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NR 509 Midterm Study Guide (Version 2), NR 509 Advanced physical assessment, Chamberlain
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NR 509 Midterm Study Guide (Version 2), NR 509 Advanced physical assessment, Chamberlain
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NR 509 Midterm Study Guide Week 3Ch. 1
● Basic and Advanced Interviewing Techniques
Basic Interviewing Techniques
● Active listening: Active listening means closely attending to what the
patient is communicating, connecting to the patient's emotional state,
and using verbal and nonverbal skills to encourage the patient to expand
on his or her feelings and concerns.
Empathic responses: Empathy has been described as the capacity to identify
with the patient and feel the patient's pain as your own, then respond in a
supportive manner.
Guided questioning: Guided questions show your sustained interest in the
patient's feelings and deepest disclosures and allows the interviewer to
facilitate full communication, in the patient's own words, without
interruption.
Nonverbal communication: Nonverbal communication includes eye contact,
facial expression, posture, head position and movement such as shaking
or nodding, interpersonal distance, and placement _of_ the arms or legs—
crossed, neutral, or open.
Validation: Validation helps to affirm the legitimacy _of_ the patient's
emotional experience.
Reassurance: Reassurance is an appropriate way to help the patient feel that
problems have been fully understood and are being addressed.
Partnering: When building rapport with patients, express your commitment to
an ongoing relationship.
Summarization: Giving a capsule summary _of_ the patient's story during the
course _of_ the interview to communicate that you have been listening
carefully.
Transitions: Inform your patient when you are changing directions during the
interview.
Empowering the patient: Empower patients to ask questions, express their
concerns, and probe your recommendations in order to encourage them
to adopt your advice, make lifestyle changes, or take medications as
prescribed.
Advanced Interview Techniques
, 2
Determine scope _of_ assessment: Focused vs. Comprehensive:
Comprehensive: Used patients you are seeing for the first
time in the _of_fice or hospital. Includes all the elements
_of_ the health history and complete physical examination.
Is appropriate for new patients in the _of_fice or hospital
Provides fundamental and personalized knowledge
about
the patient
Strengthens the clinician–patient relationship
Helps identify or rule out physical causes related to
patient concerns
Provides a baseline for future assessments
Creates a platform for health promotion through
education and counseling
Develops pr_of_iciency in the essential skills _of_ physical
examination
Focused: For patients you know well returning for routine
care, or those with specific “urgent care” concerns like
sore throat or knee pain. You will adjust the scope _of_
your history and physical examination to the situation at
hand, keeping several factors in mind: the magnitude and
severity
_of_ the patient’s prob- lems; the need for thoroughness;
the clinical setting—inpatient or outpatient, primary or
subspecialty care; and the time available.
Is appropriate for established patients, especially during
routine or urgent care visits
Addresses focused concerns or symptoms
Assesses symptoms restricted to a specific body system
Applies examination methods relevant to assessing the
concern or problem as thoroughly and carefully as
possible
Being aware _of_ your reactions helps develop your clinical skills.
Your success in eliciting the history from different types _of_
patients grows with experience, but take into account your own
stressors, such as fatigue, mood, and overwork.
Self-care is also important in caring for others. Even if a patient is
challenging, always remember the importance _of_ listening to the
patient and clarifying his or her concerns.
Components _of_ the Health History
Initial information
Date and time _of_ history-time is especially important in emergent
situations
Identifying data-age, gender, marital status, occupation-identify source
_of_ history ie: family member, friend etc.
, 3
Reliability-usually documented at end _of_ interview ie: “patient is vague
when describing symptoms”.
Chief Complaint(s)
Try to quote the patients
words Present Illness
Complete, clear and chronological description _of_ the
problem prompting the patient visit
Onset, setting in which it occurred, manifestations and any
treatments Should include 7 attributes _of_ a symptom:
Location
Quality
Quantity or severity
Timing, onset, duration, frequency
Setting in which it occurs
Aggravating or relieving factors
Associated manifestations
Differential diagnosis is derived from the “pertinent positives” and “pertinent negatives”
when doing Review _of_ Systems that are relevant to the chief complaint.
Present illness should reveal patient’s responses to his or her symptoms and what effect this
has on their life.
Each symptom needs its own paragraph and a full description.
Medication should be documented, name, dose, route, and frequency. Home remedies,
non- prescriptions drugs, vitamins, mineral or herbal supplements, oral contraceptives, or
borrowed medications.
Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how
long
Alcohol and drug use should always be investigated and is _of_ten pertinent to the
Presenting Illness.
Past history
Childhood Illness: measles, rubella, mumps, whooping cough,
chickenpox, rheumatic fever, scarlet fever, and polio. Also include
any chronic childhood illness
Adult illnesses: Provide information in each _of_ the 4 areas:
, 4
Medical: diabetes, hypertension, hepatitis, asthma and HIV;
hospitaliations; number and gender _of_ sexual partners;
and risk taking sexual practices.
Surgical: dates, indications, and types _of_ operations
Obstetric/gynecologic: Obstetric history, menstrual
history,
methods _of_ contraception, and sexual function.
Psychiatric: Illness and time frame, diagnoses, hospitalizations,
and treatments.
Health Maintenance: Find out if they are up to date on
immunizations and screening tests.
Family history
Outlines or diagrams age and health, or age and cause
_of_ death, _of_ siblings, parents, and grandparents
Documents presence or absence _of_ specific illnesses in
family, such as hypertension, coronary artery disease,
elevated cholesterol levels, stroke, diabetes, thyroid or
renal disease, arthritis, tuberculosis, asthma or lung
disease, headache, seizure disorder, mental illness,
suicide, substance abuse, and allergies, and symtoms
reported by patient.
Ask about history _of_ breast, ovarian, colon, or prostate
cancer
Ask about Genetically transmitted diseases
Personal or social history
Describes educational level, occupation, family _of_ origin,
current household, personal interests, and lifestyle
Capture the patients personality and interests, sources _of_
support, coping style, strengths, and concerns
Includes lifestyle habits that promote health or create risk,
such as exercise and diet, safety measures, sexual
practices, and use _of_ alcohol, drugs, and tobacco
Expanded personal and social history personalizes your
relationship with the patient and builds a rapport
Review _of_ systems
Documents presence or absence _of_ common symptoms
related to each _of_ the major body systems
Understanding and using Review _of_ Systems questions may
seem challeng- ing at first. These “yes-no” questions should
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