Exam 1 and 2 - CEL, Comms and LEAPS Flashcards
What are the advantages/disadvantages of different question styles?
Open: Advantages: - Gain patient’s perspective - Give’s patient a chance to describe problem Disadvantages: - may take longer/harder to control - may not be relevant info - may make note taking harder
Closed:
Advantages:
- specific info
- can fill in gaps/gain more precise info
- useful in emergency
Disadvantages:
- feels like interrogation
- patient limited in how they can respond
- cultural background may effect how patients respond to open/closed questions
Probing: Advantages: - Patient can expand/give more details - Allows doctor to see form patient’s perspective Disadvantages: - interview may be overly long - patient may go off track
What are the 5 key elements of active listening?
- Pay attention (eye contact, don’t look at watch, don’t mentally prepare rebuttal)
- Show that you’re listening (own body language, facial expressions, posture, small verbal encouragers)
- Provide Feedback (reflect, ask questions, ‘What I’m hearing is…’, clarify, summarize)
- Defer judgment (allow speaker to finish, don’t interrupt)
- Respond Appropriately (respectful, candid, open and honest)
What are the benefits of silence and reflection?
- gives and yourself patient time to reflect
- opportunity to observe patient
- opportunity to plan next stage of interview
What are the benefits of summarising?
Benefits to doctor:
- opportunity to pause
- chance to put thought in order, hypothesize
- chance to communicate back your understanding
- chance to clarify, check accuracy, move on
Benefits to patient:
- gives them space to think
- shows them doctor has heard their message
- gives them a chance to correct or add in, raise other concerns
- promotes trust and collaboration
What are the steps in preparing for an interview?
- Attend to self comfort (bathroom break, eating etc)
- Finish previous patient notes
- Read/Review relevant info, i.e. patient notes, test results, referral info etc before hand.
What is patient-centred care?
Definition: Care that is respectful of, and responsive to individual patient preferences, needs and values. Patient centred care ensures that patient values guide all clinical decisions.
- Describe the steps in the medical interview using the Calgary Cambridge Framework.
1) Initiating the interview (pre-preparation, introduction, patient consent, ask open question etc)
2) Gathering info
3) Physical exam
4) Explaining and planning
5) Close the session (determine next steps, safety nets, prescription, referral, summary, what do do if things go wrong, check patient agrees and is comfortable, ask for correction or any other questions).
History of presenting illness
- opening questions – what, when why when who etc
- S – Site (Where? Show me)
- O – Onset (when? Suddenly/gradually?)
- C – Character/Description (throbbing, sharp, stabbing?)
- R – Radiation (does it radiate/spread/travel and where?)
- A – Associated Symptoms – (nausea, headache ect?)
- T – Timing (When? Specific time of day, constant?)
- E - Exacerbating Factors – anything make it better? Pain meds?
- S – Severity – (pain scale, at rest, moving, upstairs etc)
- I – Impact (ability to work, sleep, relationships, mood etc)
- A – ‘Anything else?’
- Red flags?
Comprehensive patient history
a) Current General Health
- Current problems
- medication use if relevant
- probe for age specific issues, such as oral contraceptive pill
- Specifically ask about common conditions such as hypertension in some patients.
b) Past Medical History
- Previous general health
- previous illnesses
- previous admissions to hospital
- any surgical procedures
- Accident and injuries
c) Medication
Why? – might be the cause of an issue (i.e. side effect),
- might preclude use of other medications
- if someone is admitted to hospital they might need to continue current medication
- it’s an opportunity to review need for taking, dosage and frequency
- opportunity to see if they are taking them as prescribed
Ask about:
- regular prescriptions
- over the counter
- natural therapies
- dietary supplements
- Complementary and integrated treatments (i.e. chiro, acupuncture).
ALWAYS ASK – NAME, DOSAGE, FREQUENCE, SIDE EFFECTS, RESON FOR USE.
d) Allergies
- prescribed meds, foods, pollens/airbornes, animals, anything else (i.e. bee sting)
- Ask SEVERITY and TYPE of reaction.
- Do they carry an epipen?
e) Family History:
- may be suffering from or have predisposition to genetically determined disease.
- another family member might have experience with is
- ask about illnesses of parents/siblings
- ask about age/cause of death of parents, siblings etc
f) Social History
- how do they spend an average day?
- relationships – social, martial status, children and any related problems
Social history could:
- contribute to aetiology of illness
- aggravate/limit severity
- interfere/help with getting well
- SUPPORT SYSTEMS?
g) Lifestyle – Use of elicit drugs
- Ask about current and past.
- If Y- what types?
- how much at one time? (quantity)
- how often? (frequency)
- how long? (duration)
- how old were you?
- do you think it causes any problems in your day to day life?
h) Lifestyle – Alcohol
- do you currently drink?
- how often? (frequency)
- What type?
- how much do you drink on once occasion?
- Binge? How often and how much?
IF N – has this always been the case and is there a particular reason for stopping?
i) Lifestyle – Smoking
- Ask about current and past.
- IF Y- how many a day? (quantity)
- What type? (filtered, rolled)
- how often? (frequency)
- how long? (duration)
- have you ever tried to quite? When, how long, nicotine replacement, quitline?
- do you think it causes any problems in your day to day life?
- IF N – but yes to past:
- how long ago did you quit?
- how long did you smoke for?
j) Lifestyle – Exercise/Physical Activity
- do any exercise?
- what?
- how often?
- intensity?
k) Lifestyle – Diet
- it could be a risk factor for a number of problems
- Don’t accept ‘good’ as answer or ‘what is your diet like’
- Ask if they have a specific diet, i.e. vegan, vego etc
- Food allergies?
- average day?
- can go through food groups
- consumption of take away foods?
- soft drunk/energy drinks?
- how much water?
l) Red Flags
m) Is there anything else?
What is the aetiology of anxiety disorders?
Psychosocial:
- origins lie in childhood events, i.e. separation and loss
- maladaptive learning (i.e. OCD)
- prior exposure to extreme stressor
Biological Factors: - genetics - gender - altered neurotransmitter activity, specifically decreased activity of serotonin and more. - medical conditions - substance abuse
What are the symptoms of anxiety?
Feelings of panic, fear, and uneasiness Problems sleeping Cold or sweaty hands or feet Shortness of breath Heart palpitations Not being able to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension Dizziness Loss of Appetite Loss of sex drive
What is the difference between normal and abnormal anxiety?
At the low end of the intensity range, anxiety is normal and adaptive. At the high end of the intensity range, anxiety can become pathological and maladaptive. While everyone experiences anxiety, not everyone experiences the emotion of anxiety with the same intensity, frequency, or duration as someone who has an anxiety disorder.
Discuss the physiological mechanisms and pathways involved in anxiety
- increased HR and CO
- constriction of arteriolar and venous smooth muscle
- respiratory airways open
- breakdown of glycogen and fat increases plasma glucose and FFA
- skeletal muscle bloos vessels dilate - increased muscle BF
- pupils dilate
- digestive and urinary activities are shit down
What is the prevalence of anxiety disorders in Australia?
14.4%
What is the mental health first aid action plan?
ALGEE
A - Approach, assess and assist
L - Listen non-judgmentally
G - Give support and information
E - Encourage the person to get appropriate professional help
E - Encourage other supports - i.e. self help, family and friends
