Diagnostics and Treatment

1. Diagnostics and Treatment HS20-DT1 Explore the tools and procedures used to diagnose and monitor medical conditions. HS20-DT2 Assess the importance of interpreting diagnostic findings to support treatment options for specific pathologies.

2. Diagnosing and Assessing Patients • (a) Assess the significance of monitoring vital signs in health care, including obtaining accurate medical history and patient perception of pain. ((K, S) • (b) Identify examples of procedures (e.g., visual inspection) and tools (e.g., stethoscope, octoscope and sphygmomanometer) commonly used for non-invasive diagnostic observations in health care. ((K) • (c) Measure and record vital signs (e.g., pulse, respiration, temperature, blood pressure and degree of pain) of self and/or others. ((S) • (d) Explain the procedures, safety concerns and relevance of common laboratory tests (e.g., blood testing, blood glucose, culture swabs, urinalysis, stool, biopsy and microscopy) used in medical diagnosis. ((K,S) • (e) Research the operation, risks, benefits and imaging modalities (e.g., sound, light, radiation and nuclear medicine) of medical imaging tools, including X-ray radiography, magnetic resonance imaging [MRI], computed tomography [CT], ultrasound and positron emission tomography [PET]). ((K, A, STSE) • (f) Describe technological advances in medical imaging tools (e.g., X-ray, ultrasound, computerized tomography and magnetic resonance imaging). ((K, S, STSE) • (g) Discuss factors (e.g., severity of illness, dose received, cost and availability) that influence the choice to use a diagnostic tool or procedure. ((K) • (h) Discuss the responsibility, including preparation and expectations, of the patient in diagnostic and imaging procedures. ((K, A, STSE) • (i) Identify differences in tools and procedures used in diagnosing illness from the perspectives of Western, Indigenous, traditional, complementary and alternative approaches to health care. ((K, A, STSE) • (j) Discuss the importance of diagnosis in improving the care of patients, protecting the health of clients and improving the economics of health care. ((K, STSE, A)

3. Tools and Procedures of Diagnosis • (a) Identify tools and procedures that may be used to assist health care providers in monitoring the progression of a specific pathology. ((K) • (b) 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) • (c) Interpret diagnostic results and choose an appropriate course of action based on participation in a role-play, simulation and/or case study. ((K, S) • (d) Explain why medical practitioners often use multiple tools and procedures to establish a medical diagnosis. ((STSE) • (e) Discuss possible implications (e.g., incorrect diagnosis, improper treatment and psychological effect on patient) associated with incorrect interpretation of diagnostic findings for the patient and others. ((K, A, STSE) • (f) Describe some treatment options (e.g., dialysis, radiation therapy, surgery and organ transplantation) which have been designed to address specific health care issues. ((STSE) • (g) Describe various treatment options that might be considered at various stages of a specific pathology from the perspective of Western, Indigenous, traditional, complementary and/or alternative approaches to health care. ((K)

4. What is a diagnosis?Assess the significance of monitoring vital signs in health care, including obtaining accurate medical history and patient perception of pain. ((K, S) • Diagnosis – • Why do we need it? • How does measuring vital signs connect to diagnosis?

5. What is a diagnosis?Assess the significance of monitoring vital signs in health care, including obtaining accurate medical history and patient perception of pain. ((K, S) • 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.

6. 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? Check your vital signs. How bad is your discomfort on a scale of 1-10? (severity assessment) What are your symptoms (for how long, where)? • Why do they do this (logically, financially)? They are trying to treat the greatest need, first. This means:

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? How much pain are you feeling on a scale of 1-10 (severity assessment)? What symptoms do you have? • Why do they do this (logically, financially)? People with a higher severity assessment get treated first. 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 (determining urgency)!“Why are you here?” Establish symptoms“Do you have a family history of _____________?” • 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 worse 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?Discuss factors (e.g., severity of illness, dose received, cost and availability) that influence the choice to use a diagnostic tool or procedure • Tools are used based on _________ of _________, _____, and ____________. Why? • _______ received also _______. Why? • Wait lists, how are they organized? • How will this influence what tool/treatment is used?

11. When are diagnostic tools used?Discuss factors (e.g., severity of illness, dose received, cost and availability) that influence the choice to use a diagnostic tool or procedure • Tools are used based on severity of illness,cost, and availability. Why? Limited resources available when providing healthcare to everyone. • Dose received also varies. (According to need). • 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. • How will this influence what tool/treatment is used?Worse pain? Stronger medication. “Kill an ant with a sledgehammer” - story

12. Tools and Procedures to DiagnoseIdentify examples of procedures (e.g., visual inspection) and tools (e.g., stethoscope, octoscope and sphygmomanometer) commonly used for non-invasive diagnostic observations in health care. (K) • Pick two, summarize – what are they? What are they used for? How do they work? Are there risks/safety concerns? • 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] – • Octoscope [niv] - • Visual inspection [niv]- • Sphygmomanometer [niv] - • Computerized tomography (CT) [niv] - Is it a lab test [l]; invasive [inv] or non-invasive [niv] tool?

14. 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?

15. 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?

16. 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?

17. Tools and Procedures to DiagnoseExplain the procedures, safety concerns and relevance of common laboratory tests (e.g., blood testing, blood glucose, culture swabs, urinalysis, stool, biopsy and microscopy) used in medical diagnosis. ((K,S) • 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?

18. 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?

19. 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 area’s 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. Some arguably could be both (MRI, Ultrasound)!

20. Imaging ModalityDescribe technological advances in medical imaging tools (e.g., X-ray, ultrasound, computerized tomography and magnetic resonance imaging). ((K, S, STSE)Research the operation, risks, benefits and imaging modalities (e.g., sound, light, radiation and nuclear medicine) of medical imaging tools, including X-ray radiography, magnetic resonance imaging [MRI], computed tomography [CT], ultrasound and positron emission tomography [PET]). ((K, A, STSE) • 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?

21. Imaging ModalityDescribe technological advances in medical imaging tools (e.g., X-ray, ultrasound, computerized tomography and magnetic resonance imaging). ((K, S, STSE)Research the operation, risks, benefits and imaging modalities (e.g., sound, light, radiation and nuclear medicine) of medical imaging tools, including X-ray radiography, magnetic resonance imaging [MRI], computed tomography [CT], ultrasound and positron emission tomography [PET]). ((K, A, STSE) • For one the following imaging modalities (CT Scan, MRI, X Ray, Ultrasound)– research: MRI • Operation (how it works, what happens) – strong magnetic fields used to generate images – generates images of areas that can’t be seen using a tube-like structure that the patient will be moved into. • Risks – if you have metal on or in your person, it can be problematic.- • Benefits - doesn’t use radiation. - can detect things that CT or X Ray may not be able to. • If you were providing informed consent – how would you explain the process to the patient?

22. Imaging ModalityDescribe technological advances in medical imaging tools (e.g., X-ray, ultrasound, computerized tomography and magnetic resonance imaging). ((K, S, STSE)Research the operation, risks, benefits and imaging modalities (e.g., sound, light, radiation and nuclear medicine) of medical imaging tools, including X-ray radiography, magnetic resonance imaging [MRI], computed tomography [CT], ultrasound and positron emission tomography [PET]). ((K, A, STSE) • For one the following imaging modalities (CT Scan, MRI, X Ray, Ultrasound)– research: CT • Operation (how it works, what happens) – Have to drink liquid contrast before your scan – may use an IV- similar to an MRI in that you will be moved into a tube for pictures to be taken. • Risks – Radiation(Low)-Exposure Potential allergic reaction to dye. • Benefits – Cheaper than MRI – can see different parts of the body rather than X Ray. • If you were providing informed consent – how would you explain the process to the patient?

23. Responsibility of the Patient Discuss the responsibility, including preparation and expectations, of the patient in diagnostic and imaging procedures. ((K, A, STSE) • 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?

24. Responsibility of the Patient Discuss the responsibility, including preparation and expectations, of the patient in diagnostic and imaging procedures. ((K, A, STSE) • What is on the patient to do to prepare for some procedures?May have to consume some form of “contrast” prior to procedure to light up internal organs for visual. Fasting – may have to refrain from consuming food or drink prior to examination. May have to fast for blood tests prior to other tests (if getting bloodwork may have to consume food before as well). • What have you been asked to do (or not do) prior to certain procedures – why might this be? The consumption of some things (or not consuming) may improve the quality of the assessment.

25. Let’s diagnose! 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) • There is a stress fracture in the fourth metatarsal. Can you find it? • What do you recommend as treatment? • What tool was used for this visual? Why? What other forms of assessment might be used?

26. Let’s diagnose! 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) • There is a stress fracture in the fourth metatarsal. Can you find it? • What do you recommend as treatment? Rest? Putting a cast on may not do much. • What tool was used for this visual? Why? What other forms of assessment might be used? X Ray – other imaging tools could have been used, but with less accuracy.

27. Multiple Diagnostic ToolsExplain why medical practitioners often use multiple tools and procedures to establish a medical diagnosis. ((STSE) • Why might we use multiple diagnostic tools? • What is an example of something we may use multiple diagnostic tools for? What are these different tools? • As diseases progress, new treatments and diagnoses may emerge or be required. These different treatments may include alternative forms of medicine if conventional medicine is inadequate (and may improve patient morale).

28. Multiple Diagnostic ToolsExplain why medical practitioners often use multiple tools and procedures to establish a medical diagnosis. ((STSE) • Why might we use multiple diagnostic tools? Visual inspection - To get a clear idea of what is wrong (may check range of motion, swelling in the area).More assessments = more definitive diagnosis. • What is an example of something we may use multiple diagnostic tools for? What are these different tools?Broken metatarsal – visual inspection, range of motion check, and then x-ray? • As diseases progress, new treatments and diagnoses may emerge or be required. These different treatments may include alternative forms of medicine if conventional medicine is inadequate (and may improve patient morale).

29. Let’s diagnose! 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) • Is it a boy or girl? How do you know? • Would/should you do a gender reveal?! • What tool was used for this visual? Why?

30. Let’s diagnose! 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) • Is it a boy or girl? How do you know?Boy! • Would/should you do a gender reveal?! ???? • What tool was used for this visual? Why? Ultrasound – views tissue rather than bone and is safer ferda baby.

31. Use of DiagnosisDiscuss possible implications (e.g., incorrect diagnosis, improper treatment and psychological effect on patient) associated with incorrect interpretation of diagnostic findings for the patient and others. ((K, A, STSE)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.

32. (Mis)Use of DiagnosisDiscuss possible implications (e.g., incorrect diagnosis, improper treatment and psychological effect on patient) associated with incorrect interpretation of diagnostic findings for the patient and others. ((K, A, STSE)Improper Treatment • What are some physical and psychological affects of improper treatment? • How might this cause problems on a society-scale?

33. (Mis)Use of DiagnosisDiscuss possible implications (e.g., incorrect diagnosis, improper treatment and psychological effect on patient) associated with incorrect interpretation of diagnostic findings for the patient and others. ((K, A, STSE)Improper Treatment • What are some physical and psychological affects of improper treatment? Getting the wrong treatment (drug) for something can potentially make it worse. Depending on the effects/outcome of the treatment it can make patients fearful of further medical care. • How might this cause problems on a society-scale?It can generate mistrust between public and health care system, and this in turn can impact government spending on health care (and may not be as efficient spending of resources).

34. How does diagnosis differ culturally?Identify differences in tools and procedures used in diagnosing illness from the perspectives of Western, Indigenous, traditional, complementary and alternative approaches to health care. ((K, A, STSE) • Some cultures don’t have an MRI. What’s the difference? Why? • “You feel tense”, “negative energy”, visual inspection of the individual, interviewing of individual – does this work? Why or why not? • We are constantly assessing the health of ourselves and others. The differences at times may drift too far away from holistic approaches. That being said we also need to respect the validity or evidence supporting many forms of diagnoses.

35. How does diagnosis differ culturally?Identify differences in tools and procedures used in diagnosing illness from the perspectives of Western, Indigenous, traditional, complementary and alternative approaches to health care. ((K, A, STSE) • Some cultures don’t have an MRI. What’s the difference? Why?May be lack of money. No perceived need. • “You feel tense”, “negative energy”, visual inspection of the individual, interviewing of individual – does this work? Why or why not? It can in different scenarios, so it may be worth trying for certain patients. • We are constantly assessing the health of ourselves and others. The differences at times may drift too far away from holistic approaches. That being said we also need to respect the validity or evidence supporting many forms of diagnoses.

36. Diagnosis and Improving Patient CareDiscuss the importance of diagnosis in improving the care of patients, protecting the health of clients and improving the economics of health care. ((K, STSE, A) • Diagnosis is a critical part of providing optimal health care. What would make health care as you know it, better? • Is there an economic sweet spot to providing health care? Does the system work? • Should we offer private care in addition to public care? What are the potential issues of this?

37. 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.

38. 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.

39. Story time – Reflecting on Experience • 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. • For friends/family, it was frustrating not to know what was wrong. They are still people trying to perform a service “as best as they can” – but so many other factors may be at work.

40. Activity – Cure Petlak • Mr. Petlak (male, age 28) 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.

41. 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:

42. 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: 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)

43. Developing Treatments and Diagnostic Tools /10Describe some treatment options (e.g., dialysis, radiation therapy, surgery and organ transplantation) which have been designed to address specific health care issues. ((STSE) • 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 – Child with hand transplants • Can marijuana cure cancer? • Good websites to look at: iflscience or EurekAlert then search: Health and Medicine.

44. Other Interesting Treatments and Tools • Ketamine (treatment) – depression treatment (blocks receptor that normally would bring you down). • Liquid biopsies (diagnostic tool) • Cellular immunotherapy (reprogramming of T Cells). • Genetic screening!