EEI 10/9a Outpatient Interview Cases Flashcards
The guide to PT practice
Diagnosis Prognosis Intervention Outcomes Examination Evaluation
Goals of PT interview
- Establish Rapport
- PMH
- History of Present Illness (HPI)/CC
- Functional limitations/baseline status
- Ask yourself about red flags, referrals, etc
- Develop a hypothesis
importance of establishing rapport with your patient
- Hearing vs active listening (clarify, ask questions, practice eye contact)
- nonverbal cues
- **Patient’s goal
- Patient centered interview (what brings you here, goals for today)
- Open vs Close ended questions
- barriers of communication (language and hearing imparirment)
Breakdown of PMH Interview
- Interview
- Self-report measures
- questionnaire with targeted follow up
- social history
- comorbidities
- medications
- psycho-social (depression, safety at home, recent drastic changes in body)
good questions to include in the self-administered questionnaire in an outpatient ortho setting (self report measures)
latex sensitivity? heart problems? occupation? List out comorbidities? diabetes? diabetes before age 18?
If yes on questionnaire, what do you do?
follow up!
health history should include
demographics - age, race, education level
- can explain some diseases/disabilities
- age (breast and prostate cancer = older adults, vs MS and RA = younger diagnosis)
- race (sickle cell = black, skin cancer = white)
- education (communication targets)
what should the social history interview include?
part of PMH
- occupation with follow up about requirements on job
- hobbies/rec
- habits (caffeine > 2-3x per day side effects are insomnia, tachycardia; for alcohol > 14 male and >7 female side effects are HTN, Hepatitis, Serosis; tobacco)
- family medical history
- support systems
comorbidities during interview
- PMH
- cancer if >50y/o think recurrence if prior hx
- infection (pneumonia, UTI) think redness, heat, swelling
- cardiac think shoulder pain, HTN, CVA, angina and avoid aerobic activity
- depression effects outcome, poor recovery in back, knee, hip
- pulmonary think asthma, COPD decreased endurance and make sure they have inhaler
- osteoperosis post menopausal or long term steroids, compression fractures, no bending
- diabetes
- seizures
- pregnancy (no stim and manips because ligamentous laxity)
- surgeries (DVTs)
Medication side effects
- cardiac (orthostatis hypo, nitroglyc)
- steroids (long term effects on bone)
- NSAIDS (GI bleeds)
- asthma (inhaler!)
- insulin (fatigue and hypoglycemia)
- seizure meds
HPI/CC
History of Present Illness/Chief Complaint
- Pain
- Stiffness
- Weakness
- Numbness
- ligament tears
- OPQRST (onset, provocation, quality of pain, region/radiation, severity, time - history)
interviewing about pain
- behavior and quality: constant (mechanical or chemical) vs intermittent (mechanical)
- better or worse?
- nerve distro (dermaatome or periph nerve)
- bone (tenderness to palpation, deep and localized)
- vascular (widespread and throbbing)
- muscle (resist motion and stretching cause pain) - location
- numeric rating scale
- severity/intensity (1-10 scale)
- irritability
- stability - periph or central?
parasthesia vs anesthesia
parasthesia = numbness/tingling from damage to a nerve anesthesis = no feeling because nerve has been cut
functional limitations aspect of the interview?
- what do your symptoms prevent you from doing?
- different outcome measures
what do you ask yourself as a PT during the patient interview?
manage case by:
- referral to another healthcare practitioner and cannot be managed by PT
- by PT with a consult from another practitioner
- independently by PT