Assessment and Diagnosis Flashcards
MOTIVATIONAL INTERVIEWING (1)
Motivational interviewing (MI) is a counseling style that guides a person through a patient-centered conversation to help the person consider whether there is a health-related behavior to change, how to do it, and most importantly, why to make a change. It is used to enhance intrinsic motivation to change by exploring and resolving ambivalence.
OPEN-ENDED QUESTIONS (1)
Open questions are preferred in MI because they get the patient talking. A goal in MI is to increase patient speech while reducing clinician speech so that the patient’s perspective is elicited fully. Open questions generally evoke more responses and change talk than closed questions, especially those asked about the patients’ own concerns or thoughts about their issues.
Example: “Tell me about your use of alcohol and drugs” instead of asking a closed question like “How many times have you used alcohol or other drugs this week?”
PERSON-FIRST STRENGTH-BASED LANGUAGE (1)
The goal of person-first strength- based language is to avoid language that dehumanizes or stigmatizes people. It should use language that is neutral, nonjudgmental, and based on facts, actions, or
physiology/biology. Focusing on strengths can empower people to take more control over their own health and healing. It is recommended to use words that indicate awareness, a sense of dignity, and positive attitudes toward people with a disability/disease; this places emphasis on the person, rather than the disability/disease
Example: “Jill takes her medication about half the time.” instead of: “Jill is nonadherent with her medication. Jill has poor medication adherence.”
Example: “Lorrie has diabetes. Lorrie has lived with diabetes for ten years.” instead of: “Lorrie is a diabetic. Lorrie has been diabetic for ten years.”
COMMUNICATION FOR SOCIAL/CULTURAL OR CLINICAL CONTEXT (1)
Sociocultural differences between patients and providers influence communication and clinical decision-making. Evidence clearly links clinician-patient communication to patient satisfaction, adherence, and health outcomes.
Components of cross-cultural care include effective use of interpreters, familiarity with differences in disease epidemiology, and comfort level in working with patients who are culturally different than oneself. Patient-centeredness encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient. Cross-cultural care aims to take this a step further to include skills that are especially useful in cross-cultural interactions but remain vital to all clinical encounters.
BEHAVIOR CHANGE THEORY (1)
Behavior change is a process that progresses from low awareness and no intention to change, through high awareness and active efforts to initiate or maintain change. Stages of change: Precontemplation, Contemplation, Determination, Action, Maintenance, Relapse. Encourage and elicit “change talk” using DARN-C: desire, ability, reasons, need, and commitment to change.
PATIENT HISTORY (2)
Nutrition, physical activity, medical/medication therapy, mental health, health, family, and social history
CHRONIC CONDITIONS/COMPLICATIONS ACROSS THE LIFESPAN OF A PATIENT WITH DIABETES (2)
Macrovascular: atherosclerosis, coronary heart disease, peripheral arterial disease, cerebrovascular disease
Microvascular: retinopathy, nephropathy (chronic kidney disease), neuropathy
The development of complications can be delayed with management of hyperglycemia, hypertension, and dyslipidemia.
COMPREHENSIVE ASSESSMENTS OF PATIENTS WITH DIABETES (2)
Functional status
Comprehensive foot exam (annual)
Sensory/neuropathy assessment
Eye exam (annual)
Dental exam (annual)
Review of medications and complementary alternative medication (CAM)
Developmental and cognitive ability
Cultural, ethnic, lifestyle, and health literacy
Self-care skills and behaviors
ROUTINE FOOT EXAMINATION (2)
The feet should be visually inspected at each routine visit to identify problems with nail care, poorly fitting footwear resulting in barotrauma, fungal infections, and callus formation. Foot problems due to vascular and neurologic disease are a common and important source of morbidity. Patients who may have neuropathy or who have calluses or other foot deformities should be referred to podiatry.
ROUTINE EYE EXAMINATION (2)
Patients with diabetes are at increased risk for vision loss, related both to refractive errors (correctable visual impairment), cataracts and glaucoma (which are more prevalent in persons with diabetes), and to retinopathy. It is important to ask about visual impairment and regular screenings for diabetic retinopathy (ie: dilated eye exam).
SIGNS OF AUTONOMIC NEUROPATHIES (2)
Hypoglycemic unawareness, resting tachycardia, orthostatic hypotension, gastroparesis, erectile dysfunction
FOOT SELF CARE (2)
Check feet daily for cuts, sores, calluses, etc.
Wash feet daily
Never walk around barefoot
Wear well-fitting shoes
Trim toenails straight across
Don’t remove corns or calluses
Ask healthcare providers to inspect feet at medical visits
Choose foot-friendly activities
ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) RISK SCREENING (2)
ASCVD Risk calculation
Blood pressure screening (every visit)
Dyslipidemia
LABORATORY ASSESSMENTS FOR PATIENTS WITH DIABETES (2)
Lipid profile: initial, then annual if on statin
A1C: every 3-6 months
BMP: Annually
UACR: Annually
URINE ALBUMIN-TO-CREATININE RATIO (UACR) (2)
Normal rate of albumin excretion: < 30 mg/day
30-300 mg/day = moderately increased albuminuria (“microalbuminuria”) indicative of nephropathy
> 300 mg/day = severely increased albuminuria (“macroalbuminuria” or “proteinuria”)
Refer to nephrologist if increasing albuminuria or GFR < 30 mL/min/1.73m*2
