Assessment and Diagnosis

Signs and symptoms of NSIP are typical of ILD, yet lack the specificity to allow differentiation from other forms of IIP. 

In patients with NSIP, the most common physical examination findings are dry, basilar predominant, inspiratory crackles. These velcro-Uke crackles are heard in the vast majority of patients. Clubbing remains more common in UIP, yet can occur in NSIP. It should be kept in mind that none of the above features are specific to NSIP as the clinical characteristics of NSIP are insufficient to distinguish from other types of IIPs (3,9-13,18-20,22,24—26,36 2). Physical examination should include a systemic evaluation for signs of connective tissue disease given its common association with NSIP. 

Laboratory investigation of patients with suspected NSIP remains nonspecific yet experts recommend a complete blood count with differential, basic chemistries including assessment of renal function, liver fimction tests, antinuclear antibodies, rheumatoid factor, and a urinalysis (43). 

These data illustrate the limitations of HRCT in diagnosing NSIP. The role of HRCT in the evaluation of patients with suspected NSIP remains important however, radiographic findings compatible with NSIP should be viewed as supportive rather than definitive. SLB should be obtained to confirm the diagnosis of NSIP. 

Despite the relative safety of VATS-SLB, a decision to pursue SLB should take into account the patient s age, comorbidities, and potential to alter disease course given biopsy result and subsequent therapeutic trial. Previous literature suggested that clinical deterioration associated with an acute exacerbation of IPF occurred in 2.1% of patients undergoing SLB for evaluation of UIP (64). Recently, SLB has been noted to exacerbate idiopathic NSIP with associated rapid deterioration in respiratory status (32). These findings warrant further investigation. 

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Although ADHD is considered a childhood disorder, signs and symptoms persist into adolescence and adulthood in approximately 40% to 80% and 60% of cases, repectively.1,9 Adult ADHD is difficult to assess, and diagnosis is always suspect in patients failing to display clear symptoms prior to 7 years of age.4 Adults with ADHD have higher rates of psychopathology, substance abuse, social dysfunction, and occupational underachievement. 

Verhulst, F. and Koot, H. (1992). Child Psychiatric Epidemiology Concepts, Methods and Findings. Assessment and Diagnosis. London Sage, pp. 42—96. 

Untreated ADHD is a significant risk factor for substance abuse disorders in adolescents (36). In contrast, pharmacotherapy, that is stimulants, was associated with an 85% reduction in the risk of substance abuse disorders in youths with ADHD. Most authorities recommend complete assessment and diagnosis of both ADHD and any dual diagnoses before starting stimulant medication. 

TABLE 78—1. Assessment and Diagnosis of Premenstrual Dysphoric Disorder... 

Baron T, ToUe R. Assessment and diagnosis of neuropathic pain. Curr Opin Support Palliat Care 2008 2 1-8. 

Brunton S. Approach to assessment and diagnosis of chronic pain. / Pam Pract 2004 53 83-10. 

Stone, J., Carson, A., Sharpe, M. (2005) Functional symptoms and signs in neurology Assessment and diagnosis. Journal of Neurology, Neurosurgery and Psychiatry, 76 (suppl 1), i2-il2. 

The Clinical Presentation of Toxic Trauma Assessment and Diagnosis... 

Discuss assessment, nursing diagnosis, planning, implementation, and evaluation as they apply to the administration of drugs. 

Assessment of risk factors for ischemic stroke as well as for hemorrhagic stroke is an important component of the diagnosis and treatment of patients. A major goal in the long-term treatment of ischemic stroke involves the prevention of a recurrent stroke through the reduction and modification of risk factors. The major focus of primary prevention (prevention of the first stroke) is also reduction and modification of risk factors. Risk factors for ischemic stroke can be divided into modifiable and non-modifiable factors. Every patient should have risk factors assessed and treated, if possible, as management of risk factors can decrease the occurrence and/or recurrence of stroke.4... 

The diagnosis of chronic bronchitis is based primarily on clinical assessment and history. By definition, any patient who reports coughing up sputum on most days for at least 3 consecutive months each year for 2 consecutive years suffers from chronic bronchitis. Table 43-1 presents a classification and treatment scheme for chronic bronchitis. 

Differential Diagnosis. With a careful assessment and a dependable history, one can reliably diagnose ADHD (even in an adult who was never diagnosed as a child). However, the broad array of symptoms results in a rather wide differential diagnosis. Please consider each of the following when trying to determine if a patient has ADHD. 

Olson KR, Pentel PR, Kelley MT. Physical assessment and differential diagnosis of the poisoned patient. Med Toxicol Adverse Drng Exp 1987 2(1) 52-81. 

Hening W (2004) The clinical neurophysiology of the restless legs syndrome and periodic limb movements. Parti diagnosis, assessment, and characterization. Clinical Neurophysiology 115 1965-1974... 

To improve your assessments. In contrast to the physician s view, you may have a differing opinion about the importance of using the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria as the primary means to assess and treat the patient. Most physicians rely on the DSM criteria to make a diagnosis. Their specific diagnoses often lead, naturally, to specific psychotropic medication recommendations. In this way, assessment by a physician may be more specific and, at times, more reductionistic than an assessment by a therapist, who, for example, might prefer a narrative of the patient s complaints. 

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