activity – Cure Petlak • Using experiences or online resources like WebMD, Medicine.net, or MayoClinic (none of which is perfect, FYI). • HELP ME GET BETTER! • Diagnosis: • Treatment: • CAM Treatment:

27. Activity – Cure Petlak • Using experiences or online resources like WebMD, Medicine.net, or MayoClinic (none of which is not perfect, FYI). • HELP ME GET BETTER! • Diagnosis: Ulcerative Colitis • Treatment: Anti-inflammatory drugs (lots of side effects)!Colon removed in some cases!Changing your diet can be beneficial (I would argue this is alternative)

28. Responsibility of the Patient • What is on the patient to do to prepare for some procedures? • What have you been asked to do (or not do) prior to certain procedures – why might this be?

29. How does diagnosis differ? • Some cultures, don’t have an MRI? What’s the difference? • “You feel tense”, “negative energy”.

30. Developing Treatments and Diagnostic Tools /10 • Options: dialysis, radiation therapy, surgery, and organ transplants • Article Assignment - Find an interesting article pertaining to new developments in diagnosis and treatment. How do they work (or are proposed to work)? • Validity of article – Do you think this article is legit, why or why not? Where do the sources lead? Is there any inherent bias – towards what? Article Search Ideas • Organ Transplant – Man planning to do a head transplant • Can marijuana cure cancer? • Good websites to look at: iflscience or eurekalert then search: Health and Medicine.

31. Tools and Procedures • a. Pose questions about the importance of diagnosis. • b. Assess the significance of monitoring vital signs in health care, including accurate medical history and patient perception of pain. (K, S) • c. Identify examples of tools and procedures (e.g., stethoscope, octoscope, sphygmomanometer, and visual inspection) used for non-invasive observations in health care. (K) • d. Perform observations and record vital signs (e.g., heart rate, breathing rate, temperature, blood type and blood pressure) of self and/or other students. (S) • e. Explain the procedures and relevance of common laboratory tests (e.g., blood testing, blood glucose testing, culture swabs, urinalysis, biopsy, and microscopy) in medical diagnosis. (K,S) • f. Research the operation, risks, benefits, and imaging modalities (e.g., sound, light, radiation, and nuclear medicine) of medical imaging tools, including X-ray, magnetic resonance imaging [MRI], computerized tomography [CT], ultrasound, positron emission tomography [PET]). (K, A, STSE)

32. Tools and Procedures • g. Describe technological advances in diagnostic tools (e.g., X-ray, ultrasound, computerized tomography and magnetic resonance imaging). (K, S, STSE) • h. Provide examples of how technologies are used to provide information about certain symptoms to support a diagnosis including the differences between physiological and anatomical imaging (e.g., PET compared to CT, MRI compared to a Functional MRI and Ultrasound compared to an X-Ray). (K, STSE) • i. Discuss the factors (e.g., severity of illness, dose received, cost, and availability) that influence the use of a diagnostic tool or procedure. (K) j. Explain why medical practitioners often use multiple tools and procedures to establish a medical diagnosis. (STSE) • k. Discuss the responsibility, including preparation and expectations, of the patient in diagnostic and imaging procedures. (K, A, STSE) • l. Identify differences in tools and procedures used in diagnosing illness from the perspectives of Western, Indigenous, traditional, complementary, and alternative approaches. (K, A, S, STSE)

33. Importance of Diagnostics • A. Suggest explanations based on interpretation of data from diagnostic assessment tools. (e.g. identifying a broken bone in an x-ray, ultrasound of a pregnancy to determine number of fetuses and identifying high blood pressure based on given values) (K, S) • b. Describe how treatment options (e.g., dialysis, radiation therapy, surgery, and organ transplants) have been developed to address specific health care issues. (STSE) • c. Identify tools and procedures used to assist health care providers in monitoring the progression of a specific pathology and the treatment options available at each stage. (K) • d. Interpret diagnostic results and choose an appropriate course of action (e.g., role-play, simulation and case study). (K, S) • e. Discuss personal and societal implications of incorrect interpretation of diagnostic findings (e.g., incorrect diagnosis, improper treatment, and psychological effect on patient). (K, A, STSE) • f. Describe various treatments that might be prescribed in Western, traditional, and complementary and alternative approaches to health care with respect to a specific pathology. (K)