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Health Assessment > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is health assessment?

A

systematic method of COLLECTING and ANALYZING data for the purpose of planning patient-centered care.

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2
Q

Physical Appearance and Hygiene Components of General Inspection (4)

A

-General Appearance: Any obvious findings like tremors or facial drooping?
-Age: Does the patient appear to be the stated age?
-Skin: What is the color and condition of the patient’s skin? Any variations in color? Any obvious lesions?
-Hygiene: Is the patient clean and well groomed? Any odors?

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3
Q

Body Structure and Position Components of General inspection (3)

A

-Stature: What is the patient’s position or posture? Does patient sit or stand straight up?
-Nutritional status: Well-nourished? Thin? Obese?
-Body Symmetry: Right and left sides of body symmetric in size?

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4
Q

Body Movement components of General Inspection (3)

A

-Patient’s movement: Does the patient walk or move with ease? Any use of assistive devices?
-Gait: Is the gait balanced and smooth?
-Involuntary movement: Any involuntary movements like tremors or tics?

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5
Q

Emotional/Mental Status and Behavior Components of General Inspection (6)

A

-Alert: Is patient alert to person, place, and time (AAO x 3)?
-Eye contact: Does patient maintain eye contact? (some cultural variations, so simply inquire)
-Conversation: Does patient converse appropriately?
-Facial expressions (affect) and body language: Appropriate for the conversation? Any distress?
-Dress/Attire: Is the patient dressed appropriately for the weather?
-Behavior Appropriate?: Is the patient’s behavior appropriate?

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6
Q

Questions to assess alertness (3)

A

-Person–Who are you?
-Place–Where are you located?
-Time–What day is it? What month is it?

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7
Q

4 components of general inspection

A

Physical appearance and hygiene
Body structure and position
Body Movement
Emotional/mental status

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8
Q

What is a health history?

A

information about the patient’s current state of health, current medications, previous illnesses and surgeries, a family history, personal and psychosocial history, and review of systems

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9
Q

Components of health assessment

A

Collect health history
Perform physical exam
Document data
Analyze and Interpret Data
Develop care plan

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10
Q

Signs

A

objective data observed, felt, heard, or measured.

Ex: rash, enlarged lymph nodes, and swelling of an extremity.

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11
Q

Symptoms

A

subjective data perceived and reported by the patient. Ex: pain, itching, and nausea

Primary data: from patient; Secondary data: from family

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12
Q

Types of health assessments

A

Comprehensive
Problem-based/focused
Episodic/follow-up
Shift
screening

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13
Q

6 vital signs

A

Temperature
Heart Rate
Respiratory rate
Blood pressure
Oxygen Saturation
Pain

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14
Q

Context of care

A

circumstances or situations related to health care delivery including setting and environment, nurse expertises, patient’s history

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15
Q

3 assessment techniques for physical exam

A

palpation
inspection
ascultation

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16
Q

When systolic and diastolic levels fall in different categories, how do you classify blood pressure

A

use the higher CATEGORY NOT the higher number

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17
Q

Normal blood pressure range?

A

less than 120/80 mmHg

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18
Q

Prehypertension Blood pressure range

A

Systolic: 120-139

Diastolic: 80-89

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19
Q

Hypertension Stage I range

A

Hypertension Stage I
Systolic: 140-159
Diastolic: 90-99

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20
Q

Hypertension Stage II range

A

Stage II
Systolic: > 160
Diastolic: > 100

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21
Q

Problem-based/focused assessment

A

involves a history and physical examination that is limited to a specific problem or complaint (e.g., a sprained ankle). Common in a walk-in clinic or emergency department. Nurse also considers the potential impact of the patient’s underlying health status.

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22
Q

Comprehensive assessment

A

detailed history and physical examination performed at the onset of care. It encompasses health problems experienced by the patient; health promotion, disease prevention, and assessment for problems associated with known risk factors; or for age- and gender-specific health problems.

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23
Q

Episodic/follow-up assessment

A

usually done when a patient is following up with a health care provider for a previously identified problem.

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24
Q

Screening assessment/examination (what is it and where performed)

A

short examination focused on disease detection.

May be performed in a health care provider’s office (as part of a comprehensive examination) or at a health fair.

Ex: include blood pressure screening, glucose screening, cholesterol screening, and colorectal screenings

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25
Q

Shift assessment:

A

during hospitalization, purpose is to identify changes to a patient’s condition from the baseline; thus the focus of the assessment is largely based on the condition or problem the patient is experiencing.

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26
Q

Inspection (any equipment?)

A

Visual and olfactory exam of patient

-pen light

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27
Q

tangential lighting

A

create shadows by directing pen light at a right angle

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28
Q

Palpation

A

feel for texture, size, shape, consistency, pulsation and location of certain parts of a patient’s body


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29
Q

Precaution for palpation

A

Nurse’s touch should be gentle, warm, and nails short. Must state purpose and 
need for touch, and manner and location of touch

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30
Q

Surfaces of hand best for palpation, vibration, temperature?

A

palmar surface and finger pads = more sensitive to palpation than fingertips.
ulnar surface of hand extending to fingertip = very sensitive to vibration

dorsal surface of hand (back) = more sensitive to temperature


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31
Q

Light palpation (depth and usage)

A

(approx 1 cm)
should be done PRIOR to deep palpation
Good for 
assessing skin, pulsations, and tenderness


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32
Q

Deep palpation

A

approx 4 cm
-used to determine size and contour of an organ

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33
Q

Four characteristics of Auscultation

A

Intensity: loudness of the sound

Pitch: frequency of sounds. (High pitch =breath, low pitch =heart)
Duration: short, medium, or long. Layers of soft tissue can dampen the
 duration of sound
Quality: hollow, dull, crackle


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34
Q

What is stethoscope good for and why

A

good for evaluating conditions of heart, blood vessels, lungs, + intestines because uses selective listening and blocks out extra sounds

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35
Q

4 things to do before stethoscope usage

A

-Disinfect stethoscope in between uses
- warm the head of the stethoscope
- remove distractions, quiet room is best for auscultating
-use on bare skin

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36
Q

3 Factors that can interfere with accurate auscultation:

A

-Pt gets cold/shivers + muscles contract and interfere with normal sounds
-Listening over clothing can be less accurate
-Friction of body hair rubbing can sound like abnormal lung sounds/crackles

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37
Q

How to perform rectal temp reading?

A

pt should be in Sim’s position with upper leg flexed. Insert 1-1.5 inches

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38
Q

What to know about rectal temp?

A

most accurate

Not performed often because it is invasive, less comfortable, requires more time, and has an increased risk of an infection compared to the others.

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39
Q

Types of Electronic thermometers
(how they work and accuracy of each)

A

oral, axillary, or rectal temperature. (1 below core temp, 2 below core temp, core temp)

Measures temperature of blood flowing near the tissue

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40
Q

What is Tympanic membrane thermometer?

A

inserted inside the ear, measures temperature of blood flowing near the tympanic membrane

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41
Q

Temporal artery thermometer (how it works and when accurate)

A

Detects heat emitted from pt’s forehead to behind the ear (temporal artery to temporal artery)

High accuracy in children over 2 yr old and adults in critical care

  • avoid taking after extreme temps
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42
Q

Use of diaphragm vs bell of stethoscope

A

Diaphragm: large part for high pitch sounds like breath, bowels, normal HR

Bell: small part for low pitch sounds like extra heart and vascular sounds

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43
Q

What does automated BP device do?

A

senses blood flow vibrations and convert into electrical impulses

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44
Q

How to choose cuff size? What happens if wrong size?

A

Ideal cuff bladder: encircle 80% of upper arm
Ideal cuff width = cover 40% of circumference of limb
Cuff too wide = BP underestimated
Cuff too narrow = BP overestimated

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45
Q

Pulse oximeter

A

measures oxygen saturation in arterial blood + pulse rate. Will be accurate for oxygen saturation 70-100%,

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46
Q

Where to use pulse oximeter? When is it inaccurate?

A

-on highly vascular area (digits, ear lobes)

-inaccurate on cold digits or with nail polish

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47
Q

How to measure height in adults or older children? What to measure height in?

A

-Lower height attachment until it is in firm contact with the top of patient’s head (not bent), no shoes, eyes parallel to floor

-Height recorded in feet and inches OR centimeters for children, adolescents, adults

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48
Q

Two growth measures

A

height and weight

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49
Q

3 Height Influences

A

age, genetics, diet

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50
Q

How to measure weight?

A

use platform scale, no shoes, calibrated to 0 before use

  • record in kg and pounds for older children and adults
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51
Q

What does sudden weight gain and loss indicate?

A

sudden increase: fluid volume
sudden decrease: disease

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52
Q

6 Weight Influences

A

Diet
Genetics
Age
Exercise
Health conditions
Fluid Volume

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53
Q

When is temperature the highest and lowest?

A

Diurnal variation means lowest in morning, highest in evening

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54
Q

How does menstruation and exercise affect body temp?

A

They increase it

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55
Q

What precaution to take for oral temp?

A

Wait 10 minutes if patient just smoked, had hot or cold liquids
-position under tongue

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56
Q

Why is axillary temp inaccurate?

A

2 degrees less than core b-c no major blood vessels in axillary

also many times it is not directly under arm.

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57
Q

Expected temperature ranges for adults (C and F)

A

from 96.4° to 99.1° F (35.8° to 37.3° C)

with an average of 98.6° F (37° C)

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58
Q

What to do with the ear in tympanic membrane temp readings?

A

tug up for over 3 yrs, tug down for under 3 yrs to straighten ear canal

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59
Q

Heart Rate range and average

A

60-100 beats/min, 70 beats/min

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60
Q

How to measure heart rate

A
  1. palpate pulse at the radial, brachial, carotid artery or by auscultating the heart
  2. measure number and rhythm
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61
Q

How does heart rate measurement differ by rhythm in adults?

A

if regular rhythm: count 30 secs x2 or 15 secs x4

If irregular rhythm: count full minute. Will be ‘regular irregularity’ or ‘irregular irregularity’

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62
Q

5 Respiratory Rate influences

A

-age
-fear
-anxiety
-exercise
-high altitudes

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63
Q

How do men, women, and children breath?

A

Men and children typically breathe diaphragmatically, while woman breathe thoracically

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64
Q

What 4 things to note when measuring respiratory rate?

A

Amount: ventilatory cycles per minute (measure 30 sec*2)
Depth: described as deep, normal, or shallow
Rhythm described as regular or irregular
Effort: if normal = even, quiet, effortless

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65
Q

Adult respiratory rates and oxygen saturation

A

12-20 breaths/minute
92%

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66
Q

What to know about pediatric blood pressure? (2)

A

-assessed routinely from age 3 and up

-usually lower than adult

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67
Q

Pulse pressure

A

difference between systolic and diastolic

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68
Q

Systolic vs Diastolic

A

systolic = maximum pressure exerted on arteries when ventricles contract or eject blood from heart. (1st korotkoff sound, top)

Diastolic = minimum amt of pressure exerted on vessels, when ventricles relax and fill with blood (5th korotkoff sound, bottom)

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69
Q

Direct vs indirect BP measurement

A

Direct: catheter in artery, reserved for critical care
Indirect: sphygmomanometer and stethoscope

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70
Q

Orthostatic hypotension

A

measure BP at sitting, laying, and standing; drop in BP
as patient goes from lying/sitting to standing

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71
Q

When can children use oral temperature?

A

Age 5 and up

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72
Q

Thermometers and findings for children under 5

A

Recommended route = axillary, tympanic membrane, and temporal artery (most accurate in children); rectal in febrile (1 in)

Finding: 98.6 F/37 C

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73
Q

Two reasons for low temperature variations in children

A

Low temperature from environmental exposure, and inability to regulate as newborns b-c skin thinner

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74
Q

3 reasons for high temps in children

A

High temperature associated with viral/bacterial infections, dehydration, and environmental exposure to heat

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75
Q

How to measure heart and respiratory rate for children?

A

Listen to apical pulse for FULL MINUTE, count respirations for FULL MINUTE with pediatric stethoscope (no palpation!)

Infants+children usually breathe diaphragmatically, observe abdominal movement

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76
Q

Expected vs abnormal pediatric HR and RR findings

A

Expected findings: elevation in HR and RR usually from crying, fever, respiratory distress, dehydration

Abnormal finding: decreased HR, can indicate serious condition

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77
Q

How measure infant height?

A

top of head to feet in supine

measure in inches or cm

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78
Q

How to measure infant weight

A

platform scale, no clothes or diaper

measure in oz or grams

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79
Q

Errors leading to false low BP (5)

A

-Arm ABOVE THE HEART
- Cuff too WIDE
- Not inflating cuff enough
- Deflating cuff too RAPIDLY (< 2-3 mmHg/sec)
- Pressing diaphragm too firmly on brachial artery

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80
Q

Errors leading to false-high BP (7)

A
  • Legs crossed
    -Arm BELOW THE HEART
  • Cuff too NARROW
  • Cuff wrapped too LOOSELY/UNEVENLY
  • Deflating cuff too SLOWLY (> 2-3 mmHg/sec)
  • Reinflating cuff before completely deflating it
  • Failing to wait 1-2 minutes before repeating measurement
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81
Q

How does age affect BP?

A

Age: From childhood to adulthood there is a gradual rise.

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82
Q

How does Gender affect BP

A

After puberty, females usually have a lower blood pressure than males; however, after menopause, a woman’s blood pressure may be higher than a man’s.

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83
Q

How does pregnancy affect BP?

A

During pregnancy, diastolic blood pressure may gradually drop slightly during the first two trimesters of pregnancy, but then it typically returns to the prepregnant levels by term.

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84
Q

How do Emotions affect BP?

A

Feeling anxious, angry, or stressed may increase the blood pressure.

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85
Q

How do personal habits affect BP?

A

Ingesting caffeine or smoking a cigarette within 30 minutes before measurement may increase blood pressure.

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86
Q

How does Weight affect BP?

A

Obese patients tend to have higher blood pressures than nonobese patients.

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87
Q

How does race affect BP?

A

The incidence of hypertension is twice as high in African Americans as in whites.

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88
Q

Pain

A

unpleasant sensory and emotional experience with actual or potential tissue damage

-whatever a person says it is
-6th vital sign

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89
Q

Pain threshold

A

point at which stimulus is perceived as painful, does not vary significantly over time

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90
Q

Pain tolerance

A

duration or intensity of pain that a person endures or tolerates before responding outwardly

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91
Q

5 influences on pain

A

culture, expectations of pain, physical illness, emotional health, role behaviors

92
Q

Decreased pain tolerance with: (6)

A

w/ repeated exposure to pain, fatigue, anger , boredom, sleep deprivation, apprehension

93
Q

Increased pain tolerance with: (6)

A

↑ w/ alcohol, medication, hypnosis , warmth, distractions , strong faith

94
Q

Pain can effect (4)

A

perfusion, oxygenation, metabolism, tissue integrity

95
Q

Pain can result in impaired: (6)

A

elimination, nutrition, sexuality, motion, sleep, development

96
Q

Cognitive and cultural influences on pain perception (3)

A

-attention individuals give to pain
-expectation/anticipation of pain
-judgment/explanation of pain (decreased tolerance in those who see pain as unexplainable)

97
Q

Cognitive Bias and pain

A

nurse’s attitudes and beliefs on pain can affect how they perceive and respond to pain of others

98
Q

Problem-based vs emotional based coping

A

problem-based coping: efforts to manage or change stressor; changes in your activity pattern or self-care activities

emotional-based coping: manage your emotional response including social and religious support

99
Q

Best indicator of pain existence and severity

A

patient self-report

100
Q

Uses of Numeric rating scale (NRS)

A

-okay in children and adults
-inaccurate in cultures who read vertically or where individuals pick a sacred number

101
Q

Faces Pain Scale Revised (FPS-R)

A

-okay for adults and ages 6 and up

102
Q

Clinically Aligned Pain Assessment (CAPA)

A

establishes pain as more than a number. It contains 5 questions examining how the pain affects comfort, functioning, sleep, and patients changes in pain and level of pain control

103
Q

Differences in acute, ischemic, and persistent pain

A

• Acute pain= sudden onset, short duration
• Ischemic pain = gradual increase in intensity • Persistent pain= > 6 months

104
Q

Symptom Analysis of pain

A

Onset
Location
Duration
Characteristics
Aggravating and Alleviating Factors
Related Symptoms
Treatment
Severity

105
Q

Referred pain

A

pain located far from site of pathology

106
Q

Visceral pain and how it presents

A

Visceral pain = inner organs + blood vessels
Caused by tumor = aching + well localized
Caused by obstruction = intermittent cramping + poorly localized

107
Q

Somatic pain and how it presents

A

Somatic pain = muscle, bones, soft tissues
Well localized, described as aching or throbbing

108
Q

Related Symptoms of low-to-moderate acute pain

A

Low-to-moderate acute pain intensity = SNS palpitations, dyspnea, diaphoresis, increase RR

109
Q

Related symptoms of severe/deep pain

A

PNS pallor, rapid irregular breathing, nausea, vomiting

110
Q

5 steps for patients who cannot communicate

A
  1. Attempt a self-report from pt or explain why self report is not possible
  2. Look for potential causes of pain. Ex: pathological conditions, common problems, procedures
  3. List patient behaviors that indicate pain
  4. Proxy reporting = identifying behaviors that caregivers or others knowledgeable about pt may recognize to indicate pain
  5. Administer analgesics that are ordered to examine whether pain is reduced
111
Q

4 abnormal findings during pain when you OBSERVE patient

A

• Guarding of painful body part
• Rubbing or pressing painful area
• Distorted posture
• Fixed or continuous movement

112
Q

5 abnormal findings during pain when you LISTEN to patient

A

Moaning, grunting, screaming, crying, gasping

113
Q

Abnormal finding when you MEASURE blood pressure during pain

A

SNS may increase systolic BP

114
Q

Wong-baker FACES pain scale

A

okay for ages 3 and up

115
Q

Abnormal finding when you PALPATE pulse during pain.

A

HR may increase

116
Q

Abnormal finding when you ASSESS respiratory rate and pattern during pain

A

RR may be slow and deep (relaxation technique) or rapid and shallow

117
Q

Abnormal finding when you INSPECT site for appearance of pain.

A

Inflamed area, incisions or visible injury

118
Q

Abnormal finding when you PALPATE the site for tenderness

A

Tissue damage or incision may lead to pain on palpation

119
Q

Pain response in children (neonate, young, school age)

A

Neonate: global response of ↑ HR and BP; decreased Oxygenation, pallor, sweating

Young children: unable to distinguish pain and anxiety

School children: understand and describe location of pain

120
Q

Pain response in older adults (3)

A

-perception of pain NO DIFFERENT than that of any other adult (PAIN IS NOT AN EXPECTED PART OF AGING)

-slowed transmission of pain

  • Be sure to ask how pain affects function, sleep, appetite , activity, mood , and relationships
121
Q

Reliable pain assessment tools for older adults

A

Iowa Pain Thermometer (IPT), Faces Pain Scale-revised (FPS-r) and Numeric Rating Scale (NRS)

122
Q

Health promotion

A

process of enabling people to increase control over and improve their health; dependent on adaptation to change

123
Q

Disease prevention

A

component of health promotion; behaviors motivated by a desire to avoid illness, detect illness early and manage illness when it occurs

124
Q

What does health promotion encompass?

A

health, wellness, disease, and illness

125
Q

Illness

A

Physical manifestations and subjective experiences

(can have illness with no disease)

126
Q

Disease

A

functional/structural disturbance when person’s adaptive mechanism to counteract stimuli and stresses fails

(can have disease with no illness)

127
Q

3 things on Wellness

A
  • positive state of health of an individual, family, or community
    -constantly changing
  • multidimensional( Physical, mental, spiritual, social, occupational, environmental, intellectual, and financial)
128
Q

Health

A

State of complete physical, mental, and social well-being; not necessarily an absence of disease

129
Q

US Preventive Services Task Force vs HealthyPeople 2030

A

US Preventive Services Task Force = Makes recommendations about preventive services, assigns a grade to how beneficial that service will be for the people

HealthyPeople 2030 = sets goals + objectives for people in the U.S.

130
Q

Biggest and second biggest predictor of life expectancy, morbidity, and mortality

A

-Low SES

-Ethnic and racial minority 2nd biggest predictor

131
Q

Elimination of health disparities focuses on (2)

A
  1. increasing access to health services
  2. developing cultural competence
132
Q

Individual assessment for health promotion

A

comprehensive assessment on health status, behaviors, and risk.(includes family history and personal factors); nurse-pt relationship important, nurse must be sensitive to each person’s goals and values

133
Q

Family Assessment for health promotion

A

-use a genogram to understand familial risks across generation
Square = male Circle =female Blacked out shape = deceased

-important to understand family dynamics, strengths, and context

134
Q

Community assessment for health promotion

A

requires participation from community representatives and data collection strategies through observations, interviews, and understanding the structure, makeup of community

135
Q

USPSTF Five levels of recommendation

A

U.S Prevention services Task Force Recommendation

A : high certainty of substantial net benefit (recommends)
B: high / moderate of moderate net benefit ( recommends)
C: moderate certainty of small net benefit (consider patient preferences/ selective recommendation)
D: harm > benefit; moderate/ high certainty of 0
I: insufficient evidence for or against

136
Q

Four elements of health promotion

A

optimization of health
evidence
patient/community centered
enculturation

137
Q

Primary Prevention

A

Combination of strategies aimed at optimizing health and prevention of disease

Ex. health education, immunization, exercise, safe living/work environments, protection from accidents, and effective stress management to prevent disease.

138
Q

Secondary prevention

A

screening to identify people in early state of disease and cure or limit disability

139
Q

Tertiary Prevention

A

minimize effects of disease and disability through collaborative disease management; rehabilitative

Can use a lot of primary prevention strategies in tertiary prevention.
Strategies similar but goal differ. Ex: aerobic exercise to maintain health but also for obese patient weight loss

140
Q

Screenings should be: (3)

A

safe, cost-effective, and make a difference in morbidity/mortality

141
Q

What must screening be to be accurate?

A

screening must have high degree of RELIABILITY and VALIDITY.

Reliable = same result is achieved when different people perform the test

Validity = ability of test to detect disease, needs to be both sensitive and specific

142
Q

Sensitivity vs specificity

A

Sensitivity: correctly identify those with condition
Specificity: identify those without condition

143
Q

What 5 factors affect HR?

A

physical exertion, fever, anxiety, hypotension, hormonal imbalances

144
Q

7 characteristics of physical setting for health history

A

-private
-quiet
-comfortable room (ideally unoccupied or with curtain closed)
-no environmental distractions
-patient should be comfortable and ideally in street clothes
-nurse and patient alone
-nurse and patient face to face

145
Q

How does age affect patient centered care in health history?

A

It may influence accuracy, participation, or completeness of data.

Older adults may have decreased ability to participate. Parents often involved for children.

146
Q

How to incorporate culture in patient centered care in health history?

A

avoid stereotyping and interact with individuals as a unique person

147
Q

How does language affect patient centered care in health history?

A

limited english proficiency (LEP) may indicate need for certified translator

148
Q

How does physical/emotional distress affect patient centered care in health history?

A

limit number and nature of questions to only those necessary; save rest for later

-use focused assessment

149
Q

How does hearing impairment affect patient centered care in health history?

A

speak slowly and clearly, face the individual so they can see your face

150
Q

How does visual impairment affect patient centered care in health history?

A

provide assistance with written forms

151
Q

How does cognitive impairment affect patient centered care in health history?

A

secondary sources such as medical POA may be needed; rely more on preestablished health record

152
Q

Gender identity vs gender expression

A

Gender identity : internal sense of gender; formed by age 3

Gender expression: how individual presents their gender in society

153
Q

2 parts of professional behavior to build rapport

A

make good first impression with appearance (dressing, hygiene, grooming)

present a caring, confident, warm, professional demeanor

154
Q

7 parts of effective communication to build rapport

A

-efficient
-calm and unhurried
-actively listen
-understand patient POV
-communicate acceptance and respect
-avoid reactions
-listen first, document 2nd

155
Q

4 keys to a successful patient interview

A

-good first impression
-be prepared (review any available health data prior to meeting)
-be attentive
-avoid medical jargon

156
Q

What happens in Introduction phase of interview? (4)

A

-Introduce self and ask patient what they would like to be called
-Describe purpose and process of the interview/encounter
-Prepare patient for what to expect (length of time)
-If other people in room, ask patient for their relationship and if they are okay with the person being present

157
Q

What is purpose of introduction phase of interview?

A

build rapport

158
Q

What is the single-most important factor for successful interviewing?

A

the communication skill of the nurse. Nurse should use therapeutic communication

159
Q

What happens in the discussion phase of an interview? (2)

A

-facilitate and maintain a patient-centered discussion
-use various communication skills and techniques to collect data and enhance conversation

160
Q

What happens in the summary phase of the interview? (5)

A

-summarize the data with the patient
-allow the patient to clarify data
-create shared understanding of the problems with the patient
-plan for next steps and end interview
-emphasize data that have implications for health promotion, disease prevention.

161
Q

Behaviors to avoid in interview (5)

A

• using medical terminology
• Asking why
• value judgements
• being authoritarian or paternalistic
• interrupting patient ( or changing subject )

162
Q

Types of interview questions and their purpose

A

Open- ended : broad, encourages free flowing open response

Directive: closed -ended, allow patient to focus on set of thoughts (must use with open-ended to allow patient to use their own words to avoid inaccurate conclusions)

163
Q

What is the purpose of Permission giving?

A

helps patients feel that it is safe to discuss such topics.

Ex: Many people your age have questions about sex. What questions or concerns do you have?

164
Q

8 things on the art of asking questions

A
  • define words as needed and avoid technical terms
  • encourage specificity
  • adapt questions to patient’s developmental level, knowledge and understanding
  • ask one question at a time
  • be attentive to feelings (certain emotional responses may mean more info needed)
  • prefix sensitive questions by letting patient know you are required to ask or use permission- giving )
  • if patient has questions, you can answer or gather more info to give additional resources
    -Avoid giving in-depth answers or providing more information than necessary
165
Q

When is comprehensive health history done?

A
  • generally for new patients in all settings; postponefor unstable patients
    -taken during admission or when pt’s reason for seeking care is to relieve generalized symptoms
166
Q

When is episodic/follow- up health history done?

A

-specific problem or problems for which pt is already been receiving treatment
-Focus on changes that have taken place since the last visit
-Disease management or health promotion (Early detection of complications or decline in health)

167
Q

How does problem-focused health history look different?

A

data limited to specific problem, but detailed enough so related data collected particularly data that may affect presented problem

168
Q

How to handle personal questions during interview?

A

use brief, direct answers

You can share supportive personal experiences

169
Q

How to handle silence during interview?

A

be comfortable with it; it may indicate patient is thinking or patient is not ready to discuss that topic

170
Q

How to deal with others in room while doing interview?

A

learn their relationship with the patient and get patient’s permission for their presence

If they are disruptive/ speak for the patient, ask them to stop or to leave
If they are disruptive children, give them a distraction

171
Q

How to deal with a talkative patient?

A

redirect conversation if needed with closed-ended questions

172
Q

How to deal with crying patient?

A

offer tissue and let patient know it is acceptable

173
Q

How to deal with angry patient?

A

identify the source of anger

If pt angry w/ someone else, discuss w/ pt on how to approach that person

If pt angry with nurse, encourage them to discuss feelings. If not resolved, may need to switch out nurses

174
Q

What is interpretation?

A

when nurses share w/ pt the conclusions they have drawn from the data pt has given to nurse

Ex: let me share my thoughts on what you have said..you said xyz, I wonder if xyz is contributing to

175
Q

What is summarization?

A

nurse condenses and chronologically orders data; useful for patients who ramble

176
Q

What is confrontation?

A

asking patients about inconsistencies between patient’s reports and your observations; use a confused or misunderstanding tone rather than an accusatory or angry one

177
Q

What is reflection?

A

gain clarification by restating a phrase used by pt in the form of a question.

Ex: Pt: I just didn’t feel right. Nurse: you didn’t feel right? Pt: Uh huh, I was dizzy

178
Q

What is clarification?

A

Obtaining more information on conflicting, vague, or ambiguous information

179
Q

What is facilitation?

A

use phrases to encourage patient to continue talking

ex: go on, uh huh,

180
Q

What is active listening?

A

listening with a purpose to the spoken words as well as noticing nonverbal behaviors.

181
Q

What is included in biographic data (10)? When is it gotten and when is it updated?

A

collected first visit and updated as changes occur

-Name, preferred name
- gender, gender identity
- race / ethnicity
- birthdate, place
- address, phone# , email address
- contact person
- religion
- marital
- source of data
- occupation

182
Q

How to recognize potential victim of human trafficking or IPV?

A

They are unable to speak, nervous, or have someone else speak for them

183
Q

chief complaint/concern

A

Patient’s reason for seeking care, presenting problem

-often recorded in direct quotes
- if more than one problem, have pt list all and prioritize problems

184
Q

History of presenting illness

A

same as symptom analysis; you can use OLDCARTS

-unnecessary for well visits

185
Q

3 components of Present health status (and their components)

A

-Current health conditions (diagnosis length, impact of illness on ADLs)

-Medications (all kinds, dose/frequency, perception of effectiveness, reason for medication)

-Allergies ( get symptoms to determine if allergy or adverse effect)

186
Q

Gravidity vs pavity

A

Gravidity: number of pregnancies
Pavity: number of births

187
Q

7 Components of Past Health History (and their related bits)

A
  • Childhood illnesses
  • Surgeries (type, date, outcome)
  • hospitalizations (illness, date, outcome)
  • Accidents / injuries (type, date, outcome)
  • Immunizations
  • last examination ( type , date , outcome )
  • Obstetric history (gravidity, parity, # of abortions/miscarriages
188
Q

3 things to know for family history collection

A

-identify illnesses of genetic, familial, or environmental nature (include blood relatives, spouse, children)
-use genogram or patient narrative
-go back 3 generations

189
Q

8 Components of personal and psychosocial history

A
  • Personal status
  • Family and social relationships
  • diet/nutrition
  • functional ability
  • environment
  • mental health
  • health promotion
  • drug use
190
Q

How to gather personal status?

A

-get general statement on self-esteem
-examine culture, religion, education, work satisfaction, hobbies, interests,

191
Q

How to gather family and social relationships? (3)

A

-note general satisfaction and thoughts on these relationships
-note health of family and friends
-be aware of IPV and ask about abuse

192
Q

How to gather diet and nutrition?

A

Ask about likes and dislikes, food tolerance, eating habits, dietary restrictions, recent appetite or diet changes

Ask about overeating, sporadic eating

193
Q

How to gather functional ability?

A

perceived ability to complete ADLs

194
Q

How to gather mental health?

A

Ask about personal stress and sources, anxiety, nervousness, depression, irritability, anger

195
Q

How to gather environment? (3)

A

Ask about safety in home and neighborhood
Ask about transportation
Ask about international travel

196
Q

How to gather health promotion activities

A

Ask about sleep habits, exercise, routine health exams, safety practices, stress management

197
Q

How to gather drug use? Tobacco? Alcohol? Illicit?

A

identify substance used, amount used, duration of habit

Tobacco: record history in pack-years (cigarettes). Number of packs smoked per day multiplied by number of year smoked

Alcohol: type, amount, frequency, any high risk behaviors

Illicit drug: ask about high risk behaviors such as sharing needles and driving under the influence of drugs

198
Q

What illicit drugs should you ask about?

A

Ask about marijuana, cocaine, crack cocaine, bariturates, amphetamines

199
Q

What is the purpose of review of systems? What else to know about it?

A

-to make sure nothing is missed
-conducted to inquire about the past and present health of each of the patient’s body systems. You should conduct symptom analysis if info identified

-no need to recollect data for a system already discussed in previous sections
-use medical terms in documentation

200
Q

How do present health status differ in older adults

A
  • often have many medication, so ask about allergies, adverse effects/ and access to medications)
  • ask about any recent immunizations
201
Q

How to enhance health history for older adults? (3)

A
  • seek info directly from patient before allowing report from 3rd party
    -maintain eye contact so patient can see mouth
    -Make more time to interact with them. Will have multiple symptoms, conditions, medications, and long past health history
202
Q

How does past health history and family history differ in older adults?

A

-memory may affect accuracy of past health history
-questionable value of family history question

203
Q

How does personal status differ in older adults?

A

Ask about changes in role/perception in retirement, income changes, current living arrangements and satisfaction with those arrangements

204
Q

How do family and social relationship questions differ in older adults?

A

Ask about participation and access to family and friends activities; pets, familial conflict

205
Q

How does diet/nutrition differ in older adults?

A

They have decreased appetite, saliva, and chewing

Use Mini Nutritional Assessment -Short Form (MNA-SF) - six questions on food intake, weight loss, mobility, psychological stress, acute disease, dementia, depression

206
Q

How is functional ability questioned in older adults?

A

independent, partially independent, or dependent)

ability to perform ADLs and IADLs i. e shopping, meal prep / finance management

207
Q

How is mental health questioned in older adults? What is typical? What is atypical?

A

-determine circumstances to distinguish from pathologic

• increases in sadness, grief, response to loss, temporary “blue” moods are typical and expected
- Anxiety is rational within reason (prolonged, exaggerated, or anxiety that interferes w/ function is not normal and is often attributed to physical illness

  • Depression= often overlooked but key to suicide prevention *white men > 65 yrs have ↑ risk of suicide
208
Q

How is sleep questioned in older adults? Why is it included?

A
  • ask about bedtime rituals, sleep quality

-poor sleep can increase prevalence of other problems (poor sleep is not a normal part of aging process!)

209
Q

How is alcohol use questioned in older adults?

A

type, amount, frequency

-tolerance decreases with age so effects felt quicker and longer

210
Q

How is environment questioned in older adults?

A

-asked about hazards in home and neighborhood

Do you have stairs? Do you feel safe? Do you have any tripping hazards, loose rugs, smoke detectors, cords

211
Q

How does pediatric health history differ?

A

-observe parent-child interactions (allow child participation as age appropriate)
-Adolescents should have chance to talk w/ nurse alone ( legal right in most states)

212
Q

What is added to pediatric biographic data?

A

name of informant and relationship to child
-any child nicknames

213
Q

How is chief complaint questioned in pediatrics?

A

-recorded in words of parent or child

If for well-child visit, say which well-child visit
If for acute/ chronic illness, brief sentence on symptoms

214
Q

What to add to pediatric symptom analysis?

A

sleep, eating, and elimination patterns which can offer clues on severity

215
Q

How is family history questioned in pediatrics?

A

-still 3 generations including siblings
-pay attention to congenital issues, infants and child deaths
- note any substance use

216
Q

How is personal status questioned in pediatrics? (3)

A

-current level of functioning
- ask parent to describe personality and temperament (include children over 6 in conversation)
- ask about school performance, behavior patterns, unusual behaviors

217
Q

How does past health history differ for pediatrics? (3)

A
  • include Perinatal history for children under 2 and children with congenital, birth or pregnancy complications

-include developmental history (age in which developmental milestones were reached)

-check immunization history at every visit

218
Q

What does perinatal history include?

A

prenatal care, maternal care, labor and delivery, newborn course

219
Q

How does Family and social questioning differ in pediatrics? (4)

A
  • Composition (any recent changes, pets, important family members )
  • Family life (activities, culture, parenting style, discipline methods & effectiveness, childcare / Family dynamics )
  • SES ( income sources, government assistance)
    -Friends (relationships with those their age including bullying, fighting)
220
Q

How to ask about pediatric home environment?

A

Ask about facilities, home safety, community, employment (for teens)

221
Q

How to ask about pediatric development?

A

-use corrected age for premature children until age 3
- assess developmental milestones, school performance, future plans for adolescents

222
Q

How to assess diet and nutrition in pediatrics? (3)

A

-note diet restrictions associated with nutritional deficiencies or dental caries
*excess juice, junk, low calcium or iron

-For newborns, note formula amount, type, frequency; age of solid food intro

-For adolescents, ask about weight perceptions and behaviors to evaluate for eating disorders, extreme diets, or laxative use

223
Q

How to assess sleep in pediatrics?

A

note where, with who, amount, and ease of staying and falling asleep

-for newborns, note position and environment

224
Q

How to address pediatric mental health? (4)

A

-mostly addressed in past health history and social history

• identify current stresses ; identify signs and symptoms of mental illness
• ask about child’s coping ability ( any trusted adults? )

-Use Pediatric Symptom Checklist(PSC) for ages 4 and up; parents note behavioral and emotional issues
* PSC Youth report can be used for adolescents to self- report

225
Q

How to assess sexuality in pediatrics? (5)

A

-ask about puberty
-For girls, ask about age of menarche, menstruation, last menstrual period, frequency and duration
-For boys, ask about testicular changes, self-examination
- evaluate sexually active for pregnancy, STIs , and consensual relations (evaluate sex trafficking)
- gender identity ( gender dysphoria ↑ risk of bullying and mental health problems

Health Assessment (3 decks)

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