Exam 1 Flashcards
Parts of a successful patient interview
selecting an appropriate physical setting, using a patient centered approach, and creating a positive rapport with the patient; privates, queit, comfortable room free of distraction, sit face to face
Central element of Patient Centered Care
treating each patient as a unqiue individual, respecting the patient for who they are, and responding to needs and preferences
Gender Identity
represents a persons own internal sense of gender
Gender Expression
refers to how an individual presents his or her gender within the context of a culture and society
Cisgender
gender identity consistent with the sex assigned at birth
Transgender
gender identity that does not mathc the sex assigned at birth; male identifies as female (transfemale) or female identifies as male (transmale)
Nonbinary
person does not identify as male or female
Agender
person does not identify with any gender
Family Members as Translators
family members are discouraged as being translators bc the family may alter th emeaning of what is said or describe what they think is wrong with the patient
Three phases of the interview
introduction, discussion and summary
Introduction Phase
greet the patient; introduce self to patient; establish puropse of the visit from patient; describe the purpose and process of the interview
Discussion Phase
facilitate and maintain a patient centered approach; use various communication skills and techniques to collect data
Summary Phase
summarize the data with the patient; allow the patient to clarify the data; create a shared understanding of the problems with the patient; plan for next steps and end einterview
Key Points to Ensure a Successful INterview
make a good first impression, be prepared, be an attentive listener through the interview, avoid using medical jargon
Open Ended Questions
broadly stated questions encourage a free flwoing, open response; elicit responses that are more than one or two words
Directive Questions
or closed ended questions; require only one or two words to answer or leads patinets to focus on a set of thoughts
Facilitation
uses phrases to encourggae the patient to continue talking
Reflection
technique used to gain claification by restating a phrsase used by the patient in the form of a question
Confrontation
used when inconsistencies are noted between what the patient reports and observations or other data about the patient; tone of voice is imp when using; use a ton that communications confusion or misunderstanding rather than one that is accusatory and angry
Why Questions
try to avoid them because they can be perceived as threatning and may put patients on the defense; say “I noticed severeal prescriptions left in the bottle….did you intend to take them all”
Overly Talkative Patient
use of directive or close ended questions may help to maintain direction and flow of the conversation
Comprehensive Health History
performed for new patients in any setting, including a hospital admissino, an initial clinic visit or home visit
Problem Based Assessment
includes data that is limited in scope to a specifc problem; such as a lacerated foot; but should still include impt stuff such as allergies
Episodic Assessment
generally focuses on a specific problem or problems for which a ptient has already received treatment
Components of Health History
biographic data, resons for seeking care, history of presenting illness, present health status, past health history, family history, personal and psychosocial history, review of systems
OLD CARTS
onset, location, duration, characteristics, aggravating afactors, related symptoms, treatment, severity
When does patient inspection begin?
as soon as you meet the patient
General Appearance
includes overall state of health, age, level of consciousness, obvious signs of distress, skin and hygiene
Unintentional Weight Change
increase- may be the first sign of fluid retention (1L of fluid retained = incrased by 2.2 lbs)
Temperature
regualted by he hypothalamus; range 96.4-99.1 F; lowest temp in the morning and highest in late afternoon/early evening
Oral Temperature
smoking, ingestion of hot/cold food/liquid impacts accuracy delay reading for 10 mins in these situations
Tympanic Membrane Temp
tug ear upward on helix for adults (and downwards on the earlobe for infants and children); helps straighten the external auditory canal
Axillary Temp
though to poorly reflect core body temp bc it is not close to any major blood vessels and thermometer is placed between skin surfaces; but common for infants and children
Rectal Temp
reflect core body temperature and is considered more accurate than noninvasive approaches ; but is taken on infants and comatose
Mean usually breathe…
diaphragmatically which increased the movement of the abdomen
Women usually breathe….
thoracic; which is seen with movement of the chest
Blood Pressure
force of blood against the arterial walls and reflect the relationship between cardiac output and perpheral resistance
Systolic Blood Pressure
maximum pressure exerted on arteries when the ventricles contract or eject blood from the heart
Diastolic Blood Pressure
represents the minimum amount of pressure exerted on the vessels; this occurs when the ventricles relax and fill with blood
Pulse Pressure
the difference between the systolic and diastolic pressure; normally ranges from 30-40 mmhg
Orthostatic Hypotension
a 20-30 mmhg drop in BP when the patient moves from a lying or sitting position to standing indicates orthostatic hypotension
Age (BP)
from childhood to adulthood there is a gradual rise in BP
Gender- BP
after puberty, females usually have a lower blood pressure than males; however, after menopuase, a womans BP may be higher
Pregnancy -BP
during pregnancy, diastolic BP may gradually drop slightly during the first two trimesters of pregnancy, but then it typically returns to the prepregnant levels by term
Race- BP
the incidence of hypertension is twice as high in african americans as in whites
Emotions- BP
feeling anxious, angry, or stressed may increase blood pressure
